2017-2021 District of Columbia Eligible Metropolitan …

2017-2021 District of Columbia Eligible Metropolitan Area

Integrated HIV/AIDS Prevention and Care Plan

2017-2021 District of Columbia Eligible Metropolitan Area Integrated HIV/AIDS Prevention and Care Plan

DC Department of Health (DC DOH) HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA)

Section I: Statewide Coordinated Statement of Need/Needs Assessment A. Epidemiologic Overview.................................................................... B. HIV Care Continuum.......................................................................... C. Financial and Human Resources Inventory..................................... D. Assessing Needs, Gaps, and Barriers............................................... E. Data: Access, Sources, and Systems.................................................

Section II: Integrated HIV Prevention and Care Plan A. Integrated HIV Prevention and Care Plan........................................ Table: Goals, Objectives, Strategies, and Activities............................ B. Collaborations, Partnerships, and Stakeholder Involvement....... C. People Living with HIV and Community Engagement....................

Section III: Monitoring and Improvement.......................................................

Appendix: Expanded Financial Inventory........................................................

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62 82 106 107

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2017-2021 INTEGRATED HIV PREVENTION AND CARE PLAN Including the Statewide Coordinated Statement of Need

District of Columbia Eligible Metropolitan Area SECTION 1: Statewide Coordinated Statement of Need/Needs Assessment

The map above represents the District of Columbia Eligible Metropolitan Area (DC EMA) as designated by the United States Department of Health and Human Services, Health Resources and Services Administration (HRSA). It spans a wide metropolitan region of 6,922 square miles, comprising five counties in suburban Maryland, 11 counties and six independent cities in Northern Virginia, and two counties in West Virginia. The EMA is home to 6,162,244 people, according to 2013 estimates from the US Census Bureau. Ryan White (RW) funds are critical to maintaining a robust continuum of high quality HIV care, treatment, and support services for persons across the region. Sub-recipients/providers throughout the DC EMA receive funding from the Ryan White HIV/AIDS Treatment Extension Act of 2009 through one or more of the RW Parts (A, B, C, D, and F) which support specific types of programs and target specific activities. Sub-recipients include health departments, hospitals, federally qualified health centers, community-based organizations, and training centers. While RW funding covers the EMA, the Centers for Disease Control and Prevention (CDC) funds the region's jurisdictions separately. The DC Department of Health (DOH) receives Centers for

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Disease Control (CDC) funding for HIV prevention efforts. Throughout the years of prevention efforts, there has been increased physiological understanding of the virus, improved sensitivity and specificity in screenings, and advancements in effective treatment protocols that achieve virologic control, reducing the amount of the virus in a person to an undetectable level. In response, the CDC now promotes High Impact Prevention strategies in an effort to prevent new infections using evidence based behavioral interventions and expanded testing, but also facilitates efforts to keep people living with HIV engaged in care and virally suppressed. In addition, these strategies also address condom distribution, HIV prevention planning, capacity building, social marketing, and program marketing and evaluation.

Due to the way HIV prevention and care has evolved as a result of these advances, health departments and planning bodies are integrating prevention and care service planning in order to design a more coordinated, effective, regional response to the epidemic. Prevention and care planning bodies and providers will consult on decisions in areas of shared responsibility, work together to maximize testing, entry, and retention in care, and create a shared workgroup for combined planning. DC DOH supports initiatives directly in line with the tenets of integration and has developed an Integrated Prevention and Care Plan to be implemented from 2017-2021.

I-A. Epidemiologic Overview and Profile

The DC EMA is one of nine EMAs/TGAs that cross state boundaries and the only one that includes counties and independent municipalities spanning four jurisdictions. Its main city is Washington, DC, which has one of the highest rates of HIV in the country. Although all four jurisdictions comprising the DC EMA border each other, they each have unique and substantial variations in population characteristics and public policies that impact HIV service planning and delivery. Each also addresses health and social service needs of its residents in a different way. Two percent of residents in Washington, DC, are diagnosed and reported with HIV.1 The estimated prevalence rate in the Nation's Capital is twice as high as the established guidelines of 1%, a criterion that defines a generalized epidemic among residents of a specific geographic area,2 established by the United Nations Joint Program on HIV/AIDS and the CDC. A generalized epidemic requires a multilayered approach to alleviate its overall impact. The overall prevalence of people living with HIV (PLWH) for the EMA at the end of 2014 (0.6 %) is nearly twice the national estimated prevalence rate of 0.4% for diagnoses of HIV.3 The epicenter of the EMA is the District of Columbia, which is 10.7% of the EMA population, but 46.6% of all EMA HIV cases. At the end of 2014, there were a total of 36,369 people living with HIV in the DC EMA.

1 District of Columbia HIV/AIDS, Epidemiology Annual Report 2012. 2 Ibid. 3 Center for Disease Control and Prevention, HIV Surveillance Report 2008, Vol. 20, 2010.

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