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Health Departments and HIV Screening. Institute of Medicine Workshop 1: Screening and Access to Care April 15, 2010 Natalie Cramer, Associate Director, Prevention. Presentation Overview. Role of Public Health Public Health and HIV Programs Public Health and HIV Testing

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Health departments and hiv screening

Health Departments and HIV Screening

Institute of Medicine

Workshop 1: Screening and Access to Care

April 15, 2010

Natalie Cramer, Associate Director, Prevention


Presentation overview
Presentation Overview

  • Role of Public Health

  • Public Health and HIV Programs

  • Public Health and HIV Testing

  • Policies Impacting Health Departments

  • Challenges and Barriers for HIV Testing in Health Departments

  • Recommendations


Public health and hiv prevention programs
Public Health and HIV Prevention Programs

  • Since 1988, CDC has provided HIV prevention resources to 65 state, local and territorial health departments to implement comprehensive prevention programs.

  • In FY2007 these 65 jurisdictions received approximately $581 million to conduct HIV prevention programming.



Health departments hiv services
Health Departments & HIV Services

  • Services and Activities

    • HIV testing

    • Behavioral interventions

    • Capacity building

    • Program evaluation

    • Quality assurance

    • Surveillance

  • Response

    • Develop and enforce policy

    • Provide direct services

    • Partner with external entities

      • Funding

      • Coordination

      • CBA / TA

      • Evaluation

    • Engage communities


Health departments hiv testing activities
Health Departments & HIV Testing Activities

In FY2007 Health Department spending on Counseling and Testing was $152.1 million

  • Targeted HIV counseling, testing, referral

  • Routine HIV screening


Coordination of hiv testing services
Coordination of HIV Testing Services

  • Direct provision

  • Interfacing with health department funded institutions

  • Interfacing with other entities (not financially supported by health departments)

    • Local health departments

    • Hospitals and other health care settings

    • Correctional institutions

    • Substance abuse treatment centers

    • Other federally funded institutions (ex. Veterans Administration)


Health departments funding for hiv testing
Health Departments Funding for HIV Testing

Cooperative Agreements with CDC

CDC Funding Covers:

Development and maintenance of capacity and infrastructure

support essential complementary services (e.g. partner services, linkages to medical care, treatment and prevention services)

activities that recruit individuals into testing (e.g. social marketing, public information)


Federal policies impacting health departments
Federal Policies Impacting Health Departments

  • CDC – FOA, Cooperative Agreements, Guidance, Recommendations

  • HRSA – RW Part C – early intervention, Part A, plans, national testing goal

  • SAMHSA – block grants

  • CMS – Medicare, Medicaid, CLIA

  • FDA – Testing devices, guidelines

  • OCR - HIPAA


States implementing components of cdc s 2006 revised hiv testing recommendations
States Implementing Components of CDC’s 2006 Revised HIV Testing Recommendations

*All states implement targeted HIVCTR

The National HIV Prevention Inventory: The State of HIV Prevention Across the U.S., A Report by NASTAD and the Kaiser Family Foundation (KFF), July 2009


States implementing components of cdc s 2006 routine testing recommendations
States Implementing Components of CDC’s 2006 Routine Testing Recommendations

Since 2006, states continue to change laws and regulations

Eleven states have removed written informed consent requirements (AZ, CA, IA, IL, IN, LA, ME, MD, NH, NM, NC)

CT, HI, MA and MT have removed separate written informed consent

Eight states have proposed legislation to remove written informed consent (MA, MI, NE, NY, PA, RI, TX, WI)


Testing of pregnant women and newborns
Testing of Pregnant Women and Newborns Testing Recommendations

States making changes to their laws and regulations to be in line with 2006 Recommendations

In last two years: CO, DE, MD, TX, VA, VT

27 states have opt-out testing of pregnant women

25 states have opt-in

11 states have newborn testing


Implementation of Opt-Out Testing in Health Care Settings Testing Recommendationsby Health Departments after the ETI (as of February 2008)

  • 80%

    increase

Number of Health Departments

The National HIV Prevention Inventory: The State of HIV Prevention the U.S., A Report by NASTAD and the Kaiser Family Foundation (KFF), July 2009.


Insurance policies impacting health departments
Insurance Policies Impacting Health Departments Testing Recommendations

  • Medicare

  • Medicaid

  • Private insurers


Challenges for health departments federal policies
Challenges for Health Departments – Federal Policies Testing Recommendations

  • Restrictions:

    • Funding Opportunity Announcements

    • Cooperative Agreements

  • Lack of coordination between federal funding agencies


Challenges to health department state policies
Challenges to Health Department – State Policies Testing Recommendations

  • Limit of scope/contradictory to federal recommendations

  • Budgets and workforce

  • Differing philosophies among state program partners

  • Emergency preparedness


Challenges to health departments local institution policies
Challenges to Health Departments – Local Institution Policies

  • Expectation of collaboration without authority or oversight

  • Institutional resistance

  • Philosophies and policies may be incompatible (e.g. data collection and sharing, counseling)

  • Resistance if health department cannot ensure continued funding


Challenges to health departments insurance policies
Challenges to Health Departments – Insurance Policies Policies

  • Lack of resources to meaningfully scale up services

  • Advances are often limited

    • Medicare policy

    • Medicaid coverage

  • Limited capacity to bill insurance companies for testing


Other challenges
Other Challenges Policies

  • Current systems of M&E rely on limited measures

  • ADAP waiting lists

  • Need for adequate and sustained funding for HIV testing

  • Policy changes alone = increased testing?


Summary recommendations
Summary Recommendations Policies

  • Resolve reimbursement issues

  • Scale up/maintain funding

  • Improve federal coordination

  • Please contact Natalie Cramer at [email protected] with questions.


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