AIDS Action Weekly Update Special Edition

Grounding Prevention in Science and Linking It to Care

Linkages Between Prevention and Care

Linking HIV prevention to care and treatment emerged as a major theme of the summit. It was discussed at each of the plenary sessions, largely in reaction to the CDC's AHP initiative. The initiative, unveiled in April of 2003, called on the CDC's HIV Community Planning Groups (CPGs) to prevent new infections by working together with persons diagnosed with HIV. Although this was only one of the initiative's four priorities, it has spurred an unusual amount of cooperation between local CPGs and Ryan White Planning Councils.

The second plenary of the summit was devoted to a discussion of HIV Prevention and Care linkages. Dr. Robert Janssen of the CDC and an author of the AHP initiative acknowledged that the initiative had caused a great deal of confusion and even some anger among community planning organizations and that local control remained a significant issue. He also said that significant progress had been made in helping to spur cooperation between CPGs and Ryan White Planning Councils. Similarly, HRSA's Douglas Morgan noted that the 2000 reauthorization of the Ryan White CARE Act allowed funds to be used for prevention services. Ryan White Planning Councils for both Title 1 (funding directed at "Eligible Metropolitan Areas") and Title 2 (funding directed at states) are required to coordinate with prevention services.

Echoing the plenaries, a number of workshops were designed to further the links between prevention and care. Epi 101: Understanding Epidemiologic Terms and Concepts for the HIV Prevention and Care Planning Process presented a basic, but helpful workshop centered on helping grantees to find, define and analyze data to better create an integrated HIV epidemiologic profile to be used for both prevention and care grant making. CDC and HRSA created a joint project to streamline the work of health department staff, CPGs and Planning Councils and to ensure that everyone is working off a common set of data.

Presenters were concerned about the differences in HIV and AIDS reporting. They noted that HIV surveillance data represent more recent infections and that they provide a minimum-number estimate for health departments. HIV data only include cases that have been tested confidentially and reported to the health department, thereby missing many individuals who have been tested anonymously. In contrast, AIDS data reflect the impact of AIDS diagnoses on the community since the beginning of the epidemic. A weakness of this data set is that AIDS is only a subset of the total number of HIV cases. Creation of a properly integrated epidemiologic profile can help community planners to assess needs and better integrate care and treatment services.

More information on integrating care and prevention data can be found at www.cdc.gov/hiv/epi_guidelines.htm.

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