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Role Of States

Fact Sheet

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Role Of States

  1. 1. The Role of Health Departments in Administering Federal HIV/AIDS Programs State public health agencies serve an essential and unique Components: role in the delivery of HIV/AIDS prevention, care and Care & treatment access treatment programs. The agencies are entrusted through Surveillance & epidemiology U.S. law as the “central authorities of the nation’s public STD, TB & viral hepatitis programs Linkages to: Prevention health system” and as such, bear the primary public Hepatitis B Coordinators sector responsibility for health.1 State public health Hepatitis C Coordinators responsibilities include: disease surveillance; Substance abuse State HIV/AIDS Mental health epidemiology and prevention; provisions of primary Programs Reproductive health health care services for the uninsured and indigent; and Maternal & child health Adolescent & school health overall planning, coordination, administration, and fiscal Correctional health Partners with: management of public health services. Rural & migrant health Local/city/county health departments Medicaid Community-based agencies Housing CORE FUNCTIONS OF STATE HEALTH State laboratories Academic/research institutions DEPARTMENTS Hospitals, public clinics, health centers Federal agencies State public health agencies provide leadership, resources and technical assistance to local and community-based agencies and work in partnership with • Ensuring accountability: State health department staff the federal government, other state and local agencies conduct site visits to ensure that the appropriate level and community-based entities to meet the needs of all and quality of HIV/AIDS prevention and care is citizens within their borders. State and local health delivered by providers in their jurisdictions. departments have a primary responsibility to address the disparities among racial and ethnic minority populations. • Planning: State health departments are responsible for coordinating planning for the delivery of both HIV prevention and care services. This coordination Three core functions of public health according to involves convening local health jurisdictions, the Institute of Medicine (IOM): scientists, providers, community members and • Assessment consumers, as well as developing comprehensive • Policy Development statewide prevention and care plans. • Assurance • Setting policies and standards: State health State public health departments conduct each of these departments set, monitor and enforce policies and activities as part of their response to the HIV/AIDS standards that guide the provision of care and epidemic: prevention services across providers in their jurisdictions. • Collecting and analyzing information: State health departments have established systems to collect and • Carrying out national and state mandates: State analyze data on the number of individuals living health departments are the lynchpin in ensuring that with HIV/AIDS and detailed demographic data on federal and state mandates are carried out. These individuals receiving services through federally mandates include things such as the federal funded HIV/AIDS prevention and care programs. requirements to implement partner services programs This data is then reported to the federal government and to protect the confidentiality of people with in the aggregate to inform its overall HIV prevention HIV/AIDS. and care strategies.
  2. 2. The Role of Health Departments in Administering Federal HIV/AIDS Programs • Managing and overseeing environmental, educational, and personal health services: State U.S. State HIV/AIDS health departments manage and oversee the Prevention Programs comprehensive statewide delivery of HIV Technical Counseling, Primary prevention for HIV positive Assistance & Testing & individuals prevention education and care services. This Capacity Partner STD testing/treatment linkages ensures that a continuum of services is provided Building Services Prevention case management without duplication of effort. Small group interventions • Assuring access to health care for populations Community-level interventions Social/prevention marketing disproportionately affected by HIV/AIDS: State Perinatal transmission prevention health departments coordinate outreach to IDU prevention & access to sterile needles underserved populations, providing tailored HIV Research prevention interventions and increasing access to Program Structural & Coordination& Interventions primary care. Evaluation Service Integration • Developing resources and capacity and providing technical assistance: State health programs which are aimed at ensuring that departments provide technical assistance and individuals and their partners learn their HIV capacity building services to HIV prevention and serostatus, receive counseling on behavior change to care providers, assisting them with providing the avoid infection or prevent transmission, and obtain highest quality of targeted HIV prevention referrals for prevention and care services. education and care. Health Education/Risk Reduction: States provide • Responding to health hazards and crises. Since support for and technical assistance on targeted the beginning of the HIV/AIDS epidemic, state education and outreach activities for individual, health departments have been the primary entities group, and community-level interventions and street responsible for monitoring the epidemic and and community outreach. These programs include identifying outbreaks or clusters of cases in peer education in correctional facilities, educational neighborhoods or communities. services to Spanish speaking populations, in-service trainings for social service/AIDS service agencies, THE ROLE OF STATES IN HIV/AIDS services using indigenous community educators and PREVENTION peer opinion leaders, street outreach with homeless HIV prevention and surveillance programs are funded people and injection drug users (IDUs), education by the U. S. Centers for Disease Control and programs for African American religious leaders, and Prevention (CDC) under general authority provided skills-building activities on risk reduction. by federal public health law. Although Congressional Community Planning: Since 1994, state and local Appropriators frequently direct HIV prevention funds health departments have implemented a community for specific activities, there is no legislation dictating planning process to ensure the participation of how HIV prevention resources are allocated by CDC. infected and affected communities in the development Since 1988, CDC has provided HIV prevention of effective HIV education and prevention resources to 65 state, local, and territorial health interventions. This process assists state and local departments to implement comprehensive HIV health departments with the targeting of resources to prevention programs in their jurisdictions. In FY2007, populations at highest risk and encourages state, local, and territorial health departments received development of effective interventions. $297 million for these efforts. States conduct the Capacity Building: States provide financial and following efforts as part of their comprehensive HIV technical assistance to strengthen their own prevention programs: infrastructure and that of non-governmental Counseling, Testing, Partner Services: States provide organizations they fund to deliver effective prevention and coordinate the delivery of counseling, testing, programs. referral (CTR) and partner services (PS)
  3. 3. The Role of Health Departments in Administering Federal HIV/AIDS Programs Public Information: State public health agencies are responsible for the collection, evaluation, and U.S. State HIV/AIDS distribution of public information and materials. Care and Treatment Access Programs Prevention Research and Program Evaluation: States conduct prevention research and program evaluation Technical Assistance Direct Health and and Quality activities to monitor progress, outcome and impact of Support Services Assurance the programs they support, as well as to assess needs AIDS Drug and develop culturally appropriate services. Assistance Health Insurance Programs HIV Care Consortia Continuation Programs THE ROLE OF STATES IN HIV/AIDS CARE & TREATMENT Home and Community- Statewide Planning Based Health Care and Ryan White Program – Part B and Coordination Support Services Part B of the Ryan White Program provides funds to all states, the District of Columbia, Puerto Rico, and U.S. territories to improve the quality, availability and THE ROLE OF STATES IN HIV/AIDS organization of care services for people living with HIV. EPIDEMIOLOGY & SURVEILLANCE Part B is designed to assure that people living with HIV have access to quality medical care, regardless of Of CDC’s total HIV prevention budget of $692 whether they live in rural, suburban, or urban areas. million in FY2007, state and local health States received almost $1.2 billion in federal funds in departments received approximately $67 million FY2008, including $794 million in dedicated funds to to conduct HIV/AIDS surveillance and support AIDS Drug Assistance Programs (ADAPs). seroepidemiologic activities. ADAPs are state-administered drug programs that provide access to HIV/AIDS medications for low HIV/AIDS epidemiology, surveillance and income, uninsured and underinsured individuals. The seroprevalence activities provide data that are critical vast majority of states (40) provide state general to targeting the delivery of HIV prevention, care and revenue funding to augment federal ADAP dollars. treatment services. State health agencies are uniquely positioned to conduct these activities because of the In FY2007, ADAPs provided medications to over expertise, statutory authority, and confidentiality 146,000 uninsured and underinsured Americans protections of existing public health disease living with HIV/AIDS. surveillance and reporting systems. States conduct a variety of surveillance activities to track the Part B Base (non-ADAP) funds may be used to support HIV/AIDS epidemic. The five main types of a wide range of services including outpatient medical surveillance are discussed below: and dental care, supportive services (e.g., case management and client transportation services), Core Surveillance: Core surveillance is the primary rehabilitative services, home and community-based source of population-based data on persons living health care services, and continuation/purchase of with HIV and AIDS in the U.S. HIV/AIDS case health insurance coverage. States may also use Part B surveillance is conducted in every state and territory, Base funds to support HIV counseling, testing and as well as six cities directly funded by the CDC.2 Core referral services in care settings. Part B Base funds allow surveillance programs include monitoring the number states to provide a continuum of enabling services that of yearly cases of newly diagnosed HIV infections and are critical components of comprehensive HIV care, the AIDS cases and identifying trends from surveillance hallmark of the Ryan White Program. Part B also data. provides supplemental grants to states to support HIV Incidence Surveillance: HIV incidence surveillance services in emerging communities—cities reporting was developed to provide reliable and scientifically between 500 and 1,999 reported AIDS cases in the most valid estimates of the number of newly-acquired HIV recent five years. States also receive almost $7 million infections. Jurisdictions conducting incidence for outreach to minority communities to bring surveillance are also eligible to participate in Variant, individuals into care through the Minority AIDS Atypical, and Resistance HIV Surveillance, a project Initiative.
  4. 4. The Role of Health Departments in Administering Federal HIV/AIDS Programs that collects samples of specific HIV specimens and been in existence since the early part of this century tracks the different HIV strains seen in the jurisdiction. and is currently administered by CDC under general Jurisdictions funded to conduct incidence surveillance authority. CDC’s total FY2007 STD prevention and collect and test blood specimens from all newly treatment budget is approximately $152 million. Of reported HIV infections; calculate population-based this, approximately $130 million was provided directly estimates for HIV incidence; and monitor and track to state and local health departments. State STD HIV strains for resistance to antiretroviral drugs. prevention programs also provide surveillance and data management, leadership and program Behavioral Surveillance: The National HIV management, outbreak response plans, and evaluation Behavioral Surveillance project is a multi-year, CDC activities. sponsored surveillance effort whose goal is to measure THE ROLE OF STATES IN HEPATITIS an extensive set of HIV risk behaviors and related risk PREVENTION factors among selected high-risk populations in 26 cities with the highest number of people living with CDC provides funding to 49 states, five cities, and the HIV/AIDS at the end of 2000. The project attempts to District of Columbia to support an Adult Viral identify the prevalence of and trends in Men who have Hepatitis Prevention Coordinator. The role of the Sex with Men, people who use intravenous drugs, and coordinator is to work with other public health heterosexual with high-risk behaviors. programs to integrate viral hepatitis prevention services into existing settings (e.g., STD and HIV Morbidity Monitoring: The Morbidity Monitoring clinics). The average funding award of $90,000 in Project (MMP) is developing a surveillance system that FY2008 supports little more than personnel costs, is nationally representative of HIV-infected persons leaving no funds for service provision (e.g., hepatitis A receiving medical care in the U.S. Twenty states and and B vaccine, hepatitis B and C testing). CDC’s six cities have been selected for the project, which budget for addressing chronic adult viral hepatitis was utilizes HIV care providers to collect the data. The $17.6 million in FY2008. three primary goals of MMP are: to supplement core HIV/AIDS surveillance data with linked medical THE ROLE OF STATES IN HIV-RELATED record abstractions and patient interviews; to provide HOUSING data to estimate quality of care, clinical outcomes, risk behaviors, health care utilization and unmet needs HOPWA funds are used to meet local community among HIV-infected persons receiving medical care; needs including short-term transitional supported and to provide population-based data to aid in policy housing and/or rental assistance for low income planning, resource allocation and evaluation of persons with HIV/AIDS, building community prevention and treatment initiatives in the U.S. residences, and providing coordinated home care services. Enhanced Perinatal Surveillance: This program The Housing Opportunities for People with AIDS monitors progress made in reducing perinatal HIV (HOPWA) program is the centerpiece of the federal transmission. The near elimination of mother-to-child housing response for people living with HIV/AIDS. HIV transmission is the greatest success of HIV Created in 1990, HOPWA is a formula-funded, flexible prevention in this country. Enhanced perinatal funds program that gives state and localities hardest-hit by the go to state and local health departments that are in AIDS epidemic desperately needed resources and local high-morbidity areas (60 or more HIV-positive women control over the use of these resources to meet the giving birth) that have HIV surveillance. housing needs of people with HIV/AIDS. In FY2008, states and local jurisdictions and CBO’s received $300 THE ROLE OF STATES IN STD PREVENTION & million for HOPWA services. HOPWA will serve TREATMENT approximately 70,500 people with these funds. State and local public health agencies administer both REFERENCES HIV and STD prevention and care services and have worked to closely link these programs to strengthen “The Future of Public Health.” Institute of Medicine, January 1, 1 1988. efforts in addressing these co-morbidities. 2 The six cities directly funded by the CDC are: Chicago; Houston; Los Angeles; New York; Philadelphia and San Federal funding for STD prevention and treatment has Francisco.