Health Department Structural Changes to Advance Integration of HIV Prevention and Care Services

IHAP TA Center

An underlying goal of integrated HIV prevention and care planning is to better leverage resources and improve the efficiency and coordination of HIV prevention and care service delivery.

Prevention and care divisions within health departments have sometimes functioned in silos, which contributes to reporting burdens and duplicated efforts among staff. In recent years, many health departments have moved toward a more integrated structure of their HIV prevention and care departments as a way to better leverage resources and improve efficiency and coordination of HIV prevention and care service delivery.

Integrating programs and services allows jurisdictions to:

  • Enhance capacity to address multiple health-related goals
  • Respond to syndemics with similar risks for acquisition
  • Decrease barriers to providing services
  • Maximize opportunities for people to receive the best care and treatment when they interact with providers
  • Eliminate duplicative services
  • Maximize federal and state resources (lower costs)

Increasingly, health departments are identifying opportunities to integrate structures and policies across HIV prevention and care, sexually transmitted infections (STIs), viral hepatitis, and other infectious disease programs to enhance service delivery and improve health equity.

Promising Practices and Tips

  • Understand that integration takes time and change is hard. It will likely take years - not months - to integrate existing prevention and care structures, and the process should not be rushed. Successful integration will require a cultural or paradigm shift for those involved, so it is important to make sure all stakeholders, including community planning groups, providers, and health department staff, are a part of the conversation from the beginning. Similarly, any agencies that may experience funding changes should be alerted to the upcoming changes well in advance of making funding decisions.
  • Determine what integration means for your jurisdiction. Integration can mean different things to different jurisdictions and it should not be a prescriptive ‘one size fits all’ approach. It may not be feasible, or even practical, for you to fully integrate prevention and care services. It is important to recognize that integration can take many different forms, from co-location of prevention and care staff, to integrating care and prevention funding streams, or integrating HIV/Hepatitis C (HCV)/STI prevention and care service delivery within a clinic.
  • Co-locate the HIV prevention and care divisions. While it may not be possible to fully integrate HIV prevention and care divisions, having the care and prevention staff co-located in the same building and on the same floor can help facilitate collaboration and communication.
  • Allow for joint HIV prevention and care funding opportunities. Funding agencies to provide HIV care and prevention services will allow you to maximize the impact of limited public funding and allow you to pull from multiple smaller sources to support and sustain new and innovative HIV prevention, care, and treatment programs. In doing so, economies of scale could be achieved in leveraging funding streams to have the greatest net impact on services and programming.
  • Engage community-based and local health partners early in the process to let them know about integrated funding and programming, and gather feedback on how they could implement integrated services at their agencies. For example, the Washington State Department of Health developed a white paper and concept paper to inform partners about proposed changes to their current portfolio of HIV Community Services. This allowed them to gather feedback prior to releasing a request for application (now closed) for community partners to submit applications to develop and implement an HIV Community Services System that integrated care and prevention services.
  • Get on the same page. Prevention and care staff may use different terminology or definitions for the same concepts. Create a common lexicon or a care and prevention crosswalk of key service definitions, data systems, and data points to help cross train care and prevention staff.

“Wisconsin has been in the unique position since the creation of our department to have prevention and care housed under one Director of the HIV Program within the Division of Public Health. This puts us at an advantage for knowing and collaborating often with our surveillance, care, and prevention colleagues. This also allows for more streamlined approaches to addressing treatment as prevention and utilizing ADAP Rebate funds for early intervention services. I know many states are facing challenges when integrating programs due to structural barriers, but the integration of prevention and care is one thing that is working well for us in Wisconsin.”

— Sara DeLong, HIV & HCV Testing Coordinator, Wisconsin Department of Health Services, Division of Public Health

Tools and Resources

  • Moving Integrated HIV Prevention and Care Planning into Action: Integrated Funding for HIV Services
    During this webinar, hosted by the IHAP TAC, the Washington State Department of Health described their experience, challenges, and lessons learned with braiding the funding of prevention and care services within the state.
  • Health Department Structural Changes to Advance Integration of HIV Prevention and Care Services
    This webinar discussed challenges and promising practices from jurisdictions that have successfully integrated care and prevention services within their health department. During the webinar, members of the Massachusetts Department of Public Health and the North Carolina Department of Health and Human Services presented their process for integrating care and prevention services, including assessment of health department infrastructure and preparing health department staff for integration.
  • The Collaborative Integration of Prevention and Care: Planning Bodies, Funding, and Service Delivery
    This session at the 2018 National Ryan White Conference explored best practices for integrating prevention and care within health departments and planning bodies. Members of the recently formed Washington, DC Regional Planning Commission on Health and HIV (COHAH) discussed the rationale for merging their prevention and care planning councils, steps to achieve this integration, and the benefits of the collaborative relationship between the Planning Body and Part A Recipient. The IHAP TAC presented challenges and promising practices from jurisdictions that successfully integrated their HIV prevention and care programs within health departments and provided different models of funding procurement of care and prevention services within their jurisdictions.