[Federal Register Volume 63, Number 96 (Tuesday, May 19, 1998)]
[Notices]
[Pages 27628-27643]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-13307]
[[Page 27627]]
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Part II
Department of Health and Human Services
_______________________________________________________________________
Centers for Disease Control and Prevention
_______________________________________________________________________
Human Immunodeficiency Virus (HIV) Prevention Projects and HIV
Prevention Community Planning Guidance; Notice
Federal Register / Vol. 63, No. 96 / Tuesday, May 19, 1998 /
Notices
[[Page 27628]]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
[Announcement Number 99004]
Human Immunodeficiency Virus (HIV) Prevention Projects and HIV
Prevention Community Planning Guidance
AGENCY: Centers for Disease Control and Prevention (CDC), Department of
Health and Human Services.
ACTION: Request for comments.
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SUMMARY: CDC is preparing to announce the availability of fiscal year
1999 funds to provide support for HIV prevention projects through State
and local health departments. This program announcement will assist the
Nation's disease prevention efforts by supporting HIV prevention
activities and the community planning process to best target resources
and activities. CDC invites comments from organizations and individuals
on the draft of this announcement which is included. Based on comments
received, the final announcement will be published later this year.
Also included for comment is the HIV prevention community planning
guidance document. This document will be included in the application
kit for applicants for HIV prevention funding.
Dates: Submit written comments in response to this notice to: Jessica
Gardom, Division of HIV/AIDS Prevention, National Center for HIV/STD/TB
Prevention (NCHSTP), Centers for Disease Control and Prevention (CDC),
Mailstop E-58, 1600 Clifton Road, NE., Atlanta, GA 30333.
Comments must be received on or before June 18, 1998.
Supplementary Information: The following is a complete text of the
draft program announcement for HIV Prevention and HIV Prevention
Community Planning Guidance.
Human Immunodeficiency Virus (HIV) Prevention Projects
Purpose
The Centers for Disease Control and Prevention (CDC) announces the
availability of fiscal year (FY) 1999 funds for cooperative agreement
programs for Human Immunodeficiency Virus (HIV) Prevention. This
program addresses the Healthy People 2000 priority area of HIV
Infection. The purpose of this program is to assist public health
departments (1) to reduce or prevent the transmission of HIV by
reducing or preventing behaviors or practices that place persons at
risk for HIV infection; and (2) to reduce associated morbidity and
mortality of HIV-infected persons by increasing access to early medical
intervention.
Eligible Applicants
Eligible applicants are health departments of States and their bona
fide agents that currently receive CDC HIV prevention funds under
Program Announcement 804. This includes the 50 States, six cities
(Chicago, Houston, Los Angeles, New York, Philadelphia, and San
Francisco), the District of Columbia, Puerto Rico, American Samoa, the
Virgin Islands, the Federated States of Micronesia, Guam, the Northern
Mariana Islands, the Republic of the Marshall Islands, and the Republic
of Palau.
Availability of Funds
Approximately $250 million is expected to be available in FY 1999
to fund 65 awards. It is expected that the awards will range from
approximately $60,000 to approximately $24,000,000. It is expected that
the awards will begin on or about January 1, 1999. Awards will be
funded for a 12-month budget period within a project period of 5 years.
Continuation awards within an approved project period will be made
on the basis of satisfactory progress as evidenced by required reports
and the availability of funds. Funding estimates may change. Should
funds available for this program either increase or decrease
significantly during the project period, funding may be awarded
competitively.
A. Direct Assistance
You may request Federal personnel, equipment, or supplies as direct
assistance, in lieu of a portion of financial assistance.
B. Use of Funds
Funds may not be used to supplant State or local health department
funds available for HIV Prevention. Funds may not be used to provide
direct medical care (e.g., ongoing medical management, medications,
etc.). With documented opportunity for comment by the HIV Community
Planning Groups (CPGs), funds awarded for HIV Prevention activities may
be used to support HIV/AIDS Surveillance and HIV Sero epidemiology
projects. CDC must approve the use of prevention funds for surveillance
and the activities supported must directly improve and support HIV
prevention activities or the community planning process. The CPG
comments on the use of prevention funds may be addressed in the overall
letter of concurrence submitted with the application. A separate
letter(s) of concurrence must be submitted if the request to use
prevention funds for these activities occurs at a later time.
C. Funding Preferences
In 1999, current levels of funding will be maintained for all
project areas. Priority will be given to funding activities and
interventions identified through the HIV Prevention Community Planning
process.
Program Requirements
A comprehensive HIV prevention program includes the following
components:
A. A participatory HIV prevention community planning process, in
accordance with the guidelines and requirements in the HIV Prevention
Community Planning Guidance;
B. Epidemiologic and behavioral HIV/AIDS surveillance, as well as
collection of other health and demographic data relevant to HIV risks,
incidence, or prevalence;
C. HIV prevention counseling, testing, referral, and partner
notification (CTRPN), with strong linkages to medical care, treatment,
and other needed services;
D. Health education and risk reduction (HE/RR) activities,
including individual-, group-, and community-level interventions;
E. Increasing access to diagnosis and treatment of other STDs;
F. School-based efforts for youth;
G. Public information programs;
H. Quality assurance and training;
I. Laboratory support for HIV prevention;
J. HIV prevention capacity-building activities, including expansion
of the public health infrastructure by contracting with non-
governmental organizations, especially community-based organizations;
K. An HIV prevention technical assistance assessment and plan;
L. Evaluation of major program activities, interventions, and
services.
All of these components except B, E, and F are funded under this
announcement. In conducting activities to achieve the purpose of this
program announcement, the recipient will be responsible for the
activities under A and CDC will be responsible for conducting the
activities under B.
A. Required Recipient Activities
1. HIV Prevention Community Planning
All recipients must:
Develop a comprehensive HIV Prevention Plan for their
jurisdictions
[[Page 27629]]
through a participatory process as described in the Guidance on HIV
Prevention Community Planning (included in application kit).
Justify discrepancies between the plan and the proposed
program activities.
HIV prevention community planning is an ongoing, iterative planning
process that is (1) evidence-based (i.e., based on HIV/AIDS and other
epidemiologic data, including STD and behavioral surveillance data;
qualitative data; ongoing program experience; program evaluation; and a
comprehensive needs assessment process) and (2) incorporates the views
and perspectives of the groups at risk for HIV infection, as well as
providers of HIV prevention services. In HIV prevention community
planning, recipients share responsibilities for developing a
comprehensive prioritized HIV prevention plan with other State and
local agencies, non-governmental organizations, and representatives of
communities and groups at risk for HIV infection.
Persons at risk for HIV infection and persons with HIV infection
should play a key role in identifying prevention needs not adequately
met by existing programs and in planning culturally competent services.
Priority setting accomplished through a participatory process will
result in programs that are responsive to high priority, community-
validated needs within defined populations. Refer to the Guidance on
HIV Prevention Community Planning in the application kit.
2. Counseling, Testing, Referral, and Partner Notification (CTRPN)
a. General
All recipients must:
Provide CTRPN services consistent with the current CDC HIV
Counseling, Testing, and Referral Standards and Guidelines.
The major functions of CTRPN programs are to provide individuals a
convenient opportunity to: (1) Learn their current HIV sero status; (2)
participate in counseling to help initiate and maintain behavior change
to avoid infection or, if already infected, to prevent transmission to
others; (3) obtain referral to additional prevention, medical care, and
other needed services; and (4) provide prevention services and referral
for sex and needle-sharing partners of infected persons.
b. Counseling and Testing
All recipients must:
Routinely offer, on a voluntary basis with informed
consent, confidential client-centered HIV prevention counseling and HIV
laboratory testing services.
Provide, unless prohibited by law or regulation, anonymous
opportunities for persons to receive client-centered HIV prevention
counseling and HIV laboratory testing.
Implement and maintain a written policy for contacting
clients, especially those who are infected with HIV or at high risk of
becoming infected, but have not returned to receive their HIV test
results and post-test counseling.
Develop, implement, and maintain a mechanism for assessing
the proportion of tested clients who return to receive HIV test results
and post-test counseling in both confidential and anonymous testing
programs.
When low return rates (e.g., less than 90% return for sero
positives or less than 75% return for sero negatives) are identified,
reasons for the low rate must be documented and steps must be taken to
correct factors that are contributing to the low rates.
HIV prevention counseling must be client-centered; i.e., tailored
to the behaviors, circumstances, and special needs of the person being
served. Client-centered counseling is conducted in an interactive
manner, responsive to individual client needs. The focus is on
developing realistic prevention goals and strategies rather than simply
providing information. HIV prevention counseling should be:
Culturally competent;
Sensitive to issues of sexual identity;
Developmentally appropriate; and
Linguistically specific.
Recipients are encouraged to give priority to providing services in
areas with high rates of HIV sero prevalence or AIDS incidence and
sites serving clientele known to have high rates of HIV infection or
risk behavior.
The availability of anonymous services may encourage some persons
at risk for HIV infection to seek services that they would otherwise be
reluctant to access. Counseling for clients who test positive in
anonymous testing sites should include information about the benefits
of receiving follow-up services under a confidential system,
information about how to enter such a system, and strong encouragement
to access such services.
Some clients who are HIV infected or at high risk of infection may
require prevention case management, which includes multiple counseling
sessions. Recipients should provide additional prevention counseling to
meet the needs of these clients. Funds awarded through the cooperative
agreement can be used to support such ongoing counseling and prevention
case management in coordination with patient care systems such as the
Ryan White funded early intervention services.
If recipients opt to charge for services, they should do so on a
sliding scale. No one should be denied services because of an inability
to pay. Funds generated from charging clients should be used to support
HIV prevention program activities and services.
For additional guidance on the implementation of these services,
refer to the attachments.
c. Referral and Linkages With Other Service Providers
All recipients must:
Develop, implement, and maintain a system to ensure
clients who are HIV positive receive appropriate counseling, and are
entered and maintained in an appropriate system of care, which includes
prevention services.
Develop, implement, and maintain a mechanism for assessing
the proportion of HIV-seropositive persons referred for specific
additional services who complete their referrals (i.e., are seen by and
receive services from the persons or organizations to which they are
referred).
Clients who are at increased risk for HIV infection and clients who
are infected with HIV often need many services such as further HIV
prevention counseling, evaluation of immune system function, early
medical intervention for HIV infection, STD screening and treatment,
substance abuse counseling and treatment, tuberculosis testing and
treatment, and family planning. These services should be provided at
the testing site, if possible.
All clients who are found to be HIV-infected at any CTRPN service
site should receive:
A CD4+ cell test, an initial viral load staging, or the
current recommended test to determine stage of illness; and appropriate
medical management;
An assessment of medical eligibility for treatment;
Counseling about the benefits of early medical treatment
opportunities, either on-site or through referral, to receive
appropriate medical therapies including STD diagnosis and treatment and
TB skin testing;
Prevention case management;
Referral for substance abuse treatment, if indicated;
Referrals for all indicated services;
Follow-up to ensure that referrals have been successfully
accomplished.
If these services are not available at the HIV testing site,
individuals must be referred to another service provider.
[[Page 27630]]
Information about services available through referral should be
regularly updated so that counselors can refer clients for services
currently available in the local area. A system that (1) links
counseling and testing sites with other health, medical, and
psychosocial service providers and (2) provides feedback to the health
department on completion of referrals is an essential component of
current HIV prevention program standards of care.
Funds provided through this cooperative agreement cannot be used to
provide ongoing clinical and therapeutic care of HIV-infected persons.
Support for such services should be obtained from other sources of
funding, or the services should be obtained through referral to local
providers.
d. Partner Notification
All recipients must:
Establish standards, implement, and maintain procedures
for confidential voluntary notification of sex and needle-sharing
partners of HIV-infected persons, consistent with the CDC Partner
Notification Guidance, to be published.
Maintain their good faith effort to notify spouses of
infected persons as required by law and as certified to CDC.
Develop, implement, and maintain a mechanism to determine
that notification and appropriate follow up of partners has been
completed.
Develop, implement, and maintain a system to assess the
partner notification program and improve its function.
In a comprehensive HIV prevention program, partner notification is
essential for ensuring that sex and needle-sharing partners of HIV-
infected persons are notified about their risk and offered HIV
prevention counseling, testing, and referrals. Partner notification is
a primary prevention service with the following objectives:
(1) To confidentially inform partners of their possible exposure to
HIV;
(2) To provide partners with client-centered prevention counseling
that assists and supports them in their efforts to reduce their risks
of acquiring HIV or, if infected, of transmitting HIV infection; and
(3) To minimize or delay disease progression by identifying HIV
infected partners as early as possible in the course of their HIV
infection and assisting them in obtaining appropriate preventive,
medical, and other support services.
Partner notification programs should include the following
components, ensuring that they are consistent with State and Federal
laws:
(1) Client Referral: In client-referral, the HIV-infected person
notifies his or her sex or needle-sharing partners of their exposure to
HIV. Program staff will provide the client with counseling and support
on techniques to confidentially notify and refer their sex or needle-
sharing partners to client-centered HIV prevention counseling.
(2) Provider Referral: In provider referral, a health professional
who has been specially trained to provide the service notifies the HIV-
infected individual's sex or needle-sharing partners of their exposure
to HIV. In situations where the HIV-infected person chooses provider
referral, program staff will offer assistance in confidentially
notifying those partners and offering them counseling, testing, and
referral services.
(3) Spousal Notification: The Ryan White CARE Re-authorization Act
of 1996, Pub. L. 104-146, Section 8(a), requires that States take
administrative or legislative action to require a good faith effort be
made to notify a spouse of a known HIV-infected patient that such a
spouse may have been exposed to the human immunodeficiency virus and
should seek testing. The statute defines a spouse as any individual who
is the marriage partner, as defined by State law, of an HIV-infected
person, or who has been the marriage partner of that person at any time
within the 10-year period prior to the diagnosis of HIV infection. All
HIV Prevention Cooperative Agreement recipients must comply with these
requirements. Currently, all States and territories have certified to
CDC that they will require a good faith effort as required by law.
The partner notification program should be evaluated periodically
to do the following:
Help identify barriers and gaps in service delivery, as
well as define the HIV-infected population, so that services can be
better directed towards target populations;
Plan, refine, and target program intervention strategies;
Analyze and refine resource allocation;
Provide population-specific feedback to health
departments, community-based organization staff, community planning
groups, and other community prevention partners; and
Identify technical assistance needs including training.
All individual data will be maintained at the State and local
jurisdiction to assist in developing and monitoring local services. The
jurisdiction must adhere to strict protection and confidentiality of
client and partner records.
3. Health Education/Risk Reduction (HE/RR)
All recipients must:
Implement an array of HE/RR activities, and provide
resources to minority and other community-based organizations (CBOs) to
implement HE/RR activities, in accordance with the priority target
populations and interventions identified in their Comprehensive HIV
Prevention Plan.
Ensure interventions are culturally competent,
developmentally appropriate, linguistically specific, and sensitive to
sexual identity.
Briefly report to CDC the rationale (e.g., scientific or
programmatic basis) for each of the HE/RR interventions implemented.
HE/RR programs and services are efforts to reach persons at
increased risk of becoming HIV-infected or, if already infected, of
transmitting the virus to others, with the goal of reducing the risk of
these events occurring. These programs should be directed to persons
whose behaviors or personal circumstances place them at high risk.
Examples of high risk groups include men who have or have had sex with
men; persons who exchange sex for drugs, money, housing, or food;
persons with a newly diagnosed STD; youth who are engaging or are
likely to engage in high-risk behavior; women who are sex partners of
persons who engage in high-risk behavior; persons in the correctional
and criminal justice systems; or homeless persons in high-risk
situations.
High priority interventions (as identified by the community
planning group) at the individual, group, and community levels should
have priority for support with funds awarded through this cooperative
agreement. The following are brief descriptions of these programs:
a. Individual Level Interventions include a range of one-on-one
client services. Individual prevention counseling assists clients in
assessing their own behavior and planning individual behavior change,
supports and sustains behavior change, and facilitates linkages to
services that support behaviors and practices that prevent the
transmission of HIV. Project areas are encouraged to provide, either
onsite or through referral, additional prevention counseling, as
appropriate to the needs of these clients.
Prevention case management is an individual level intervention
directed at persons who need highly individualized support, including
substantial
[[Page 27631]]
psychosocial, interpersonal skills training, and other support, to
remain sero negative or to reduce the risk of HIV transmission to
others. HIV prevention case management services are not intended to be
substitutes for medical case management or extended social services.
Prevention case management services should complement ongoing HIV
prevention services such as HIV antibody counseling, testing, referral,
and partner notification and early medical intervention programs.
Coordination with HIV counseling and testing clinics, STD clinics, TB
testing sites, substance abuse treatment programs, and other health
service agencies is essential to successfully recruiting or referring
persons at high risk who are appropriate for this type of intervention.
See the HIV Prevention Case Management Guidance, September 1997.
b. Group Level Interventions shift the delivery of service from the
individual to groups of varying sizes. Group level interventions are
intended for persons at increased risk of becoming infected or, if
already infected, of transmitting the virus to others. They provide
education and support in group settings to promote and reinforce safer
behaviors and to provide interpersonal skills training in negotiating
and sustaining appropriate behavior change. The content of the group
session should be consistent with the format, i.e., groups can meet one
time or on an on-going basis. One-time sessions can provide
participants an opportunity to hear and learn from one another's
experiences, role play with peers, and offer and receive support.
Ongoing sessions may offer stronger social influence with potential for
developing emergent norms that can support risk reduction. Multiple
sessions may be needed for persons at high risk of HIV infection. A
group level intervention can include more tailored individual level
interventions with some of the group members.
c. Community Level Interventions are directed at changing community
norms to increase community support of behaviors known to reduce the
risk for HIV infection and transmission. While individual and group
level interventions also may be taking place within the community,
interventions that target the community are unique in their purpose and
are likely to lead to different strategies than other types of
interventions. Community level interventions aim to reduce risky
behaviors by changing attitudes, norms, and practices through health
communications, social (prevention) marketing, community mobilization
and organization, and community-wide events.
The primary goals of these programs are to promote healthy
behaviors, to change factors that affect the health of community
residents, and ultimately, to improve health status. The community may
be defined in terms of a neighborhood, region, or some other geographic
area, but only as a mechanism to access the social networks that may be
located within those boundaries. These networks may be changing and
overlapping, but should represent some degree of shared communications,
activities, and interests.
Community level interventions are designed to affect social norms
or shared beliefs held by members of the community. Specific activities
include, for example:
Identifying and describing (through needs assessments and
ongoing feedback from the community) structural, environmental,
behavioral, and psycho social facilitators and barriers to risk
reduction in order to develop plans to enhance facilitators and
minimize or eliminate barriers;
Persuading community members who are at risk of acquiring
or transmitting HIV infection to accept and use HIV prevention
measures; and
Informing community members--regardless of their personal
risk level--of their important role in HIV prevention in their
communities.
d. Street and community outreach programs are one type delivery
method for the interventions described above. They are defined by their
locus of activity and by the content of their offerings. These programs
reach persons at high risk, individually or in small groups, on the
street or in community settings. The programs provide them with
prevention messages, information materials, and other services, and
assist them in obtaining other HIV prevention services such as HIV-
antibody counseling and testing, HIV risk-reduction counseling, STD and
TB treatment, substance abuse prevention and treatment, family planning
services, tuberculin testing, and HIV medical intervention. Refer to
Guidelines for Health Education and Risk Reduction Activities, U.S.
Department of Health and Human Services, Public Health Service, April
1995.
4. Public Information (PI) Programs
The purposes of public information programs and activities funded
through this cooperative agreement are to build general support for
safe behavior, to dispel myths about HIV/AIDS, to address barriers to
effective risk reduction programs, and to support efforts for personal
risk reduction. In addition to informing general audiences, public
information programs should assist in informing persons at risk of
infection of how to obtain specific prevention and treatment services,
such as CTRPN and STD screening and treatment. Public information
programs and messages should be based on an assessment of needs in each
State and local area. Messages to communicate through public
information programs may include how HIV is and is not transmitted; how
to avoid becoming infected; what the impact of other STDs is on the
risk of HIV transmission; what to do if you think you might be
infected; the benefits of knowing your sero status, including early
diagnosis and treatment for HIV disease; and how to talk to your
children, friends, and neighbors about HIV prevention.
Give priority to materials directed to hard-to-reach audiences and
populations heavily affected by the HIV epidemic. Submit any newly
developed public information resources and materials to the National
AIDS Information Clearinghouse so that they can be incorporated into
the current database for access by other organizations and agencies.
5. Quality Assurance and Staff Training
All recipients must:
Develop and implement a mechanism for assessing the
performance and training needs of staff providing HIV prevention
services, especially those staff providing HIV prevention counseling
and partner notification. Staff training should be guided by the
assessment.
Develop comprehensive written quality assurance procedures
and staff performance standards and make them available to all program
staff. Management should ensure these policies and procedures are
followed.
Develop and implement a quality assurance system for all
counseling and testing providers, with special attention to assuring
that seropositive clients learn their test results.
Develop and implement a mechanism for assessing the
proportion of HIV-seropositive persons referred for additional services
who complete their referrals. Review data and improve process as
necessary.
Develop and implement a mechanism to determine that
notification and follow up of partners has been completed. Review data
and improve process as necessary.
Develop and implement a mechanism to assure HE/RR
activities
[[Page 27632]]
are culturally competent, developmentally appropriate, linguistically
specific, and sensitive to sexual identity.
Develop and maintain a mechanism to ensure the
consistency, accuracy, and relevance of information provided to the
public through local hotlines including information about referral
services.
Quality assurance is essential to make certain that delivery of
quality HIV prevention services is consistent and to ensure
interventions are delivered in accordance with established standards.
Quality assurance programs include measures to maintain high
performance expectations of staff and that appropriate, competent, and
sensitive methods are used for counseling, referral of clients, and
providing other risk reduction messages. These quality assurance
procedures and staff training should extend to the organizations
providing HIV prevention activities through contracts.
Quality assurance and staff training is an ongoing process. An
important component of this process is routine, periodic observation
during counseling sessions and subsequent feedback to reinforce
specific strengths noted and address any deficiencies detected.
Performance standards that define expectations for the context and
delivery of the counseling massages should be developed.
Feedback from client satisfaction surveys should be used routinely
as a factor in assessing the services provided.
6. HIV Prevention Capacity-Building Activities
Recipients must:
Develop, implement, and maintain a plan to provide
financial assistance to CBOs and other HIV prevention providers that
includes provisions for ensuring that funds are awarded on a timely
basis.
Issue Requests for Proposals (RFPs) within 90 days of the
receipt of the notice of grant award. Multi-year assistance is
allowable, provided the initial award was made competitively.
In order to build capacity, health departments should provide
financial and technical assistance to strengthen their own
infrastructure and that of non-governmental organizations to deliver
effective HIV prevention interventions. Some examples of capacity
building activities are implementing systems to ensure quality and
integration of services (particularly HIV, STD, TB, and drug
treatment), strengthening laboratory capacity, improving community
needs assessments, funding community-based organizations to provide
services, and providing technical assistance in all aspects of program
planning and operations.
7. HIV Prevention Technical Assistance Assessment and Plan
Recipients must:
Assess their own needs, as well as the needs of community-
based organizations in their jurisdiction, for technical assistance in
the areas of HIV prevention program planning, implementation, and
evaluation.
Develop, implement, and maintain a plan to provide the
technical assistance indicated by the assessment.
Recipients should identify their own current and projected
technical assistance needs and the needs of the jurisdiction's
community-based providers, for program planning, implementation, and
evaluation. Recipients should develop and implement a plan to provide
ongoing technical assistance for HIV prevention and early medical
intervention services in their communities, as indicated by the
assessment. These should include planning, implementing, and evaluating
prevention programs, activities, and services. Technical assistance
should include the active monitoring of services and programs provided
by CBOs.
Program management, strategies for meeting the HIV prevention needs
of populations at high risk, and strategies for overcoming barriers to
prevention should be priority areas for technical assistance programs.
8. Evaluation of Major Program Activities, Interventions, and Services
Evaluation is essential to monitor progress, measure program
success, and strengthen programs and program activities. To this end,
recipients need to conduct evaluation activities that will assess their
progress in HIV prevention efforts and will contribute to the planning,
implementation, and evaluation of effective HIV prevention programs.
The evaluation activities described here are listed as six phases.
It is expected that there will be a range in recipient capacity and
resources to conduct evaluations and that some recipients will have
already conducted some of the phases. Therefore, although the phases
are listed in an idealized sequence, recipients should implement the
phases in a manner that reflects their current evaluation achievements,
capacity, activities, resources, and needs. Each year, in their annual
CDC funding applications, recipients should submit progress reports and
data pertaining to the phases they implemented during the previous year
and establish objectives for the upcoming year. As grantees implement
new phases of evaluation, those phases that were previously initiated
should be continued.
CDC is creating a CDC Evaluation Guidance that will be disseminated
to recipients. The guidance is designed to assist recipients in
preparing their application and implementing evaluation activities
described in this announcement. To this end, the guidance provides an
overview of CDC's evaluation model, upon which this announcement is
based; describes recipient evaluation activities and data collection
for each phase; lists references for technical assistance and training
to build recipient capacity to implement these activities; and contains
definitions of key terms.
All recipients should include the following evaluation activities
in their programs:
a. Phase I: Development of a Comprehensive Evaluation Plan
Recipients should develop a comprehensive plan for evaluation of
health department and health department-funded HIV program services and
interventions. The plan should describe what will be done each year
over the next five years. Phases II through IV describe the five types
of evaluation in which grantees should engage. The plan should be
clear, specific, and realistic.
b. Phase II: Evaluation of HIV Prevention Community Planning
Recipients should track and keep records on an ongoing basis in the
following areas pertaining to the community planning process and
development and implementation of the Comprehensive HIV Prevention
Plan, using the Evaluation Guidance tools.
(1) Recruitment of community planning group members and
representation of affected communities and areas of expertise on the
community planning group (Community Planning Core Objectives 1 and 2).
(2) Application of a needs assessment and an epidemiologic profile
to determine target groups and HIV prevention strategies (Community
Planning Core Objective 3).
(3) Application of scientific knowledge in the selection and
formulation of intervention strategies (Community Planning Core
Objective 4).
(4) Developing goals and measurable objectives for the planning
process and monitoring progress on the objectives.
(5) Assessing the cost of the process.
[[Page 27633]]
(6) Assessing the extent to which resources allocated by the health
department match the epidemiologic profile.
(7) Assessment of the extent to which the final version of the
Comprehensive HIV Prevention Plan is used in the recipient health
department's budget decisions and in the health department's planning
and development of HIV prevention program activities (Community
Planning Core Objective 5).
c. Phase III: Program Design Evaluation
Prior to launching new program activities, recipients should assess
the quality of program activity designs to ensure that the proposed
interventions are scientifically sound, the implementation system is
well organized, and stated goals are clear and feasible. (Factors to be
evaluated are discussed in the section on Evaluation Reporting Format.)
d. Phase IV: Process Evaluation of HIV Prevention Programs
Conduct process evaluation through:
Ongoing data collection and monitoring regarding the
implementation of health department and health department-funded
program activities.
Assessment of the congruency between the intended and
actual implementation of health department and health department-funded
program activities.
Use evaluation findings in order to improve program
activities as indicated by the data.
e. Phase V: Outcome Evaluation
Outcome evaluation for this announcement is defined as the
assessment of the effects of an intervention on the individuals who
were targeted in the intervention. For example, changes in knowledge,
attitudes, or behavior are usually outcome variables.
Recipients whose award is more than $1 million are expected to
carry out at least one outcome evaluation during the five-year period.
Outcome evaluation may be most easily achieved for the following types
of interventions: HIV counseling and testing, referral, individual-
level counseling, group-level counseling, and institution-based
programs. CDC Evaluation Guidance (to be published) will describe
recommended outcome evaluation designs and emphasize those designs that
are cost-efficient and practically feasible to implement.
f. Phase VI: Impact Evaluation
Impact evaluation is the assessment of the effects beyond the
outcome. For example, assessment of the cumulative effect of all HIV
prevention activities in the jurisdiction is an impact evaluation.
CDC plans to conduct national impact evaluation studies using HIV/
AIDS surveillance and other public health data sets. Recipients are not
required to perform their own impact evaluation (but may do so if they
wish and resources permit); however, recipients must participate in
CDC's HIV prevention effectiveness indicators project.
9. Other Activities
Recipients must:
a. Have the capability to access the Internet and to download
documents about HIV from CDC and other sites.
b. Ensure participation of appropriate representatives
(governmental and non-governmental) in national or regional planning
and implementation meetings.
Recipients should budget funds provided through this cooperative
for these efforts. For example, travel funds should be available for
community planning co-chairs to travel to the HIV Co-chairs meeting.
B. CDC Activities
1. Provide consultation and technical assistance in all aspects of
the comprehensive HIV prevention program, including the community
planning process, and planning, conducting, and evaluating HIV
prevention and intervention activities.
2. Provide up-to-date information including diffusion of best-
practices in all areas of the diagnosis, treatment, surveillance, and
prevention of HIV.
3. Provide assistance to improve systems that monitor disease and
reporting trends.
4. In consultation with recipients, assess training needs and
determine how best to meet those needs. For HIV Prevention, CDC, in
concert with State and local health departments, will provide training,
either directly or through its network of STD/HIV prevention training
centers, for persons who supervise, manage, and perform partner
notification and other outreach activities and for staff who provide
direct patient care.
5. Facilitate the adoption and adaptation of effective prevention
intervention models among project areas through workshops, conferences,
written communications.
6. Assist recipients in evaluating their program performance, in
meeting their objectives, and in complying with cooperative agreement
requirements.
7. Coordinate multi State approaches to HIV prevention and
intervention.
8. Support individual project areas by providing technical
assistance in the development of new or innovative models for
behavioral and clinical interventions and the evaluation of them.
Application Content
A. General
Develop applications in accordance with CDC 0.1246E, information
contained in the program announcement, and the instructions and format
provided below.
Sequentially number all pages in the application and attachments,
include a table of contents reflecting major categories and
corresponding page numbers. Submit the original and each copy of the
application unstapled and unbound. Provide only those attachments
directly relevant to this application. All materials must be single
spaced, printed in 12 CPI font, unreduced, on 8\1/2\'' by 11'' paper,
with at least 1'' margins, and printed on one side only.
B. Cross-Program Activities
Submit a brief statement addressing major HIV, STD, and TB cross-
program issues. In this statement summarize progress made in the last
12 months and the current level of shared activities across HIV, STD,
and TB programs. Discuss plans to improve coordination across HIV, STD,
and TB programs over the next 12 months, including plans to increase
collaboration in surveillance and any other efforts to improve program
coordination.
C. HIV Prevention Community Planning (Not To Exceed 20 Pages)
1. National Community Planning: Progress Report and 1999 Objectives
Provide a brief summary of progress in accomplishing the following
national community planning core objectives. Also, please summarize
steps that will be taken over the next 12 months to accomplish the
national core objectives.
a. Fostering the openness and participatory nature of the community
planning process.
(1) Describe any efforts in the past 12 months in recruiting,
training, and supporting community planning group members, and methods
used to obtain input from outside group membership. Briefly profile the
number of HIV prevention community planning groups convened in the
jurisdiction. If the jurisdiction convenes other county or regional
groups that provide input to a community planning group, please
[[Page 27634]]
describe this structure. Briefly describe any changes in the planning
structure of your jurisdiction. Also briefly describe any mechanisms
used during the past 12 months for coordination with other planning
activities, e.g., Ryan White Title I and II, STD, TB.
(2) Describe any new or additional steps to be taken in each of
these areas in the next 12 months to foster the openness and
participatory nature of the community planning process.
b. Ensuring that the community planning groups reflect the
diversity of the epidemic in your jurisdiction, and that expertise in
epidemiology, behavioral science, health planning and evaluation are
included in the process.
(1) Summarize the characteristics and expertise represented by
members of the community planning groups over the past 12 months.
Discuss any gaps in representation and approaches that have been used
during the past 12 months to address the gaps. Briefly describe any
methods used to obtain input from outside group membership. Do not
include any information that might link HIV status to any individual.
(2) Please describe planned activities for the next 12 months
including plans for addressing any gaps in representation.
c. Ensuring that priority HIV prevention needs are determined based
on an epidemiologic profile and a needs assessment.
(1) Briefly describe the process that was used or steps that were
taken over the past 12 months to develop or modify the epidemiologic
profile and the needs assessment. Briefly describe how priority
populations were identified from the epidemiologic profile and needs
assessment.
(2) Describe plans for updating or modifying the Epi profile and
needs assessment over the next 12 months.
d. Ensuring that interventions are prioritized based on explicit
consideration of priority needs, outcome effectiveness, cost
effectiveness, social and behavioral science theory, and community
norms and values.
(1) Briefly describe the process that was used to prioritize
interventions over the past 12 months.
(2) Describe any changes planned in the prioritization process in
the next 12 months.
e. Fostering strong, logical linkages between the community
planning process, plans, application for funding and HIV prevention
resources.
(1) Briefly describe the linkage between this application for
funding and allocation of CDC HIV prevention resources and the HIV
Prevention Plan.
(2) Describe any changes planned in the next 12 months.
(3) Describe linkages between planned expenditures (as reported in
the budget tables), epidemiological statistics, and plans for
addressing any gaps between budget levels and epidemiologic statistics.
2. Community Planning Technical Assistance and Evaluation
a. Technical Assistance
(1) Briefly describe any technical assistance provided to the
community planning group in the past 12 months.
(2) Describe areas of needed technical assistance and planned
methods for obtaining this assistance in the next 12 months.
b. Evaluation
(1) Briefly describe how the community planning process was
evaluated over the past 12 months and the major conclusions of the
evaluation.
(2) Describe plans to evaluate the community planning process over
the next 12 months.
3. Comprehensive HIV Prevention Community Plan
Please provide as an attachment, the current version of your
Comprehensive HIV Prevention Plan. For areas without a jurisdiction-
wide planning group, include regional plans and a jurisdiction-wide
summary of recommendations and conclusions. If the jurisdiction has
developed a separate document that updates and describes refinements or
changes to the original Comprehensive HIV Prevention Plan, please
attach both the original Plan and the supplementary document that
updates the Plan. Include the proposed activities for 1999, letters of
concurrence/non-concurrence from each community planning group in the
jurisdiction, a line item budget and narrative justification, and
relevant attachments. (The Comprehensive Plan or the jurisdiction-wide
summary are attachments to the application and are not included in the
page limit for this section.)
a. Priority populations and interventions. List the populations
identified in the HIV Prevention Community Plan in rank order. For each
of these populations list the recommended interventions (e.g., CTRPN,
HE/RR) in rank order. For each intervention, list goals recommended in
the plan. Please use the following format:
Population #1
Intervention #1
Goals
Intervention #2
Goals
Population #2
D. HIV Prevention Program (Not to Exceed 30 Pages)
1. Progress Report for 1998
Summarize progress during the past year in achieving objectives
related to each of the programmatic activities listed below. For each
activity, describe progress toward achieving program objectives,
related training and quality assurance activities, program evaluation
findings, changes or adjustments resulting from evaluation findings,
and reasons for not attaining an objective.
a. HIV CTRPN;
b. HE/RR (including individual level interventions, group level
interventions, community level interventions, and street and community
outreach);
c. Public Information Programs;
d. Evaluation Activities;
e. HIV prevention capacity building activities;
f. Quality assurance and training;
g. Other activities.
2. Budget Tables
Complete the Table of Estimated Expenditures for 1998 HIV
Prevention funding, indicating 1998 HIV prevention allocations by
intervention, population, and race/ethnicity. This is used to report to
Congress and Office of Management and Budget on use of tax dollars,
targeted programs, and to justify need for additional support.
3. Program Goals, Objectives, and Activities
a. 5-Year Programmatic Goals
Based on the past 5 years' activities, provide overall programmatic
goals for the next five-year period. These are intended to provide a
general framework-objectives and activities will be developed annually,
when each of the next budget period program applications are written.
b. 1999 Priority Populations and Interventions
List the priority populations identified by the recipient in rank
order. For each of these populations, list the interventions the
grantee plans to fund in rank order. For each intervention list the
goals. For each goal, state realistic, specific, time-phased, and
measurable objectives to be achieved during the next 12 months. Outline
strategies and activities to be undertaken and services to be provided
to achieve objectives. Include, as needed, training, quality assurance,
and capacity-building objectives related to each intervention. Please
use the following format:
[[Page 27635]]
Population #1
Intervention #1
Goals
Objectives
Activities
Intervention #2
Goals
Objectives
Activities
Population #2
Intervention #1
c. Linkages Between Primary and Secondary HIV Prevention Activities
Briefly describe the linkages that will be developed and maintained
between primary and secondary prevention services in the jurisdiction.
Provide goals and realistic, specific, time phased, and measurable
objectives for the next 12 months. Outline strategies and activities to
be undertaken to achieve these objectives.
d. Linkages With Other HIV Prevention Related Activities
Briefly describe the program's proposed linkages with other HIV
prevention-related activities (e.g., epidemiologic and behavioral
surveillance; research; substance abuse, STD, and family planning
programs; and program evaluation activities) and the prevention program
strategies proposed in this application. Provide goals and realistic,
specific, time phased, and measurable objectives for the next 12
months. Outline strategies and activities to be undertaken to achieve
these objectives.
e. Coordination of HIV Prevention Services and Programs
Briefly describe the program's plans for coordination among public
and non-governmental agencies to provide HIV prevention services and
programs. Provide goals and realistic, specific, time phased, and
measurable objectives for the next 12 months. Outline strategies and
activities to be undertaken to achieve these objectives.
f. Technical Assistance
Briefly describe your need, as well as the needs of the community-
based organizations in your jurisdiction, for technical assistance in
the areas of HIV prevention program design, implementation, and
evaluation. Describe plans for addressing these technical assistance
needs. Provide goals and realistic, specific, time phased, and
measurable objectives for the next 12 months. Outline strategies and
activities to be undertaken to achieve these objectives.
g. Program Evaluation
Each year, in their annual CDC funding applications, recipients
should submit progress reports and data pertaining to the phases they
implemented during the previous year and establish objectives for the
upcoming year. As grantees implement new phases of evaluation, those
phases that were previously initiated should be continued.
4. Explain Any Differences Between the Priority Populations,
Interventions, and the Proposed Program Activities and Those
Recommended in the Comprehensive HIV Prevention Plan (e.g., other
funding sources are supporting an activity, other providers are meeting
a need, public health interest, legal constraints)
E. Concurrence of HIV Prevention Community Planning Groups
Recipients must submit letters of concurrence or non-concurrence
from each HIV prevention community planning group convened within the
jurisdiction. The letters should indicate the extent to which the
recipient and the HIV prevention community planning groups have
successfully collaborated in developing the comprehensive HIV
prevention plan and have reviewed and agree upon the program priorities
contained in this application. The letter should describe the process
used to obtain concurrence, including a description of the process used
for review of the application by the community planning group, the time
frame allotted for the review, who from the community planning group
reviewed it (co-chairs, members, subcommittee chairs), and the quality
of the concurrence (e.g., without reservation, with minor concerns,
with important concerns). At a minimum, the letters should be signed by
the co-chairs on behalf of the groups. There should be letters from
each of the community planning groups described above. If a letter of
concurrence includes reservations or a statement of concern/issues,
address those concerns in the application. Letters of non-concurrence
must cite specific reasons for the non-concurrence. In situations where
the community planning group does not concur with the program
priorities identified in the funding application and the recipient is
proposing to implement activities or allocate Federal resources based
on other priorities, a justification must be provided by the recipient
as to why the priorities identified through the community planning
process are not being implemented.
Instances of planning group concerns or non-concurrence will be
evaluated on a case-by-case basis. After consultation, CDC will
determine what action, if any, may be appropriate.
F. Budget Information
In accordance with Form CDC 0.1246E, provide a line item budget and
narrative justification for all requested costs that are consistent
with the purpose, objectives, and proposed program activities. Within
this budget, please provide the documentation requested for each cost
category:
1. Line item breakdown and justification for all personnel, i.e.,
name, position title, annual salary, percentage of time and effort, and
amount requested.
2. Line item breakdown and justification for all contracts,
including: (1) Name of contractor, (2) period of performance, (3)
method of selection (e.g., competitive or sole source), (4) description
of activities, (5) target population and (6) itemized budget.
3. Requests for any new Direct Assistance Federal assignees,
include:
a. The number of assignees requested;
b. A description of the position and proposed duties;
c. The ability or inability to hire locally with financial
assistance;
d. Justification for request;
e. An organizational chart and the name of the intended supervisor;
f. The availability of career-enhancing training, education, and
work experience opportunities for the assignee(s) and;
g. Assignee access to computer equipment for electronic
communication with CDC.
4. Complete CDC budget tables. Note: Following receipt of your 1999
award, additional budgetary information may be requested.
Submission and Deadline
(To be provided with final version)
Evaluation Criteria
A. All applications will be reviewed by CDC program consultants for
determination of progress toward stated objectives and for compliance
with program guidance. In addition, each application will also receive
an external review by an independent team of governmental and non-
governmental representatives to determine technical acceptability. The
purposes of this external review will be to evaluate each application
individually against to the following criteria:
1. The need for support as documented in the Epidemiologic Profile
and Needs Assessment including
[[Page 27636]]
(1) the degree to which trends in reported AIDS cases and HIV sero
prevalence show the need for increased HIV prevention activities and
services, and (2) the extent of unmet prevention needs as identified
through the needs assessment in the Comprehensive HIV Prevention Plan.
2. Determine progress and continued compliance with the Community
Planning Guidance and this document.
3. The extent to which the short-term and long-term objectives are
realistic, measurable, time-phased, and related to the project's
Comprehensive HIV Prevention Plan.
4. The quality of the recipient's plan for conducting program
activities, the potential effectiveness of the proposed methods in
meeting the stated objectives, and previous success in implementing
activities and services. This includes the degree to which the proposed
program activities and methods are science-based (i.e., theory-
predicted or based on findings of scientific research) and the
likelihood that the recipient can effectively implement the proposed
activities and services.
5. The quality of the proposed evaluation plan.
6. The extent to which the budget request is clearly explained, is
adequately justified, and is consistent with the intended use of
Federal funds.
7. The degree to which the applicant has met the CDC Policy
requirements regarding the inclusion of women, ethnic, and racial
groups in the proposed research. This includes:
a. The proposed plan for the inclusion of both sexes and racial and
ethnic minority populations for appropriate representation.
b. The proposed justification when representation is limited or
absent.
c. A statement as to whether the design of the study is adequate to
measure differences when warranted.
d. A statement as to whether the plans for recruitment and outreach
for study participants include the process of establishing partnerships
with communities) and recognition of mutual benefits.
B. In addition, the external review will:
1. Recommend specific actions for CDC to ensure that project areas
are developing, implementing, and refining technically acceptable
prevention plans.
2. Recommend technical assistance or other support to further a
project area's progress in implementing community planning.
3. Identify innovative or promising practices in HIV prevention and
community planning and recognize successes.
4. Determine national progress in implementing HIV prevention
community planning and potential technical assistance needs in 1999.
Other Requirements
A. Technical Reporting Requirements
A report describing progress in HIV prevention community planning
and HIV prevention program activities is required annually with the
application for funding.
An original and two copies of a financial status report (FSR) are
required no later than 90 days after the end of each budget period and
a final report after the project period. Submit the all reports to the
Grants Management Branch, CDC.
Statistical reports of HIV-antibody counseling and testing
activities (OMB [Office of Management and Budget] Approval No. 0920-
0280) are required 45 days after the end of each quarter. Project areas
are required to collect and report data for each episode of counseling
or testing funded by CDC on all of the following variables: Project
area, site type, site number, date of visit, sex, race/ethnicity, age,
reason for visit, risk for HIV infection, whether test is anonymous or
confidential, whether client accepted testing, results of test, whether
post-test counseling occurred, date of post-test counseling and state,
county, and zip code of client residence. Data should be collected in a
manner consistent with and not in place of client-centered counseling.
Project areas may collect other information to meet local data and
evaluation needs. Project areas may use CDC scan form for reporting or
a local form with data reported electronically. Project areas are
encouraged to report data at client record level. Project areas may
request technical assistance to achieve this.
For other requirements, see the following attachments.
B. AR98-1 Human Subjects Requirements
C. AR98-2 Requirements for Inclusion of Women and Racial and Ethnic
Minorities in Research
D. AR98-4 HIV/AIDS Confidentiality Provisions
E. AR98-5 HIV Program Review Panel Requirements
F. AR98-6 Patient Care
G. AR98-7 Executive Order 12372 Review
H. AR98-8 Public Health System Reporting Requirements
I. AR98-9 Paperwork Reduction Act Requirements
J. AR98-10 Smoke-Free Workplace Requirements
K. AR98-11 Healthy People 2000
L. AR98-12 Lobbying Restrictions
Authority and Catalog of Federal Domestic Assistance Number
This program is authorized under sections 317, 301, and 311 of the
Public Health Service Act (42 U.S.C. 241(a) and 247(b)), (42 U.S.C.
241) and (42 U.S.C. 243), as amended. The Catalog of Federal Domestic
Assistance (CFDA) number for this project is 93.940.
Where To Obtain Additional Information
Please refer to Program Announcement 99004 when you request
information. For a complete program description, information on
application procedures, an application package, and business management
technical assistance, contact: Kevin Moore, Grants Management
Specialist, Grants Management Branch, Procurement and Grants Office,
Announcement Number 99004, Centers for Disease Control and Prevention
(CDC), Room 300, Mailstop E-15, 255 East Paces Ferry Road, NE.,
Atlanta, GA 30305-2209; Telephone (404) 842-6550; Email address
[email protected]; See also the CDC home page on the Internet: http://
www.cdc.gov.
For program technical assistance, contact your project officer or
Jessica Gardom, Division of HIV/AIDS Prevention, National Center for
HIV/STD/TB Prevention (NCHSTP), Centers for Disease Control and
Prevention (CDC), Mailstop E-58, 1600 Clifton Road, NE., Atlanta, GA
30333; Telephone (404) 639-5248; Email address [email protected]
[[Page 27637]]
Dated: May 13, 1998.
Joseph R. Carter,
Acting Associate Director for Management and Operations, Centers for
Disease Control and Prevention (CDC).
Guidance: HIV Prevention Community Planning for HIV Prevention
Cooperative Agreement Recipients
Essential Components of a Comprehensive HIV Prevention Program
To implement a comprehensive HIV prevention program, State, local,
and territorial health departments that receive HIV Prevention
Cooperative Agreement funds should assure that efforts in their
jurisdictions include all of the following essential components:
1. A community planning process, known as HIV prevention community
planning, in accordance with this guidance;
2. Epidemiologic and behavioral surveillance, as well as
compilation of other health and demographic data relevant to HIV risks,
incidence, or prevalence;
3. HIV counseling, testing, referral, and partner notification
(CTRPN) with strong linkages to medical care, treatment, and other
needed services;
4. Health education and risk reduction (HE/RR) activities,
including individual-, group-, and community-level interventions;
5. Accessible diagnosis and treatment of other sexually transmitted
diseases;
6. Accessible diagnosis and treatment of tuberculosis and other
opportunistic infections;
7. School-based efforts for youth;
8. Public information programs;
9. Training and quality assurance;
10. Laboratory support;
11. HIV prevention capacity-building activities, including
expansion of the public health infrastructure by contracting with non-
governmental organizations, especially community-based organizations;
12. An HIV prevention technical assistance assessment and plan; and
13. Evaluation of major program activities, interventions, and
services.
This guidance addresses the first of these components, HIV
prevention community planning, and outlines the minimum standards that
CDC requires of its health departments in the implementation of the
community planning process. Definitions and programmatic standards and
guidelines referenced in this guidance are further described in the
materials included with the 1999 HIV prevention cooperative agreement
program announcement number 99004.
Financial Support of HIV Prevention Community Planning
HIV prevention cooperative agreement funds should be used to
support all aspects of the community planning process, including:
1. Supporting planning group meetings, public meetings, and other
means for obtaining community input;
2. Facilitating involvement of all community planning group members
in the planning process, particularly those persons with and at risk
for HIV infection;
3. Supporting capacity development for inclusion,* representation**
and parity*** of community representatives and other planning groups
members to participate effectively in the process;
---------------------------------------------------------------------------
* Inclusion, representation, and parity are fundamental tenets
of HIV prevention community planning. Inclusion is defined as the
assurance that the views, perspectives, and needs of all affected
communities are included and involved in a meaningful manner in the
community planning process. This is the assurance that the community
planning process is inclusive of all the needed perspectives.
** Representation, is the assurance that those who are
representing a specific community truly reflect that community's
values, norms, and behaviors. This is the assurance that those
representatives who are included in the process are truly able to
represent their community. At the same time, these representatives
should be able to participate as group members in objectively
weighing the priority prevention needs of the jurisdiction.
*** Parity, is the condition whereby all members of the HIV
prevention community planning group have the skills and knowledge
for input and participation, as well as equal voice in voting and
other decision-making activities. This is ensuring that those
representatives who are included in the process can participate
equally in the decision-making process.
---------------------------------------------------------------------------
4. Providing technical assistance to health departments and
community planning groups;
5. Supporting infrastructure for the HIV prevention community
planning process;
6. Collecting, analyzing, and disseminating relevant data; and
7. Evaluating the community planning process.
Goal of HIV Prevention Community Planning
The goal of HIV prevention community planning is to improve the
effectiveness of State, local, and Territorial health departments' HIV
prevention programs by strengthening the scientific basis, relevance,
and focus of prevention interventions. CDC monitors progress in meeting
this goal through the following five core objectives:
Core Objectives:
1. Fostering the openness and participatory nature of the community
planning process.
2. Ensuring that the community planning group(s) reflects the
diversity of the epidemic in the jurisdiction, and that expertise in
epidemiology, behavioral science, health planning, and evaluation are
included in the process.
3. Ensuring that priority HIV prevention needs are determined based
on an epidemiologic profile and a needs assessment.
4. Ensuring that interventions are prioritized based on explicit
consideration of priority needs, outcome effectiveness, cost and cost
effectiveness, theory, and community norms and values.
5. Fostering strong, logical linkages between the community
planning process, application for funding, and allocation of CDC HIV
prevention resources.
Definition of HIV Prevention Community Planning
HIV prevention community planning is an ongoing, iterative planning
process that is (1) evidence-based (i.e., based on HIV/AIDS and other
epidemiologic data, including STD and behavioral surveillance data;
qualitative data; ongoing program experience; program evaluation; and a
comprehensive needs assessment process) and (2) incorporates the views
and perspectives of groups at risk for HIV infection for whom the
programs are intended, as well as providers of HIV prevention and STD
treatment services. Together, representatives of affected populations,
epidemiologists, behavioral scientists, HIV/AIDS prevention service
providers, STD treatment providers, health department staff, and others
analyze the course of the epidemic in their jurisdiction, assess HIV
prevention needs, determine their priority prevention needs, identify
HIV prevention interventions to meet those needs, and develop
comprehensive HIV prevention plans that are directly responsive to the
epidemics in their jurisdictions. These comprehensive HIV prevention
plans address all the essential components of a comprehensive HIV
prevention program described in the section Essential Components of a
Comprehensive HIV Prevention Program, or explain why a particular
component is missing.
Prioritizing HIV prevention needs is a critical part of program
planning. Community planning group members are expected to follow a
logical, evidence-based process in order to determine the highest
priority prevention needs in their jurisdiction. These prioritized
prevention needs are particularly important to the health department in
allocating prevention
[[Page 27638]]
dollars. Specific high priority HIV prevention needs (both populations
and interventions) identified in the comprehensive HIV prevention plan
are then operationalized in the health department's application to CDC
for Federal HIV prevention funds. There should be strong, logical
linkages between the community planning process, the comprehensive HIV
prevention plans, the health department's application for Federal
funds, and the allocation of Federal HIV prevention resources by the
health department.
To meet this definition, community planning groups must focus
primarily on the tasks of planning. Once a comprehensive plan has been
developed, the community planning group should periodically review it
to determine whether or not it is necessary to:
1. Seek additional information to clarify and focus prevention
priorities;
2. Define potential methods for obtaining needed additional
information;
3. Give additional attention to strengthening specific
recommendations in the plan, such as
a. The linkages between primary prevention activities and secondary
prevention, STD treatment, drug treatment, and medical services;
b. Development of an in-depth plan for coordination of health
department HIV prevention activities with the prevention activities of
other governmental and non-governmental agencies in the jurisdiction;
c. Conducting an assessment of technical assistance needs in the
jurisdiction and developing a plan for meeting the needs;
4. Review program implementation information that would inform the
planning process and potentially affect the priorities in the plan,
e.g., progress reports from contractors, process evaluation data from
other program activities;
5. Monitor any shifts in incidence;
6. Conduct new or additional needs assessment, resource
inventories, focus groups, etc.;
7. Review new research findings on intervention effectiveness and
determine the impact, if any, on the plan; and
8. Consider how new biomedical or prevention technologies might
best be utilized.
These reviews may result in additional objectives for the community
planning group in the upcoming year and an updated or revised
comprehensive plan. Community planning groups may choose to take a
long-term approach to their planning process, in one year reviewing the
plan and developing action steps to strengthen it; in the next,
focusing on implementing the steps and revising the plan; in the next,
focusing on a particular population for which more information is
needed; in the third, returning to the basic community planning steps.
The planning process should be flexible, taking a long-term approach
and negotiating meaningful tasks for the planning group that contribute
and enhance the comprehensive plan. The important, overall goal of HIV
prevention community planning is to have in place a comprehensive HIV
prevention plan that is current, evidence based, adaptable as new
information becomes available, tailored to the specific needs of each
jurisdiction, and widely distributed in an effort to provide a road map
for prevention that can be used by all prevention providers in the
jurisdiction.
Principles of HIV Prevention Community Planning
The following principles trace their origins to several sources:
HIV prevention program assessments conducted by CDC staff; CDC's
Planned Approach to Community Health (PATCH) program; CDC's Assessment
Protocol for Excellence in Public Health (APEX/PH) project; the ASTHO/
NASTAD/CSTE State Health Agency Vision for HIV Prevention; the June
1994 External Review of CDC's HIV Prevention Strategies by the CDC
Advisory Committee on the Prevention of HIV Infection; experience and
recommendations of health departments and non-governmental
organizations; the health promotion, community development, behavioral
and social sciences literature; and CDC and its partners' experience in
implementing community planning since 1994.
All Grantees Are Required To Adhere to the Following Principles
1. HIV prevention community planning reflects an open, candid, and
participatory process, in which differences in cultural and ethnic
background, perspective, and experience are essential and valued.
2. HIV prevention community planning is characterized by shared
priority setting between health departments administering and awarding
HIV prevention funds and the communities for whom the prevention
services are intended.
3. Priority setting accomplished through a community planning
process produces programs that are responsive to high priority,
community-validated needs within defined populations. Persons at risk
for HIV infection and persons with HIV infection play a key role in
identifying prevention needs not adequately met by existing programs
and in planning for needed services that are culturally appropriate.
HIV prevention programs developed with input from affected communities
are likely to be successful in garnering the necessary public support
for effective implementation and in preventing the transmission of HIV
infection.
4. Representation on a community planning group includes:
a. Persons who reflect the characteristics of the current and
projected epidemic in that jurisdiction (as documented by the
epidemiologic profile) in terms of age, gender, race/ethnicity,
socioeconomic status, geographic and metropolitan statistical area
(MSA)-size distribution (urban and rural residence), and risk for HIV
infection. In addition to reflecting the characteristics outlined
above, these representatives should articulate for, and have expertise
in understanding and addressing, the specific HIV prevention needs of
the populations they represent. At the same time, these representatives
should be able to participate as group members in objectively weighing
the priority prevention needs of the jurisdiction.
b. State and local health departments, including the HIV prevention
and STD treatment programs.
c. State and local education agencies.
d. Other relevant governmental agencies (e.g., substance abuse,
mental health, corrections).
e. Experts in epidemiology, behavioral and social sciences, program
evaluation, and health planning.
f. Representatives of key non-governmental and governmental
organizations providing HIV prevention and related services (e.g., STD,
TB, substance abuse prevention and treatment, mental health services,
HIV care and social services) to persons with or at risk for HIV
infection.
g. Representatives of key non-governmental organizations relevant
to, but who may not necessarily provide, HIV prevention services (e.g.,
representatives of business, labor, and faith communities).
5. The HIV prevention community planning process attempts to
accommodate a reasonable number of representatives without becoming so
large that it cannot effectively function. To assure needed input
without becoming too large to function, HIV prevention community
planning group(s) seek additional avenues for
[[Page 27639]]
obtaining input on community HIV prevention needs and priorities, such
as holding well-publicized public meetings, conducting focus groups,
and convening ad hoc panels. This is especially important for obtaining
input relevant to marginalized populations that may be difficult to
recruit and retain as members of the planning group (e.g., injecting
drug users).
6. Nominations for membership are solicited through an open process
and candidates are selected, based on criteria that has been
established by the health department and the community planning group.
The nomination and selection of new community planning group members
occurs in a timely manner to avoid vacant slots or disruptions in
planning. In addition, the recruitment process for membership in the
HIV prevention community planning process is proactive to ensure that
socioeconomically marginalized groups, and groups that are under served
by existing HIV prevention programs, are represented.
7. All members of the HIV prevention community planning group(s)
are offered a thorough orientation, as soon as possible after
appointment. The orientation includes:
a. Understanding the roles and responsibilities outlined in this
document,
b. Understanding the procedures and ground rules used in all
deliberations and decision making,
c. Understanding the specific policies and procedures for decision-
making, resolving disputes, and avoiding conflict of interests that are
consistent with the principles of this guidance and are developed with
input from all parties. These policies and procedures address:
1. Process for making decisions within the planning group (vote,
consensus, etc.),
2. Conflict(s) of interest for members of the planning group(s),
3. Disputes within and among planning group(s),
4. Differences between the planning group(s) and the health
department in the prioritization and implementation of programs/
services, and
5. A process for resolving these disputes in a timely manner when
they occur.
d. Understanding HIV prevention interventions and comprehensive
prevention programs.
Orienting new members is an ongoing process that may include
mentoring new members throughout the year.
8. Health departments assure that HIV prevention community planning
group(s) have access to current information related to HIV prevention
and analyses of the information, including potential implications for
HIV prevention in the jurisdiction. Sources of information include
evaluations of program activities, programmatic research, social and
behavioral sciences, and other sources, especially as it relates to the
at-risk population groups within a given community and the priority
needs identified in the comprehensive plan.
9. Identification, interpretation, and prioritization of HIV
prevention needs reflect the epidemiologic profile, needs assessment,
and culturally relevant and linguistically appropriate information
obtained from the communities to be served, particularly persons with
or at risk for HIV infection.
10. Priority setting for specific HIV prevention strategies and
interventions is based on specific criteria outlined in this document
and each criterion should be formally considered by the HIV prevention
community planning group(s) during priority-setting deliberations.
11. The HIV prevention community planning process produces a
comprehensive HIV prevention plan, jointly developed by the health
department and the HIV prevention community planning group(s), which
includes specific, high priority HIV prevention strategies and
interventions targeted to defined populations. Each health department's
application for CDC funds addresses the plan's high priority elements
that are most appropriately met by HIV prevention cooperative agreement
funds. The comprehensive plan includes the essential elements listed in
the section Essential Elements of a Comprehensive HIV Prevention Plan.
12. Because the plan is comprehensive, it should be distributed
widely as a resource to guide programmatic activities and resources
outside of those supported with CDC Federal HIV prevention funds.
13. The HIV prevention community planning process is evaluated to
ensure that it is meeting the core objectives of community planning.
Steps in the HIV Prevention Community Planning Process
The steps of the HIV prevention community planning process follow:
1. Epidemiologic Profile: Assess the extent, distribution, and
impact of HIV/AIDS and other STDs in defined populations in the
community, as well as relevant risk behaviors. In defining at-risk
populations, special attention should be paid to distinguishing
behavioral, demographic, and racial/ethnic characteristics. This is the
starting point for defining future HIV prevention needs in defined,
targeted populations within the health department's jurisdiction. Other
methods for segmenting audiences for prevention messages may also be
used.
2. Needs Assessment/Resource Inventory: Assess existing community
resources for HIV prevention and STD treatment to determine the
community's capability to respond to the epidemic. These resources
should include fiscal, personnel, and program resources, as well as
support from public (Federal, State, county, municipal), private, and
volunteer sources. This inventory should attempt to identify HIV
prevention and STD treatment programs and activities according to the
high-risk populations defined in the epidemiologic profile. The needs
assessment/resource inventory should be based on a variety of sources
(both qualitative and quantitative), should be collected using
different assessment strategies (e.g., surveillance; survey; formative,
process, and outcome evaluation of programs and services; outreach and
focus group(s); public meetings), and should incorporate information
from both providers and consumers of services. Techniques such as over
sampling may be needed to collect valid information from certain at-
risk populations.
3. Gap Analysis: Identify met and unmet HIV prevention and STD
treatment needs within the high-risk populations defined in the
epidemiologic profile and needs assessment/resource inventory. Findings
from the needs assessment about high-risk populations (e.g., size of
population, impact of HIV/AIDS, risk behaviors) and from the resource
inventory about existing services should assist in identifying priority
prevention needs. For example, if a large number of clients are turned
away each day from an STD clinic that has a high HIV sero positivity
rate, then there is clearly a gap in HIV prevention services.
4. Intervention Inventory: Identify potential strategies and
interventions that can be used to prevent new HIV infections within the
high-risk populations defined in the needs assessment;
5. Prioritization: Prioritize (rank order) HIV prevention needs in
terms of: (1) High-risk populations; and (2) interventions and
strategies for each high-risk population based on the following
criteria:
a. Documented HIV prevention needs based on the current and
projected impact of HIV/AIDS and other STDs in
[[Page 27640]]
defined populations in the health department's jurisdiction;
b. Outcome effectiveness of proposed strategies and interventions
(either demonstrated or probable);
c. Available information on the relative costs and effectiveness of
proposed strategies and interventions (either demonstrated or
probable);
d. Sound scientific theory (e.g., behavior change, social change,
and social marketing theories) when outcome effectiveness information
is lacking;
e. Values, norms, and consumer preferences of the communities for
whom the services are intended;
f. Availability of other governmental and non-governmental
resources (including the private sector for HIV prevention); and
g. Other State and local determining factors.
Each criterion should be considered by the HIV prevention community
planning group(s) during priority-setting deliberations. At a minimum,
the community planning groups must provide a clear, concise, logical
statement as to why each population and intervention given high
priority was chosen.
6. Plan Development: Develop a comprehensive HIV prevention plan
consistent with the high priority needs identified through the
community planning process. The plan must contain all of the elements
described in the following section, Essential Elements of a
Comprehensive HIV Prevention Plan. CDC does not require a new plan each
year. Plans may cover more than one year. However, project areas are
expected periodically to review, revise, and refine the plans, as
indicated by any new or enhanced surveillance data, intervention
research, needs assessment, program policy, or technology. (See
Definition of HIV Prevention Community Planning)
7. Evaluation: Evaluate the effectiveness of the planning process.
Health departments should track and keep records on an ongoing basis in
the following areas pertaining to the community planning process and
development and implementation of the comprehensive HIV prevention
plan:
a. Recruitment of community planning group members and
representation of affected communities and areas of expertise on the
community planning group (Community Planning Core Objectives 1 and 2).
b. Application of a needs assessment and an epidemiologic profile
to determine target groups and HIV prevention strategies (Community
Planning Core Objective 3).
c. Application of scientific knowledge in the selection and
formulation of intervention strategies (Community Planning Core
Objective 4).
d. Developing goals and measurable objectives for the planning
process and monitoring progress on the objectives.
e. Assessing the cost of the process.
f. Assessing the extent to which resources allocated by the health
department match the epidemiologic profile.
g. Assessment of the extent to which the final version of the
Comprehensive HIV prevention plan is used in the health department's
budget decisions and in the planning and development of HIV prevention
program activities (Community Planning Core Objective 5).
8. Update: Use program evaluation data and updated or revised
epidemiologic, needs assessment, intervention research, program policy,
and technologic data to improve the next year's planning process and to
update, as appropriate, the comprehensive plan. (See Definition of HIV
Prevention Community Planning)
Essential Elements of a Comprehensive HIV Prevention Plan
The HIV prevention community planning process should produce a
comprehensive HIV prevention plan, jointly developed by the health
department and the HIV prevention community planning group(s), which
includes specific, high priority HIV prevention strategies and
interventions targeted to defined populations.
The necessary elements of a comprehensive HIV prevention plan
include the following:
1. Epidemiologic Profile: An HIV/AIDS epidemiologic profile that
outlines the epidemic in that jurisdiction. The profile includes data
from a variety of sources (demographic and socioeconomic data, reported
AIDS cases, reported HIV infections from areas with confidential
reporting, HIV sero prevalence and sero incidence surveys/studies
(where available], HIV risk behaviors, and surrogate markers for HIV
risk behaviors, e.g., sexually transmitted disease (STD) and teen
pregnancy rates and information on drug use.) Furthermore, the profile
includes a narrative explanation of all data provided.
2. Needs Assessment/Resource Inventory/Gap Analysis: A description
of met and unmet HIV prevention needs in target populations to be
reached by primary HIV prevention interventions, and barriers in
reaching populations. The description of target populations may include
age group, gender, race/ethnicity, socioeconomic status, geographic
area, sexual orientation, risk for HIV infection, primary language, and
significant cultural factors.
3. Prioritization: The populations at high risk for HIV in rank
order (i.e., prioritization), and the culturally and linguistically
appropriate individual-, group-, and community-level strategies and
interventions to reach each. These high-risk populations should include
defined target populations whose sero status is unknown, negative, or
positive. The strategies and interventions should include the
interventions described in the section Essential Components of a
Comprehensive HIV Prevention Program, as well as school-based programs,
and other HIV prevention activities. Both existing and proposed
interventions should be described. A clear, concise, logical statement
of the reason each prioritized intervention was selected should be
included.
4. Linkages: A description of how activities proposed in the
comprehensive plan to prevent transmission or acquisition of HIV
(primary prevention activities) are linked to activities to prevent or
delay the onset of illness in persons with HIV infection (secondary
prevention activities), to STD treatment, drug treatment, and Ryan
White Comprehensive AIDS Resources Emergency (CARE) Act planning.
5. Goals: Short and long term goals for HIV prevention in defined
populations being reached with defined interventions.
6. Surveillance and Research: A description of ongoing HIV
prevention surveillance and research activities (e.g., epidemiologic
and behavioral surveillance, research, and program evaluation
activities), how these are linked to prevention program strategies in
the plan, and any additional surveillance and research that is needed.
7. Coordination: A description of how governmental and non-
governmental agencies will coordinate to provide comprehensive HIV
prevention services and programs within the area for which the plan is
developed.
8. Technical Assistance Needs Assessment and Plan: An HIV
prevention technical assistance needs assessment identifying needs of
the health department, community planning group(s), and community-based
providers in the areas of program planning, implementation, and
evaluation, and a plan of activities that addresses the technical
assistance needs.
9. Community Planning Evaluation Plan: An evaluation plan for the
HIV prevention planning process.
[[Page 27641]]
Letters of Concurrence/Nonconcurrence
Each health department, in its application, must include a letter
of concurrence or nonconcurrence from every HIV prevention community
planning group convened within the health department's jurisdiction. At
a minimum, the letter(s) should be signed by the co-chairs on behalf of
the group(s).
HIV prevention community planning group members should carefully
review the comprehensive HIV prevention plan and the health
department's entire application to CDC for Federal funds (including the
proposed budget). Because the community planning process requires
prioritization of HIV prevention needs and because prioritization
directly corresponds to resource allocation, it is critical that the
community planning group review the proposed allocation of resources in
the health department's application (and, especially, to review
expenditure levels in light of the epidemiologic profile). Community
planning groups are not asked to review and comment on internal health
department issues, such as salaries of individual health department
staff, but instead to indicate:
1. The extent to which the health department and the HIV prevention
community planning group(s) have successfully collaborated in
developing, reviewing, or revising the comprehensive HIV prevention
plan;
2. The extent to which the activities, programs, and services, for
which the health department is requesting CDC funds, are responsive to
the priorities in the comprehensive plan;
3. The process used for obtaining concurrence, including
a. A description of the process used for review of the application
by the community planning group,
b. The time frame allotted for the review,
c. Who from the community planning group reviewed it (co-chairs,
members, subcommittee chairs), and
d. The quality of the concurrence (e.g., without reservation, with
minor concerns, with important concerns).
Letter(s) of concurrence may include reservations or a statement of
concern/issues. The health department should address these reservations
or concerns in an addendum to the HIV prevention application.
Letter(s) of nonconcurrence indicate that an HIV prevention
community planning group disagrees with the program priorities
identified in the health department's application. The letter should
cite specific reasons for nonconcurrence. In instances of
nonconcurrence and when a health department does not concur with the
recommendations of the HIV prevention community planning group(s) and
believes that public health would be better served by funding HIV
prevention activities/services that are substantially different, the
health department must submit a letter of justification in its
application. CDC will assess and evaluate these justifications on a
case-by-case basis and determine what action may be appropriate. A
letter of nonconcurrence does not necessarily mean that the
jurisdiction will lose any portion of its CDC funding. These actions
can range from:
1. Obtaining more input/information regarding the situation;
2. Meeting with the health department and co-chairs;
3. Negotiating with the health department regarding the issues
raised;
4. Recommending local mediation;
5. Approving the health department's application as is;
6. Requesting that a detailed plan of corrective action be
developed to address the areas of concern and to be executed within a
specified time frame;
7. Conducting an on-site comprehensive program assessment to
identify and propose action steps to resolve areas of concern;
8. Conducting an on site program assessment focused on a specific
area(s);
9. Developing a detailed technical assistance plan for the project
area to help systematically address the situation; and
10. Placing conditions or restrictions on the award of funds
pending a future submission by the applicant.
Roles and Responsibilities--Health Departments
State, local, and territorial health departments are responsible
for the health of the populations in their jurisdictions. States have a
broad responsibility in surveillance, prevention, overall planning,
coordination, administration, fiscal management, and provision of
essential public health services. The role of the health department in
the community planning process is to:
1. Establish and maintain at least one HIV prevention community
planning group that meets the principles described in the section
Principles of HIV Prevention Community Planning. Health departments are
required to determine how best to achieve and integrate statewide,
regional, and local community planning within their jurisdictions. In
those jurisdictions where CDC has direct cooperative agreements with
both State and local health departments, health departments are
expected to have systems and procedures in place to facilitate
coordination and communication between the State and local health
departments and their community planning groups.
2. Identify a health department employee, or a designated
representative, to serve as co-chair of each HIV prevention community
planning group in the project area; if State health departments
implement more than one planning group within their jurisdiction, they
may wish to designate local health department representatives as co-
chairs of these planning groups.
3. Assure collaboration between HIV prevention community planning
group(s) and other relevant planning efforts, particularly the process
for allocating Titles I, II, and IIIb of the Ryan White Comprehensive
AIDS Resources Emergency Act and the STD prevention program. Health
departments may consider merging the HIV prevention community planning
process with other planning bodies/processes already in place. If such
mergers are undertaken, health departments must adhere to the
principles of HIV prevention community planning, as contained in this
document.
4. Provide an epidemiologic profile of the HIV prevention community
planning group's jurisdiction to assist the group in establishing
program priorities based on the extent, distribution, and impact of the
HIV/AIDS epidemic. The profile should compile, analyze, and synthesize
data from a variety of sources (demographic and socioeconomic data,
reported AIDS cases, reported HIV infections from areas with
confidential reporting, HIV sero prevalence and sero incidence surveys/
studies [where available], HIV risk behaviors and surrogate markers for
HIV risk behaviors, e.g., sexually transmitted disease (STD) and teen
pregnancy rates and information on drug use.) Further, the profile
should include a narrative explanation of all data provided and a
summary of key findings.
5. Provide expertise and technical assistance, including ongoing
training on HIV prevention planning, STD treatment and the
interpretation of epidemiologic, behavioral, and evaluation data, to
ensure that the planning process is comprehensive and evidence based.
6. Distribute widely the comprehensive HIV prevention plan and
utilize existing networks to promote linkages and coordination among
local
[[Page 27642]]
HIV prevention service providers, public health agencies, STD treatment
clinics, community planning groups, and behavioral and social
scientists who are either in the local area or who are familiar with
local prevention needs, issues, and at-risk populations.
7. Develop an application for HIV prevention cooperative agreement
funds, based on the comprehensive HIV prevention plan(s) developed
through the HIV prevention community planning process, seek review of
the application and letter(s) of concurrence/nonconcurrence from the
community planning group(s), and allocate resources based on the plan's
priorities.
8. Operationalize and implement HIV prevention services/activities
outlined in the comprehensive plan including awarding and administering
HIV prevention funds.
9. Administer HIV prevention funds awarded under the cooperative
agreement, ensuring that funds are awarded to contractors within 90
days of the time that the health department receives notice of grant
award from CDC. Monitor contractor activities and document contractor
compliance.
10. Ensure that technical assistance is provided to assist health
departments and community-based providers in the areas of program
planning, implementation, and evaluation as identified in the
comprehensive HIV prevention plan. Health departments should meet these
needs by drawing on expertise from a variety of sources (e.g., the CDC-
supported TA network, health departments, academia, professional and
other national organizations, and non-governmental organizations).
11. Administer and coordinate public funds from a variety of
sources, including Federal, State, and local agencies, to prevent HIV
transmission and reduce associated morbidity and mortality.
12. Ensure program effectiveness through specific program
monitoring and evaluation activities. This may include conducting or
contracting for process and outcome evaluation studies, providing
technical assistance in evaluation, or ensuring the provision of
evaluation technical assistance to funding recipients.
13. Provide periodic feedback to the community planning group on
the successes and barriers encountered in implementing HIV prevention
interventions.
HIV Prevention Community Planning Groups
The role of the planning group(s) in the HIV prevention community
planning process is to:
1. Elect a community co-chair to work with the co-chair designated
by the health department.
2. Determine the technical assistance needs of the community
planning group to enable them to execute an effective community
planning process.
3. Carefully review available epidemiologic, evaluation, behavioral
and social science, cost and cost-effectiveness, and needs assessment
data and other information required to prioritize HIV prevention needs.
4. Identify unmet HIV prevention needs within defined populations.
5. Prioritize HIV prevention needs by target populations and
propose high priority strategies and interventions.
6. Identify the technical assistance needs of community-based
providers in the areas of planning, implementing, and evaluating
prevention interventions.
7. Assess how well the priorities outlined in the plan are
represented in the health department's application to CDC for Federal
HIV prevention funds.
8. Community planning groups must focus primarily on the tasks of
planning, as described above. Whether or not community planning groups
take on additional tasks beyond those described in this document is
determined locally by the health department and the community planning
group (see Definition of HIV Prevention Community Planning). The
planning process should be flexible, taking a long-term approach and
negotiating meaningful tasks for the planning group that contribute and
enhance the comprehensive plan. The important, overall goal of HIV
prevention community planning is to have in place a comprehensive HIV
prevention plan that is current, evidence based, adaptable as new
information becomes available, tailored to the specific needs of each
jurisdiction, and widely distributed in an effort to provide a road map
for prevention that can be used by all prevention providers in the
jurisdiction.
Shared Responsibilities Between Health Departments and HIV
Prevention Community Planning Groups
Together, the health department and the community planning group
should:
1. Develop and implement policies and procedures that clearly
address and outline systems for regularly re-examining:
a. Planning group composition, selection, appointment, and terms of
office to ensure that all planning group(s) reflect, as much as
possible, the population characteristics of the epidemic in State and
local jurisdictions in terms of age, race/ethnicity, gender, sexual
orientation, geographic distribution, and risk for HIV infection;
b. Roles and responsibilities of the community planning group, its
members, and its various components (e.g., subcommittees, workgroups,
regional groups, etc.);
c. Methods for reaching decisions; attendance at meetings;
resolution of disputes identified in planning deliberations; and
resolution of conflict(s) of interest for members of the planning
group(s).
2. Develop and apply criteria for selecting the individual members
of the HIV prevention community planning group(s) within the
jurisdiction. Special emphasis should be placed on procedures for
identifying representatives of socioeconomically marginalized groups
and groups that are under served by existing HIV prevention programs.
3. Determine the most effective mechanisms for input into the HIV
prevention community planning process. The process must be structured
in such a way that it incorporates and addresses needs and priorities
identified at the community level (i.e., the level closest to the
problem or need to be addressed).
4. Provide a thorough orientation for all new members, as soon as
possible after appointment. New members should understand:
a. The roles, responsibilities, and principles outlined in this
document;
b. The procedures and ground rules used in all deliberations and
decision making; and
c. The specific policies and procedures for resolving disputes and
avoiding conflict of interests that are consistent with the principles
of this guidance and are developed with input from all parties.
5. Determine the distribution of planning funds to (a) support
planning group meetings, public meetings, and other means for obtaining
community input; (b) facilitate involvement of all participants in the
planning process, particularly those persons with and at risk for HIV
infection; (c) support capacity development for inclusion,
representation, and parity of community representatives and for other
planning group members to participate effectively in the process; (d)
provide technical assistance to health departments and community
planning groups by outside experts; (e) support planning infrastructure
for the HIV prevention community planning process; (f) collect,
analyze, and disseminate relevant data; and (g) evaluate the community
planning process.
[[Page 27643]]
6. Consider what additional data are needed for decision-making
about priority needs, and propose methods for obtaining the data.
7. Develop goals for HIV prevention strategies and interventions in
defined target populations.
8. Develop, update annually, and disseminate the comprehensive HIV
prevention plan.
9. If there are multiple community planning groups in the
jurisdiction, integrate multiple HIV community prevention plans into a
project-wide comprehensive HIV prevention plan.
10. Foster integration of the HIV prevention community planning
process with other relevant planning efforts. Consider how the
following are addressed within the Comprehensive HIV prevention plan:
a. HIV prevention interventions;
b. Early intervention, primary care, and other HIV-related
services;
c. STD, TB, and substance abuse prevention and treatment;
d. Women's health services;
e. Mental health services; and
f. Other public health needs.
Centers for Disease Control and Prevention
The role of CDC in the HIV prevention community planning process is
to:
1. Provide leadership in the national design, implementation, and
evaluation of HIV prevention community planning.
2. Collaborate with health departments, community planning groups,
national organizations, Federal agencies, and academic institutions to
ensure the provision of technical/program assistance and training for
the HIV prevention community planning process. The CDC project officer
is key to this collaboration. He/she works with the health department
and the community co-chairs to provide technical/program assistance for
the community planning process, including discussing roles and
responsibilities of community planning participants, disseminating CDC
documents, and responding to direct inquiries to ensure consistent
interpretation of the guidance.
3. Provide technical/program assistance through a variety of
mechanisms to help recipients understand how to (a) ensure parity,
inclusion, and representation of all members throughout the community
planning process; (b) analyze epidemiologic, behavioral and other
relevant data to assess the impact and extent of the HIV/AIDS epidemic
in defined populations; (c) conduct needs assessments and prioritize
unmet HIV prevention needs; (d) identify and evaluate effective and
cost-effective HIV prevention activities for these priority
populations; (e) provide access to needed behavioral and social science
expertise; (f) identify and manage dispute and conflict of interest
issues; and (g) evaluate the community planning process.
4. Require that application content submitted by HIV prevention
cooperative agreement recipients for HIV prevention community planning
funds is in accordance with the principles and the roles and
responsibilities outlined in this guidance.
5. Monitor the HIV prevention community planning process,
especially around the five core objectives.
6. Require as a condition for award of cooperative agreement funds
that recipients' applications are in accordance with the comprehensive
plan developed through the HIV prevention community planning process or
include an acceptable letter of justification.
7. Identify the essential components of a comprehensive HIV
prevention program.
8. Collaborate with health departments in evaluating HIV prevention
programs.
9. Collaborate with other Federal agencies (particularly the
National Institutes of Health, the Substance Abuse and Mental Health
Services Administration, and the Health Resources and Services
Administration) in promoting the transfer of new information and
emerging prevention technologies or approaches (i.e., epidemiologic,
biomedical, operational, behavioral, or evaluative) to health
departments and other prevention partners, including non-governmental
organizations.
10. Compile annually a report on the projected expenditures of HIV
prevention cooperative agreement funds by specific strategies and
interventions. Collaborate with other prevention partners in improving
and integrating fiscal tracking systems.
Accountability
CDC is committed to the concept of HIV prevention community
planning as outlined in this guidance. In summary, CDC expects that:
1. Health departments will support and facilitate the community
planning process;
2. Community planning groups will develop plans in which they have
prioritized (rank ordered) HIV prevention needs, including populations
and interventions;
3. Health departments will reflect these priorities in their
applications to CDC and implement effective HIV prevention programs
based on the comprehensive HIV prevention plan; and
4. Community planning groups will review the entire application for
their jurisdiction, including the budget, prior to writing letters of
concurrence and nonconcurrence.
CDC will continue to conduct external reviews of health department
HIV prevention cooperative agreement applications and comprehensive HIV
prevention plans to monitor the progress health departments and
community planning groups are making in meeting these expectations.
These reviews will focus on whether or not:
1. A jurisdiction's planning process is in compliance with this
guidance and the five core objectives;
2. Priority populations and recommended interventions identified in
the comprehensive HIV prevention plan are consistent with the
epidemiologic profile, needs assessment, and behavioral/social science
data presented in the plan;
3. Proposed prevention program objectives, activities, and budget
in the application are consistent with the comprehensive HIV prevention
plan; and
4. Any discrepancies noted are adequately justified.
CDC will review the recommendations provided by the External
Reviewers and consider them when making decisions concerning issues
such as funding restrictions and conditions, as well as detailed plans
of technical assistance.
[FR Doc. 98-13307 Filed 5-18-98; 8:45 am]
BILLING CODE 4163-18-P
