High-Impact HIV Prevention: Reducing the HIV Epidemic in the United States

Summary: High-Impact HIV Prevention prioritizes and implements optimal combinations of cost-effective, scalable interventions based on current science. CDC hosted a satellite symposium at the International AIDS Conference on Sunday, July 22nd to familiarize audience members with the concept of High-Impact HIV Prevention (HIP) in theory and in practice and to provide perspectives on implementing it. Speakers presented perspectives from the national, state and local public health department, and local community-based organizations levels. Speakers included:

• Jonathan Mermin, M.D. M.P.H., Director, Division of HIV and AIDS Prevention (DHAP), CDC
• Irene Hall, Ph.D., Branch Chief, DHAP HIV Incidence and Case Surveillance Branch, CDC
• Stephanie Sansom, Ph.D., Team Lead, DHAP Prevention Economics Team, CDC
• Wayne Duffus, M.D. Ph.D., STD/HIV Medical Director of the South Carolina Department of Health
• June Gipson, Ed.S. M.S.Ed., President and Chief Executive Officer, My Brother's Keeper, Mississippi
• Grant Colfax, M.D., Director of the White House Office of National AIDS Policy, former director of HIV Prevention and Research at the San Francisco Department of Public Health

The session began with Dr. Mermin providing an overview of the HIV epidemic in the U.S. He outlined some challenges, such as flat budgets and a growing HIV prevalence, that affect the nation's ability to address the epidemic. He then explained how HIP, applied scientifically, can help guide decision-making to achieve the lowest cost per infection averted or diagnosed, and provided examples from DHAP on how this has been done. Examples included:

• the shift in health department funding to more closely mirror the geographic distribution of the HIV epidemic in the U.S.;
• testing programs that have resulted in thousands of new diagnoses of HIV infection as well as saving U.S. taxpayers $2.00 for every $1.00 spent;
• a focus on health inequities by ensuring that the populations most affected by HIV -- gay and bisexual men of all races/ethnicities and African American and Hispanic men and women -- are receiving the programs and interventions necessary to address the epidemic.

Dr. Hall expanded on the HIP presentation by showing how surveillance data is the basis for program decisions, and how it can be used to provide important feedback on patients in care. By presenting a proposed feedback loop for patient care, Dr. Hall offered a way for patients, their healthcare professionals, and health departments to all work together to achieve optimal health for the patient while reducing community viral load overall. Dr. Sansom provided a presentation on applying HIP-based modeling to a real-world situation. Dr. Sansom's team worked with the Philadelphia Health Department to arrive at the optimal allocation of resources that could make the biggest difference in addressing their local HIV epidemic in a cost-effective manner.

The next three speakers were introduced by Kevin Fenton, M.D., Ph.D., Director, National Center for HIV, Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention at CDC. He provided the framework for the discussion by noting that the first panel showed us where we are going and some tools for helping us get there, and the second panel provided examples from across the country of where we are, and how disparate groups are incorporating HIP into their program planning.

The first speaker on the second panel, Dr. Duffus, with the South Carolina Department of Health, provided a presentation on how his HIV prevention resources were allocated both pre-HIP and post HIP as South Carolina moves toward full integration of HIP principles. Dr. Gipson, the President and CEO of My Brother's Keeper, a CBO in Jackson, Mississippi, explained how her CBO is using the tenets of HIP to modify its program portfolio by focusing more on the populations most at risk through geo-mapping.

The session was closed by Dr. Colfax, the current director of the Director of the White House Office of National AIDS Policy and former director of HIV Prevention and Research at the San Francisco Department of Public Health. Dr. Colfax provided some examples of his work in San Francisco, and concluded by providing a vision for the future of HIV prevention policies in the United States.

Relevance: During these times of tight budgets and growing HIV prevalence in the United States, it is necessary to choose the right interventions that will bring about the most cost-effective solutions. High-Impact HIV Prevention is CDC's solution to achieving the National HIV/AIDS Strategy's 2015 goals and beyond. Because of differing resources and target populations, the application of HIP varies in jurisdictions across the country. This session provided examples from a spectrum of organizations that have embraced HIP to make smart decisions despite challenges.

Learn More about High-Impact HIV Prevention.