Transcript OPA/OFP HIV Prevention Project Annual Technical Support

OPA/OFP HIV Prevention Project
Annual Technical Support
Conference
Six Years of HIV Supplemental
Grants – A National Perspective
Susan B. Moskosky
Director, Office of Family Planning
Office of Population Affairs
1
Setting the Stage - The Epidemic

June 5, 1981 – CDC published MMWR describing 5
previously healthy males in LA with Pneumocystis
carinii pneumonia – later recognized as the first
reported cases of AIDS in the US

Since that time, 25 million deaths worldwide and more
than 500,000 deaths in US from AIDS
2
The Epidemic

Despite prevention efforts, since the late 1990s, ~ 40,000
new cases of HIV infection each year


many under the age of 25
African American men and women hardest hit - AIDS is
the leading cause of death for African Americans 25-44
(CDC 2001)

Primary modes of transmission


MSM
For women, heterosexual transmission through
contact with high risk sexual partners
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The Epidemic

Today, estimated 1 million living with HIV in the US

Approximately 25% of those do not know they are
infected

Implications
 Unknowing transmission to sexual partners
 Delayed entry into medical care
 Delayed behavior change that maximizes health
4
Title X Response

In December 1987, OPA issued a Program Instruction
mandating that HIV prevention education and referral
services, at a minimum, be offered as part of Title X family
planning services

January 2001 revised Program Guidelines reiterated the
information, also stating that when a program does not
offer risk assessment, counseling and testing, they MUST
provide a list of providers that offer these services
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Title X Response - Training

late 1980s/early 1990s - training of individuals
working in Title X clinics regarding HIV/AIDS

1988 - OPA provides supplemental funds to
Regional Training Centers (RTCs) for integration
of HIV training activities through MOU with CDC
- limited scope

1995 - Cooperative Agreement directly between
CDC and RTCs – training on HIV integration in
FP one of several training topics
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Title X Response - Training

2001 - Title X provided supplemental funds to Regional
Training Centers (RTC) to assess the need for training
related to providing HIV services in Title X clinics

2002-2005 – Supplemental funds provided to
implement training to address the needs identified

2006 – HIV training incorporated into general training
activities
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Title X Response - Services

Late 1990s, OFP began attending meetings with other
agencies leading prevention efforts

CDC

HRSA

Congressional Black Caucus Steering Committee (later
the Minority AIDS Initiative)
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Title X Response

In 2001, for the first time, OPA/OFP received funds from the
Minority AIDS Initiative to support supplemental grants for
projects in existing Title X clinics

Proposed to expand the availability of HIV counseling,
testing, and referral services on site in Title X Family
Planning Clinics

Two categories for funding
 Supplement or enhance existing HIV services
 Initiate HIV activities beyond basic HIV prevention
education
9
1st Cycle of Supplemental Grants

Total Funding approximately $5 M (2001-2002-2003)
 $3 M from Congressional Black Caucus (now
Minority AIDS Initiative Fund)
 $2 M + from Title X Appropriation

34 Projects in 23 Grantee Agencies

Projects in 8 of 10 PHS Region
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1st Cycle of Supplemental
Grants - Requirements

Project activities required to incorporate cultural
competency, age appropriateness, and linguistic and
educational appropriateness

Projects required to have linkages with community based
agencies providing HIV-related health and social services

Providers trained according to local requirements or the
most current CDC counseling and testing guidelines
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1st Cycle Outcomes


Services provided on-site

# Clients counseled
365,461

# Clients tested
187,702

# Positive tests
693
Change in HIV testing levels in
34 project sites from beginning
to end of 1st cycle of HIV
supplemental projects
89%
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2nd Cycle of Supplemental Grants

Increase in Funding
 $6 M Minority AIDS Funds
 $3 M + Title X Appropriation

63 projects funded – At least one in each PHS Region

62 projects continue
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2nd Cycle of Supplemental Grants

Requirements similar to 1st round of funding

Intended to contribute to “Advancing HIV/AIDS
Prevention: New Strategies for a Changing
Epidemic”
(CDC 2003)

Increased focus on collaboration and formal linkages
with HIV-related community agencies, and

Increased focus on strategies that encourage clients
to return for post-test counseling
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2nd Cycle of Supplemental
Grants

All projects required to incorporate the “A-B-C”
approach to HIV prevention activities

Care of HIV + individuals receiving Title X
services must utilize “CDC Recommendations
to Incorporate HIV Prevention into the Medical
Care of Persons Living with HIV”
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Where We Are Now
Number of HIV Tests
Total = 451,325 Tests
160,000
120,000
80,000
40,000
61,253
70,518
Cycle 1, Period 1-2
10/01 – 12/02
Period 3-4
1/03 – 12/03
132,609
131,014
Cycle 2, Period 1-2
9/04 – 12/05
Period 3-4
1/06 – 12/06
55,931
0
Period 5
1/04 – 8/04
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Where We Are Now
Number of Positive Tests by Gender
Cycle 2
Number of Tests by Gender
Cycle 2
250,000
400
203,569
200,000
348
342
Females
Males
300
150,000
200
100,000
52,153
50,000
100
0
0
Females
Males
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Where We Are Now
Figure 11a: Percent Distribution of Clients Tested for HIV by Race
Native
Hawaiian/Pacific
American
Islander
Unknown/
Indian/Alaskan
0.2%
Not Reported
Native
16%
1%
Asian
2%
Caucasian/White
41%
Multi-race/
Other
10%
African
American/Black
30%
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Where We Are Now
Figure 11b: Percent Distribution of Clients
Testing Positive for HIV by Race
American Indian/
Alaskan Native
0.4%
Native Hawaiian/
Pacific Islander
0.1%
Unknown/
Not Reported
8%
Asian
1%
Caucasian/
White
33%
Multi-race/
Other
7%
African
American/
Black
51%
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Where Are We Going From Here?

The request for applications for the 3rd cycle of HIV
prevention integration projects was published April 24,
2007 – Applications due June 25, 2007

Minority AIDS Initiative funds - $6.5 Million
Title X appropriations approximately $3.3 Million

Plan to fund 70-80 new projects with a range of $100,000
to $160,000 per award

Announcement and application kit available at
www.Grantsolutions.gov
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3rd Cycle of Supplemental Grants
Highlights

Projects should incorporate the CDC September 2006 “Revised
Recommendations for HIV Testing of Adults, Adolescents, and
Pregnant Women in Health Care Settings”

Focus on testing all clients 13-64 in health care settings (such
as Title X clinics)

Testing on-site

De-links counseling from testing

Opt-out approach to consent

ABC approach to prevention education and counseling
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
Title X responded early to the HIV epidemic and has
maintained an interest in prevention as the epidemic
has evolved

Title X providers have responded, ensuring that those
serving our clients have the knowledge and skills
necessary to provide quality family planning services,
including HIV-related prevention services

You have responded by integrating HIV counseling,
testing, and referral services into already busy clinic
operations
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
Together we have served hundreds of thousands of
Title X clients, and have contributed to the health and
well-being of our communities!!
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