Integrating HIV Prevention and Care within Health Departments

The fourth goal of the National AIDS/HIV Strategy is to achieve a more coordinated national response to the HIV epidemic. With the release of the Integrated HIV Prevention and Care Plan Guidance, including the Statewide Coordinated Statement of Need (SCSN), CDC and HRSA sought to build upon existing efforts to reduce reporting burden, streamline the work of health department staff and HIV planning groups, and promote collaboration and coordination in the use of data. People with HIV and those at increased risk for HIV infection have similar needs when accessing and using healthcare. The skills necessary to successfully recruit, link, engage, and retain individuals on PrEP and HIV treatment are very similar. By integrating HIV prevention and care services, health departments can better position themselves to achieve the goals to end the epidemic.

Prevention and care divisions within health departments have sometimes functioned in silos, which contributes to reporting burdens and duplicative 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. As discussed by jurisdictions during an IHAP TAC webinar, doing so helped increase their capacity to address multiple health-related goals; decrease administrative barriers and eliminate duplicative services; and ultimately, maximize resources to improve outcomes along the HIV care continuum and support prevention services.

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 of the upcoming changes well in advance of funding decisions being made.   
  • 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)/sexually transmitted infection (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.

Tools and Resources

  • Moving Integrated HIV Prevention and Care Planning into Action: Integrated Funding for HIV Services
    IHAP TAC
    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.
  • Seven Steps to Enhance HIV Community Services in Washington - A Plan Forward
    Washington State Department of Health, Office of Infectious Disease
    Prior to releasing a request for application (now closed ) for community partners to submit applications to develop and implement an HIV Community Services System integrating care and prevention services, the Washington State Department of Health released a White Paper to inform partners about proposed changes to their current portfolio of HIV Community Services. The white paper provided background information that informed their assessment of current services, outlined challenges they faced related to current services supporting PrEP use and HIV treatment, and offered recommendations for enhancing HIV Community Services in the state. The overall purpose of the white paper was to gather feedback on their proposed solutions to enhance services that help connect people at-risk for acquiring HIV and PLWH to healthcare, including antiretroviral medications and other important services.

  • HIV Community Services Concept Paper
    Washington State Department of Health, Office of Infectious Disease
    The Washington State Department of Health developed a concept paper to inform agencies about their vision for an HIV Community Services System that integrates care and prevention services. The concept paper outlined the changes to their current portfolio of HIV Community Services, prior to the release of a request for application (now closed) to fund agencies to develop and implement an HIV Community Services System. 

  • HIV Community Services Request for Applications (now closed)
    Washington State Department of Health, Office of Infectious Disease
    The request for application solicitation from the Washington State Department of Health invited community organizations to submit applications to develop and implement an HIV Community Services System that integrates care and prevention services.

  • 2017 HIV Community Services Provider Manual for Implementing HIV Community Service Programs in Washington State
    Washington State Department of Health, Office of Infectious Disease
    The manual provides an overview of Washington’s HIV Community Services programs, articulates applicable standards of care, and describes minimum requirements around policy, process, and reporting expected of providers receiving Washington State Department of Health funding for serving persons living with HIV or persons at high risk.

  • Health Department Structural Changes to Advance Integration of HIV Prevention and Care Services
    IHAP TAC
    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.

  • HIV/HCV/STI/TB Prevention, Linkage, and Retention in Care and Treatment Request for Response 
    Massachusetts Department of Public Health, Bureau of Infectious Disease and Laboratory Sciences
    In 2017, the Massachusetts Department of Public Health, Bureau of Infectious Disease and Laboratory Sciences issued this request for responses to fund agencies for procurement of integrated HIV/HCV/STI/TB prevention, linkage, and retention in care and treatment completion services.

  • The Collaborative Integration of Prevention and Care: Planning Bodies, Funding, and Service Delivery 
    IHAP TAC
    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 provide different models of funding procurement of care and prevention services within their jurisdictions.