Learning by Doing: Lessons From the Care and Prevention in the United States Demonstration Project

Project PrIDE in Context: Evolution of Evaluation in the Centers for Disease Control and Prevention's Multi-Jurisdictional HIV Prevention Demonstration Projects

Over the past decade, CDC has been implementing a high-impact prevention (HIP) approach to HIV, directing funds towards activities with the greatest likelihood of reducing new infections and disparities. Corresponding to this shift, the Division of HIV/AIDS Prevention (DHAP) began funding a series of multi-site demonstration projects to provide extra support and evaluative capacity to select health departments to initiate new HIP programming, with the intention of ascertaining and sharing lessons with other health departments. In this paper, we provide context for the PrEP, Implementation, Data2Care, Evaluation (PrIDE) evaluation by describing the evolution of evaluation goals and activities across three prior demonstration projects, highlighting four areas of change: 1) integrated evaluation and program implementation; 2) local program evaluation in addition to cross-site performance monitoring; 3) prescriptive allocation of resources to support local program evaluation; and 4) expansion beyond single site program evaluation to identify effective cross-site programmatic strategies. Together, these changes reflect our own learning about achieving the greatest contribution from multi-site projects and set the stage for unique aspects of program evaluation within PrIDE. We describe these features, concluding with lessons learned from this most recent approach to structuring and supporting evaluation within CDC DHAP's health department demonstration projects.

Project PrIDE in context: Evolution of evaluation in the centers for disease control and prevention's multi-jurisdictional HIV prevention demonstration projects

Over the past decade, CDC has been implementing a high-impact prevention (HIP) approach to HIV, directing funds towards activities with the greatest likelihood of reducing new infections and disparities. Corresponding to this shift, the Division of HIV/AIDS Prevention (DHAP) began funding a series of multi-site demonstration projects to provide extra support and evaluative capacity to select health departments to initiate new HIP programming, with the intention of ascertaining and sharing lessons with other health departments. In this paper, we provide context for the PrEP, Implementation, Data2Care, Evaluation (PrIDE) evaluation by describing the evolution of evaluation goals and activities across three prior demonstration projects, highlighting four areas of change: 1) integrated evaluation and program implementation; 2) local program evaluation in addition to cross-site performance monitoring; 3) prescriptive allocation of resources to support local program evaluation; and 4) expansion beyond single site program evaluation to identify effective cross-site programmatic strategies. Together, these changes reflect our own learning about achieving the greatest contribution from multi-site projects and set the stage for unique aspects of program evaluation within PrIDE. We describe these features, concluding with lessons learned from this most recent approach to structuring and supporting evaluation within CDC DHAP's health department demonstration projects.

U.S. Centers for Disease Control and Prevention and Health Resources and Services Administration Initiatives to Address Disparate Rates of HIV Infection in the South

The US South accounted for 51% of annual new HIV infections, 50% of undiagnosed infections and 45% of persons with HIV infection in 2016 while comprising 38% of the population. Myriad structural and contextual factors are associated with HIV-related disparities. This paper describes initiatives and strategies conducted by the Centers for Disease Control and Prevention and Health Resources and Services Administration to identify opportunities and activities addressing the disparity of HIV diagnoses in the South. Targeted HIV prevention and care efforts can change the trajectory of outcomes along the HIV care continuum and reduce HIV-related disparities in the South.

Improving the HIV Prevention Landscape to Reduce Disparities for Black MSM in the South

Black men who have sex with men (MSM) in the South have the highest rates of HIV diagnosis in the country adding to the persistent racial disparities in HIV experienced by this population. The current HIV prevention and care landscape is heavily driven by individual-level clinical and biomedical approaches that have shown progress in reducing HIV diagnoses, but yield less than adequate results in reducing the HIV racial disparities for Black MSM in the South. In efforts to enhance focus on reducing the racial HIV disparities and more completely address the needs of Black MSM in the South, we offer insight on comprehensive approaches that can complement our current HIV prevention and care portfolio. There are five domains we discuss which include: (1) leveraging and integrating resources; (2) building upon existing program models designed to reduce disparities; (3) workforce development and cultural sensitivity; (4) social determinants of health data utilization; and 5) policy considerations. We urge public health practitioners and healthcare providers to consider and incorporate the outlined approaches to improve HIV outcomes along the continuum of care and ultimately reduce disparities in HIV affecting the quality of life of Black MSM living in the South.

HIV Data to Care-Using Public Health Data to Improve HIV Care and Prevention

BACKGROUND

"Data to Care" (D2C) is a public health strategy that uses surveillance and other data to improve continuity of HIV care for persons with HIV (PWH) by identifying those who are in need of medical care or other services and facilitating linkage to these services. The primary goal of D2C is to increase the number of PWH who are engaged in care and virally suppressed.

METHODS

Data to Care can be implemented using several approaches. Surveillance-based D2C is usually initiated by health departments, using HIV surveillance and other data to identify those not in care. Health care providers may also initiate D2C by identifying patients who may have fallen out of care and working collaboratively with health departments to investigate, locate, and relink the patients to medical care or other needed services.

RESULTS

Although D2C is a relatively new strategy, health department D2C programs have reported both promising results (eg, improved surveillance data quality and successful linkage to or re-engagement in care for PWH) and challenges (eg, incomplete or inaccurate data in surveillance systems, barriers to data sharing, and limitations of existing data systems).

CONCLUSIONS

Data to Care is expected to enable health departments to move closer toward achieving national HIV prevention goals. However, additional information on appropriate implementation practices at each step of the D2C process is needed. This JAIDS Special Supplement explores how CDC funding to state health departments (eg, technical assistance and demonstration projects), and partnerships across federal agencies, are advancing our knowledge of D2C.