This article was cross-posted from the AIDS.gov blog.
This is the second in our series of daily re-caps from the National HIV Prevention Conference underway now in Atlanta. This biennial meeting focuses exclusively on the full spectrum of HIV prevention, giving public health professionals, community organizations, clinicians, researchers, advocates and leaders from the HIV/AIDS community an opportunity to exchange information about effective prevention approaches.
Focus on Reducing New HIV Infections
Monday's plenary session focused on the science of HIV prevention and what needs to be done in order to achieve the National HIV/AIDS Strategy (NHAS) goal of reducing HIV incidence by 25% by 2015. The session was organized around the three steps that that Strategy identifies as essential to reducing HIV incidence.
- **Maximizing the Impact of Combination Prevention
**Observing that we now have a broad range of effective, evidence-based behavioral, biomedical, and structural interventions available, Dr. David Holtgrave of the Bloomberg School of Public Health at Johns Hopkins University provided an overview of how modeling can be used to help determine the best combination of HIV prevention interventions. Modeling is a useful tool for decision making, especially in resource-constrained environments. David shared examples from his work with the Maryland Department of Health on behalf of Baltimore's Enhanced Comprehensive HIV Prevention Plan (ECHPP). He and health department colleagues used and compared their projected impact on reductions in HIV incidence to predict the impact of various combinations of interventions.
- **Intensifying HIV Prevention in Communities Where HIV Is Most Heavily Concentrated
**Dr. Moupali Das, Director of HIV Prevention at the San Francisco Department of Public Health, shared another perspective on how jurisdictions are making decisions about which combinations of prevention interventions to support for maximum reductions in new HIV incidence. Dr. Das asserted that we now have the tools to curb the epidemic and eradicate new HIV infections. San Francisco's new prevention plan calls for targeting intensive behavioral interventions to the local drivers of new HIV infections there, including alcohol use, methamphetamine use, and STDs. In light of accumulating evidence that early treatment results in better health outcomes for persons living with HIV (PLWH), including the prevention of comorbidities, San Francisco has adopted a policy to offer universal antiretroviral treatment for all HIV-positive individuals, regardless of their CD4 count. Once on treatment, the health of the individual improves and his/her viral load decreases which reduces the risk of sexual transmission of the virus. In turn, this reduces the overall community viral load, which is associated with a reduction in new HIV infections. Moupali and her colleagues have helped to pioneer the development and use of CVL as a critical tool to measure program success. In San Francisco, they map CVL by neighborhood so they can even more precisely tailor HIV prevention interventions that address disparities and prevent new infections where HIV is most heavily concentrated. Other jurisdictions, including Washington, D.C., and New York City, are now also using CVL as a tool in their prevention efforts.
- **Educating and Mobilizing All Americans to Reduce HIV Incidence
**Conference attendees were pleased that Mr. Richard Sorian, Assistant Secretary for Public Affairs at the U.S. Department of Health and Human Services, joined us to share his thoughts about this third important action step. Richard noted that several surveys show that Americans have lost a sense of urgency about HIV/AIDS with only seven percent of Americans citing it as an urgent health concern. He urged participants to strengthen efforts to educate all Americans about how HIV is and is not transmitted and how it can be prevented. He also urged that educational efforts confront and seek to reduce HIV/AIDS stigma. Finally, given the disproportionate burden of new HIV infections among gay and bisexual men, including young men, Richard made a special appeal to the conference participants to thoughtfully expand education efforts designed to reach these young men in language they can relate to and via channels that engage them. He urged that such efforts get underway without delay and include information about condom use and safer sex.
Other Strategy-Related Highlights from the Day
With more than 50 concurrent sessions offered throughout the day, my team and I could only attend a few of them. You can read the abstracts of all the sessions. Highlights of those we did attend include the following.
From the White House to Our House: Local Implementation of the National HIV/AIDS Strategy
In order for the NHAS goals to be reached, they must be operationalized at the local level, in public health departments and in community-based organizations that provide HIV prevention services. In this presentation, Ms. Judy Auerbach and colleagues from the San Francisco AIDS Foundation discussed how they recently completed a process to align the organization's programmatic activities not only with its own strategic goals, but also with those of the local health department and the NHAS. They shared examples of the logic models they developed and are using to guide staff in charting the progress of numerous program activities. These models illustrate how each project's outcomes are linked to both the city's HIV prevention goals and the NHAS goals. Judy and her colleagues observed that the many advocates who called for the Strategy now have a responsibility to make it real by ensuring that their organizations' activities are aligned with and making contributions toward achieving NHAS goals. They also shared that they are working with partners from across the state to develop and advance a California HIV/AIDS Strategy.
Addressing the Vulnerability of Women and Girls
Our colleagues at the HHS Office on Women's Health (OWH) led a session titled "Gender Responsiveness in HIV Programming: Addressing the Vulnerability of Women and Girls". They reviewed the unique risks and vulnerability of women and girls to HIV infection stemming from societal and institutional influences and suggested solutions to overcoming contextual factors that go beyond conventional and gender-neutral programs. This session was a preview of the Gender Toolkit for health departments and community-based organizations, which will soon be released by the OWH. Both the session and the toolkit examine social determinants of health and the accompanying gender norms, inequities, and inequalities that must be taken into consideration when designing, implementing and evaluating effective HIV prevention programs for women.
Using Surveillance to Evaluate Prevention
In this session, panelists explored ways that HIV/AIDS surveillance data can be used to evaluate the National HIV/AIDS Strategy as well as to inform federal, state, and local programs and policies and improve the health of persons living with HIV. Dr. Irene Hall, Chief of CDC's HIV Incidence and Case Surveillance Branch, pointed out that eight out of the nine impact measures (or Strategy Targets for 2015) established in the National HIV/AIDS Strategy can be measured by surveillance data. Her fellow panelists from the health departments in New York City and Washington, D.C., concurred that it is critical to ensure both the capacity and quality of surveillance systems across the nation, while also candidly noting that this can be challenging given resource constraints and the labor-intensive nature of surveillance activities. Dr. Hall observed that among the challenges in obtaining the data needed to assess the nation's progress toward the NHAS outcome measures is that, at present, only 30 states, and Washington, D.C., and Puerto Rico, have laws in place that allow for the collection of CD4 counts and viral load values. Further, not all of those jurisdictions have begun implementing this dimension of surveillance or sharing the information with CDC's national system.
New York City's Dr. Lucia Torian noted that among the questions that comprehensive laboratory surveillance systems can answer are how many new HIV diagnoses? What percentage of those are delayed diagnoses? What percentage of the newly diagnosed initiate care within three months? What percentage of those in care achieve suppressed viral load and how fast are they achieved after the start of ART? Is the time between HIV diagnosis and AIDS increasing? CDC's Dr. Holly Fisher reported on efforts underway to develop an evaluation plan for the Enhanced Comprehensive HIV Prevention Planning (ECHPP) initiative, which will consider inputs (e.g., resources required), outputs (activities conducted), and outcomes (low-hanging, near-term results). Insights about what worked well and what didn't will be shared with other jurisdictions to inform their planning efforts. Finally, Dr. Tiffany West-Ojo provided highlights from the Washington, D.C. surveillance system's "robust, routine, and rapid" data analysis activities. Demonstrating some of the program integration necessary to improve our response to the epidemic, the Strategic Information Branch she leads within the Department of Health manages not only HIV surveillance, but also Ryan White program data and HOPWA program data. This supports better coordinated planning and improved client tracking across systems.
Elsewhere at the Conference
Elsewhere at the conference on Monday, the AIDS.gov team engaged some of the attendees in activities designed to elicit feedback to improve the site. These activities included usability testing as well as a listening session with a small group of users about their information needs and experiences on the AIDS.gov website. Among the insights gained through usability testing were suggestions about better signaling the availability of the audio versions of the blog posts. The discussion yielded some helpful suggestions about the content available in the HIV Prevention and the National HIV/AIDS Strategy areas of the site.
Tune in tomorrow for another daily conference wrap. Following the conference we'll provide some posts reflecting on the main themes and lessons from this important gathering.
Ronald Valdiserri, M.D., M.P.H., is the Deputy Assistant Secretary for Health, Infectious Diseases, U.S. Department of Health and Human Services. (Cross-posted from White House Office of National AIDS Policy Blog.)