Declining federal funding for HIV prevention has resulted in elimination and/or reduction in the budgets for some direct service programs.

New rapid test technology offers many benefits for increasing the number of people who agree to be tested and receive their test results; however, the high cost has limited the expansion of this service.

New federal requirements for a client-level evaluation system have placed a significant burden on community-based HIV prevention providers. Less time is available to provide services and more staff time must be directed to implementing the data collection system.

The CDC has required grantees to implement its “Advancing HIV Prevention Initiative”, a strategy which includes: expanded testing to identify more HIV-infected individuals to provide them with prevention services and refer them into care; further reduction of perinatal transmission; and use of new models such as rapid testing and community-based partner counseling and referral services. No funds were allocated
for this mandate.

Additional technical assistance will be needed for community-based organizations to launch the “Diffusion of Effective Behavioral Interventions” programs identified by the CDC.

Declining and level federal funding for HIV surveillance programs has resulted in reduced ability to conduct mandated surveillance activities. Elimination of the HIV Perinatal Surveillance Program funding has created a burden on surveillance program staff in being able to collect timely and complete HIV perinatal transmission data. Level funding of essential “core” surveillance activities has made it difficult for the surveillance program to implement new CDC-required evaluation measures.

The reduction of the HIV Behavioral Surveillance funding award by 25% has led to the elimination of key initiatives, including the ability of hiring the recommended number of staff to conduct scientific surveys, which access behaviors that put people at high-risk for obtaining HIV infection.

In order to implement the CDC high-priority HIV Incidence and Resistance testing projects to all public and private sites in Virginia as directed by CDC, substantial resources will be required to meet and sustain these critical goals.

In order to conduct the new CDC-mandated surveillance project “Morbidity Monitoring Project”, surveillance staff will need to create the infrastructure to partner with approximately 25 HIV care providers to interview 400 Virginians with HIV infection.

The HIV health care services delivery system continues to strive to maintain adequate capacity to care for newly-diagnosed individuals. Areas of the state have reported lengthening waiting times for availability of an initial appointment for services. Virginia Department of Health (VDH) monitors wait times for Ryan White Part B funded services as part of routine contract reporting requirements.

New guidelines from the Centers for Disease Control and Prevention recommend HIV screening for all persons aged 13-64 regardless of risk. This may increase demand for HIV testing in both the public and private sector. Questions about payer source and ability to implement the guidelines given current resources may arise.

Bi-lingual Spanish speaking educators, counselors, outreach workers and case managers will be needed to
address the growing needs of Latino residents. Additional materials will be needed in Spanish.

Community-based organizations may take a larger role in partner counseling and referral services for newly-diagnosed persons with HIV. This is currently being piloted in response to recommendations from the Centers for Disease Control and Prevention.

Creating the technical infrastructure to support electronic lab reporting will be required. In addition, training to effectively utilize and train customers on this technology will be required.

• HIV Prevention and Treatment Services program manages federal grants/cooperative agreements for HIV Prevention, Surveillance and HIV Care services. Responsibilities include awarding funds to local agencies/providers, providing oversight and technical assistance.
• Prevention Services funds eight competitive grant programs to provide education, outreach, community-based HIV testing and prevention case management to high-risk individuals. Currently, 22 organizations provide services to their communities through 46 contracts.
• The HIV/Sexually Transmitted Diseases (STD) and Viral Hepatitis Hotline provides information, crisis counseling and referral to over 7,500 callers per year. The Hotline distributes more than 1,000,000 pamphlets, posters and educational materials annually. Staff develop and/or identify appropriate educational materials for populations at risk.
• Public awareness campaigns are conducted annually for Black AIDS/HIV Awareness Day, National HIV Testing Day, Latino AIDS Awareness Day and World AIDS Day. Fact sheets, posters and promotional materials are developed and distributed to local health districts and community-based organizations. Press releases are issued to the media which highlight locally planned events. Budget allowing, some campaigns include radio and/or other media advertisement.
• The Virginia HIV Prevention Community Planning Committee develops a Comprehensive HIV Prevention Plan to guide population and intervention priorities.
• Training to improve the scientific base of prevention programs is conducted for health educators, outreach workers and prevention case managers. Specific curriculum training on interventions identified by the CDC is also provided.
• Training of health department and community-based staff is conducted in order to provide client services in a culturally competent and non-judgmental manner.
• Capacity building support such as training in grant writing, fiscal management, board development, program evaluation, quality assurance and use of logic models is conducted to support community agency infrastructure.
• Quality assurance through site visits and quarterly report reviews is conducted. Staff develop and monitor standards for HIV prevention interventions and preparation of educators and outreach workers.
• Confidential HIV testing is offered through a variety of venues including STD clinics, TB clinics and Maternal and Child Health clinics. Anonymous testing is provided through 18 sites across the Commonwealth. Publicly-funded testing sites provided counseling and testing services to 64,810 individuals in 2004. Five hundred nine persons were newly identified as HIV-infected. An Memoranda of Agreement (MOA) with the Department of General Services funds HIV testing conducted at the local health departments.
• Memoranda of Agreement (MOA) with local health districts are implemented to support partner counseling and referral services. Two hundred eighteen sex or needle-sharing partners of HIV-infected persons were counseled and provided HIV testing in 2004.
• Rapid and oral HIV testing is provided through contracts with community-based organizations and offered in non-traditional settings such as drug treatment centers, detention centers, outreach vans and other street/community venues. Rapid testing is offered through select STD clinics in high morbidity areas.
• Training on the use of both oral and rapid testing, including quality assurance measures, is provided.
• HIV/AIDS-related morbidity and mortality trend data on adults and children are compiled from public and private providers, hospitals, and labs, then cleaned and analyzed for emerging trends. These data are disseminated via mailings, web distribution, and various postings statewide to internal and external customers.
• HIV/AIDS information and statistics are presented to customers throughout the year.
• Trainings on Virginia HIV/AIDS reporting regulations, testing technology, and HIV investigations of special epidemiological significance, e.g. unusual mode of transmission, are routinely provided to internal and external customers.
• Technical assistance on the HIV and AIDS case definition and clinical characteristics as well as HIV/AIDS-related policies and procedures is routinely provided.
• The testing of diagnostic blood specimens from all newly reported HIV infections is contracted to the Virginia Public Health Laboratory to: 1) calculate population-based estimates of HIV incidence (new infections) using collected HIV testing information, and 2) monitor and track new infections that are resistant to antiretroviral drugs.
• Linked medical record abstractions and patient interviews are conducted to estimate statewide quality of HIV care, clinical outcomes, risk behaviors, health care utilization, and unmet needs among HIV-infected persons receiving medical care.
• Interviewing populations at high risk of HIV infection in the Norfolk Metropolitan Statistical Area is contracted to Virginia Commonwealth University’s Survey of Evaluation and Research Laboratory for the purposes of collecting behavioral risk data for CDC’s National HIV Behavioral Surveillance project.
• AIDS Drug Assistance Program (ADAP) provides life sustaining medications to people with HIV who have no other access to reatment. The formulary includes 78 medications for the treatment of HIV infection and the prevention and treatment of HIV related co-morbidities.
• The State Pharmaceutical Assistance Program (SPAP) was established in 2006 to provide ADAP eligible clients enrolled in Medicare with Part D cost sharing assistance such as premiums, deductibles, co-payments and assistance with full drug costs during gaps in coverage (donut hole). This assistance counts toward the Part D true out of pocket (TrOOP) incurred cost requirement that enables beneficiaries to access full (catastrophic) prescription drug benefits, shifting costs from ADAP to Medicare Part D. SPAP services are provided through contractual agreement with a non-profit organization
• Core services and essential support services are provided to low income, uninsured individuals with HIV infection through a network of five regional consortia. Core services include primary medical care, medications not covered by ADAP, dental care, case management, mental health services and substance abuse services. Supportive services, such as transportation, assist clients to access medical care and remain adherent to antiretroviral therapy. Consortia are responsible for assessing needs and planning services in their regions. Each consortium has a lead agency that is responsible for the administration and coordination of consortium activities and the delivery of services. Federal Ryan White Part B (formerly Title II) funding for services is provided through contractual agreement with the lead agencies.
• Two organizations are funded to provide early intervention services. These programs provide increased access to medical treatment and support services for newly diagnosed and underserved individuals with HIV infection.
• Ryan White Part B also funds two community-based organizations to increase access to ADAP, primary medical care and related services for racial and ethnic minorities. This program focuses on identifying and referring individuals at risk for or infected with HIV, or those lost to care in order to link/re-engage them into needed services. These individuals are at high risk of disease progression and transmission of HIV to others. Previously, Minority AIDS Initiative (MAI) funds were used for this purpose. If MAI funds are received, they will be used to expand current efforts.
• Training for health care providers on all aspects of HIV/AIDS, hepatitis and sexually transmitted diseases diagnosis and treatment is provided through a contract with the Virginia HIV/AIDS Resource and Consultation Center. A variety of mechanisms including consultation, education and clinical training sessions are used to train providers.
• Health care services utilization trends and projections are identified via data collected through ADAP, the Minority AIDS Initiative and consortia-based services. This information is used for statewide services coordination and planning.

Objective Description

HIV causes long-term and catastrophic illness which can disable individuals in their prime working years. Prevention of infection benefits the Commonwealth by reducing the disease impact on the community and the associated public and private health care costs and by increasing productivity of individuals contributing to the tax base. Every infection averted is cost beneficial to the state.

Alignment to Agency Goals

Objective Strategies

Objective Measures

Objective Description

HIV is a complex disease process. Presentation, symptomatology, and co-morbidities vary widely from person to person and are impacted by host, virological and environmental factors as well as timely access to diagnosis and treatment. Treatment options, drug therapies and standards of care frequently change. This requires a vigilant public health response to ensure effective treatment and sufficient resources to keep pace with new medical technology. With effective medical and supportive treatment, many people with HIV can live productive lives and remain employed. Without these services, HIV disease progresses, resulting in a rapid decline in health leading to disability and death.

Alignment to Agency Goals

Objective Strategies

Objective Measures