State of Texas HIV Planning
&
Goals for the National HIV/AIDS Strategy
1. Reduce new HIV infections
2. Increase access to care and improve
health outcomes for people living with
HIV
3. Reduce HIV-related health disparities
1. Reduce new HIV infections
• Lower the annual number of new infections by 25%
• Reduce HIV transmission by 30%
• Increase the percentage of people living with HIV who know their sero-status
from 79% to 90%
2. Increase access to care and improve health outcomes for people living with
HIV
• Increase the proportion of newly diagnosed patients linked to clinical care
from 65% to 85%
• Increase the proportion of Ryan White HIV/AIDS Program clients who are in
continuous care from 73% to 80%
• Increase the number of Ryan White clients with permanent housing from 82%
to 86%
3. Reduce HIV-related health disparities
• Improve access to prevention and care services for all Americans
• Increase the proportion of HIV-diagnosed gay and bisexual men with
undetectable viral load by 20%
• Increase the proportion of HIV-diagnosed Blacks with undetectable viral load
by 20%
• Increase the proportion of HIV-diagnosed Latinos with undetectable viral load
by 20%
Gardner Cascade Continuum
Texas HIV Population Treatment Cascade, 2012
Abilene
Fort Worth
Wichita Falls
Texas HIV Plan
Update for 2014-2015
DEPARTMENT OF STATE HEALTH SERVICES
HIV/STD Prevention and Care Branch,
Shelley Lucas, Manager
Texas HIV Spectrum of HIV Engagement
Public
Awareness
Support
Participation
in Care
Full
Diagnosis
Targeted
Prevention
Successful
Linkage
Viral
Suppression
2014 – 2015 Texas Priorities
• The 27 priorities were developed from several meetings /
consultations over the last couple of years. Discussions
were had about the priorities in planners’ network
meetings, with Part A administrators, with internal DSHS
staff and with community members. The current list has
been revised based on feedback from the first release of
the Texas HIV Plan and on review of the Part A plans from
across the state.
• We then looked at the Part A plans goals/objectives and
implementation strategies. We reviewed all of the Part A
plans and mapped the goals/objectives to the state plan. In
order to make the document readable we had to take the
various goals from each plan and generalize them into
broader statements.
Public
Awareness
Support
Participation
in Care
Full
Diagnosis
Targeted
Prevention
Successful
Linkage
Viral
Suppression
Domain I: Increasing HIV awareness among members of the general
public, community leaders, and policy makers
○ Assure availability of key information for consumers, providers and
policy makers
•
Re-energize HIV awareness efforts through implementation of a media plan specifying
priority stakeholders and messages. Who: DSHS, NCT, Houston; Timeline: Plans
completed by March 31, 2014. Plans implemented April – December 2014 .
○ Draw attention to the role of social determinants in the spread of
HIV
•
Incorporate a focus on social determinants to community mobilization and HIV care
systems. Who: DSHS and local leaders of mobilization efforts and NCT providers;
Timeline: Actions taken in 2013 and 2014.
Domain I: Increasing HIV awareness among
members of the general public, community
leaders, and policy makers
o Form broad community alliances of traditional and nontraditional stakeholders to support the HIV mission
•
Facilitate delivery of technical assistance and training for local health departments,
community based providers, FQHCs and Medicaid providers to prepare for health care system
changes and to increase the capacity of non-traditional providers to serve HIV infected
persons. Who: DSHS, NCT and Houston; Timeline: Actions taken in 2013 and 2014.
Domain II: Increasing access to HIV prevention efforts
for high risk groups
○ Focus prevention programs on those most at risk as
determined by epidemiology
○ Address the environment and system issues that
intensify HIV in vulnerable populations
•
Actively train providers and partners in the role of social determinants of health. Who: DSHS, NCT;
Timeline: Ongoing in 2013 and 2014.
○ Increase knowledge and sense of urgency to act in high
risk populations
•
•
Develop targeted media strategies focused on vulnerable population to increase HIV awareness and
testing. Who: DSHS, Houston, NCT; Timeline: Plans completed by December 31, 2013.
Expand Greater than AIDS or other Act Against AIDS campaigns to cover 5 major urban areas. Who: DSHS,
NCT, Houston, Dallas, San Antonio, Austin; Timeline: at least one focused campaign mounted in each area
by December 31, 2014.
Domain III: Full diagnosis of all HIV infections
○ Evaluate effectiveness of HIV testing
programs at the population and program level
○ Effectively identify and test individuals in
populations at highest risk
○ Ensure that social and sexual networks of HIV
infected persons are offered testing and
counseling
•
Expand the number of partners and members of social and sexual networks of HIV-infected
persons who receive partner services (e.g. identification, notification, counseling and testing,
linkage to care for partners and members of social and sexual networks) Who: DSHS,
Houston, NCT; Timeline: Ongoing through 2013 and 2014.
Domain III: Full diagnosis of all HIV infections
o Expand adoption of routine HIV testing as a
part of medical care
○ Address stigma that prevents providers from
offering testing and people form seeking or
accepting testing
○ Adopt testing technologies that simplify
testing, increase access or acceptability, or
increase early diagnosis
○ Build social norms in high risk populations to
Domain IV: Speedy and timely linkage to HIV related
care and treatment
○ Assure linkage systems that are client centered and
responsive to circumstances and needs
○ Create approaches to locate and link HIV infected
individuals who know their status but are not in care
•
•
Establish a uniform definition for “lost to care” clients to allow more standardized assessment
of the scope of the issue, inform standards of care, and facilitate evaluation of efforts to
return persons to HIV care. Who: Houston, Austin, NCT, DSHS Timeline: March31, 2014.
Develop protocols for using surveillance data to identify persons out of care, and local
activities to locate and return them to care. Who: Houston, Austin, NCT, DSHS; Timeline:
Protocols developed by September 30, 2013; protocols implemented and evaluated by
September 30, 2014.
○ Use technology that supports linkage to care
○ Address stigma and other issues that prevent HIV
infected individuals from seeking medical care
Domain V: Continuous participation in systems
of care and treatment
○ Increase focus and training on retention in
care
•
Identify and provide training and support for best practices in retention in care. Who:
NCT, DSHS, Houston; Ongoing in 2013 and 2014.
○ Ensure that care systems include access to
supportive services
•
•
Continue support for supportive services prioritized in community service delivery plans.
Who: Austin, Dallas, DSHS, NCT, Houston, San Antonio; Timeline: ongoing through 2013
and 2014.
Expand transportation services, both urban and rural, through collaboration and
alternative funding. Who: San Antonio and NCT; Timeline: Ongoing in 2014.
Domain V: Continuous participation in systems of
care and treatment
o Ensure that care systems include access to
behavioral health services
•
•
•
Continue to provide funding for services to supplement locally available behavioral health
services. Who: Austin, Dallas, DSHS, NCT, Houston, San Antonio; Timeline: ongoing in 2013
and 2014.
Increase involvement and cross training with SAMHSA- funded HIV Early Intervention case
managers. Who: NCT and DSHS; Timeline: ongoing in 2014 .
Increase training and technical assistance to enhance ability of HIV case managers serve
clients with behavioral health needs. Who: NCT, Houston, DSHS; Timeline: ongoing in 2014.
○ Create mechanisms to identify and respond to
individuals at risk of dropping out of care
○ Address stigma issues and social norms that
prevent HIV infected individuals from maintaining
their HIV care
Domain VI: Increased viral suppression
○ Increase understanding of viral suppression as
a key health indicator
○ Expand access to HIV clinical care
•
•
Expand the use of telemedicine to build access primary care, behavior health services,
and specialists. Who: San Antonio, NCT, DSHS; Timeline: Ongoing in 2013-2014.
Enhance access to treatment and care through integration of preventive and treatment
services, collaboration between traditional and non-traditional providers of treatment
and care, co-location of HIV treatment, supportive, and specialty services to effectively
treat co-morbid conditions, and increased involvement of FQHC in HIV testing and care
delivery. Who: Dallas, San Antonio, NCT, Houston; Timeline: Ongoing in 2013 and 2014.
○ Enhance access to medication and treatment
for co-occurring and co-morbid conditions
Domain VI: Increased viral suppression
o Create a focus on adherence that includes
clients, clinicians and supportive services
providers
•
•
Distribute information to providers on best practices in promoting adherence and to
clients on the importance of treatment adherence through partnerships with AETC and
PTC, local provider networks, and coalitions of consumers associated with Ryan White
Planning Councils. Who: DSHS, Houston, NCT; Timeline: throughout 2014.
Maintain or start programs to enhance health literacy and to enhance client
understanding of treatment Who: DSHS, Houston, NCT, San Antonio; Timeline:
throughout 2014.
○ Address the stigma that prevents individuals
infected with HIV from adhering to treatment
Texas HIV Plan
Developing and Establishing Priorities
November 13-14, 2013
○ Focus prevention programs on those most at risk as determined by epidemiology
○ Evaluate effectiveness of HIV testing programs at the population and program level
○ Effectively identify and test individuals in populations at highest risk
○
○ Expand adoption of routine HIV testing as a part of medical care
○ Address stigma that prevents providers from offering testing and people form seeking or accepting testing
○ Adopt testing technologies that simplify testing, increase access or acceptability, or increase early diagnosis
○ Build social norms in high risk populations to seek health care
○ Assure linkage systems that are client centered and responsive to circumstances and needs
○ Use technology that supports linkage to care
○ Address stigma and other issues that prevent HIV infected individuals from seeking medical care
○
○
○
○ Create mechanisms to identify and respond to individuals at risk of dropping out of care
○
○ Increase understanding of viral suppression as a key health indicator
○ Enhance access to medication and treatment for co-occurring and co-morbid conditions
○ Address the stigma that prevents individuals infected with HIV from adhering to treatment
Red = NCT original priorities
Black Bold = first round state priorities
Domain I: Increasing HIV awareness among members of the general public, community
leaders, and policy makers
o
Assure availability of key information for consumers, providers and policy makers
○ Draw attention to the role of social determinants in the spread of HIV
○ Form broad community alliances of traditional and non-traditional stakeholders to support
the HIV mission
Domain II: Increasing access to HIV prevention efforts for high risk groups
○ Focus prevention programs on those most at risk as determined by epidemiology
○ Address the environment and system issues that intensify HIV in vulnerable populations
○ Increase knowledge and sense of urgency to act in high risk populations
Domain III: Full diagnosis of all HIV infections
○ Evaluate effectiveness of HIV testing programs at the population and program level
○ Effectively identify and test individuals in populations at highest risk
○ Ensure that social and sexual networks of HIV infected persons are offered testing and
counseling
○ Expand adoption of routine HIV testing as a part of medical care
○ Address stigma that prevents providers from offering testing and people form seeking or
accepting testing
○ Adopt testing technologies that simplify testing, increase access or acceptability, or increase
early diagnosis
○ Build social norms in high risk populations to seek health care
Domain IV: Speedy and timely linkage to HIV related care and treatment
○ Assure linkage systems that are client centered and responsive to circumstances and needs
○ Create approaches to locate and link HIV infected individuals who know their status but are
not in care
○ Use technology that supports linkage to care
○ Address stigma and other issues that prevent HIV infected individuals from seeking medical
care
Where to go with all this
•
•
•
•
2014 Comprehensive Plan?
Service Priorities?
Additional Assessments?
Monitoring?