As readers may recall, the 12 Cities Project was undertaken as an element of the HHS National HIV/AIDS Strategy Operational Plan in "an effort to support comprehensive HIV/AIDS planning and cross-agency response in 12 communities hit hard by HIV/AIDS." The project sought to advance the goals of the National HIV/AIDS Strategy (NHAS) by building on a funding opportunity announcement (FOA) released by the CDC in August 2010: "Enhanced Comprehensive HIV Prevention Planning and Implementation for Metropolitan Statistical Areas Most Affected by HIV/AIDS (ECHPP)." The participating jurisdictions were: Atlanta; Baltimore; Chicago; Dallas; Washington, D.C.; Houston; Los Angeles; Miami; New York City; Philadelphia; San Juan, PR; and San Francisco.
Coordinated by the HHS Office of the HIV/AIDS and Infectious Disease Policy (OHAIDP), and building upon the platform established by the CDC ECHPP program, the 12 Cities Project engaged additional federal partners including the Health Resources and Services Administration (HRSA), Substance Abuse and Mental Health Services Administration (SAMHSA), National Institutes of Health (NIH), Indian Health Services (IHS), and the Center for Medicare and Medicaid Services (CMS). At its core, the purpose of the 12 Cities Project was to address the fourth goal of the NHAS to "achieve a more coordinated national response to the HIV epidemic in the United States." Although the 12 Cities Project did not have dedicated funding, federal partners worked to leverage existing resources -- including informational resources -- to support better coordination and collaboration across federally-funded HIV programs at the local level in each of the 12 jurisdictions.
A qualitative evaluation, funded by the Office of the Assistant Secretary for Health and conducted by John Snow, Inc., set out to: (1) assess whether federal efforts had produced any impact on coordination, collaboration, and integration (CCI) at the local level, and (2) document whether local jurisdictions had undertaken any CCI efforts of their own. Information was gathered through interviews with 27 federal partners representing five agencies as well as key stakeholder interviews in each of the participating jurisdictions. Those interviews provided opportunities to gather feedback from nearly 300 people including program administrators, service providers, community leaders, and clients/consumers. The resulting findings are presented in a new evaluation report (PDF 2.6 MB).
As we shared recently at the October 25-26 PACHA meeting, among the positive findings from the evaluation were:
- The 12 Cities Project has reinforced, locally, the importance of integrating HIV prevention and care
- Localities perceive improved communication across federal funders
- New federal and local partners have been "brought to the table" in the jurisdictions for more coordinated conversations
- There is an increased emphasis on using data to drive decision-making
Some of the challenges highlighted in the evaluation included:
- Need for better description of federal HIV/AIDS resources, by jurisdiction
- Collaboration is resource intensive and requires ongoing support
- Legislative and other barriers impede some forms of program integration (and resource sharing)
- Cross-agency differences in data collection elements and processes pose barriers to joint prevention/care planning
- Recurrent concerns about the roles of community-based and other non-governmental organizations in the new HIV prevention paradigm which emphasizes linkage to and retention in HIV care
Lessons learned from the recently completed evaluation will continue to inform implementation of the NHAS in these 12 jurisdictions -- and elsewhere across the U.S. For example, we are already applying the lessons learned in our work on the new Care and Prevention in the U.S. (CAPUS) demonstration project which is working with eight states to join together HIV prevention and treatment into a holistic statewide continuum of service with a particular emphasis on racial/ethnic minorities. We have also shared the findings of this qualitative evaluation with leaders in the NIH-funded Centers for AIDS Research who are conducting HIV-related operational research in collaboration with local departments of health.
To learn more, view a video about the 12 Cities Project and read our blog posts about it. We welcome your thoughts and ideas about CCI in your jurisdiction and across the nation. Share your successes, challenges or suggestions in the Comments section below.
Vera Yakovchenko, M.P.H., is public health analyst at the Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services. Ronald Valdiserri, M.D., M.P.H., is deputy assistant secretary for health, infectious diseases, and director of the Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services.