Funding Allocations for CDCSupported HIV Prevention Program Activities under Program Announcement PA

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Funding Allocations for CDC-Supported HIV
Prevention Program Activities underProgram
Announcement (PA) 04012, 2005-2007 Choi Wan
Ph.D., John Beltrami M.D., and Cindy Lyles
Ph.D. Division of HIV/AIDS Prevention 2009
National HIV Prevention Conference Atlanta, GA
The findings and conclusions in this presentation
are those of the authors and do not necessarily
represent the official position of the Centers
for Disease Control and Prevention/the Agency for
Toxic Substances and Disease Registry
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Background

• CDCs Division of HIV/AIDS Prevention (DHAP)
  funds 650 million per year to address the
  domestic HIV/AIDS epidemic
• DHAP funds 300 million to 59 health
  departments each year under Program Announcement
  (PA) 04012 for HIV prevention
• these funds are supplemented by other programs
  specifically directed to communities of color and
  men who have sex with men (MSM)

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Issue

• Describe how health departments allocate CDC
  funds under PA 04012
• HIV infected persons
• HIV prevention program activities
• Does not address other federal, state, or local
  funding for HIV prevention programs

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Estimated HIV/AIDS Cases Diagnosed in 200734
states with confidential named-based reporting
by race/ethnicity
by HIV risk group
Other
Other
White
High-risk hetero.
Hispanic
IDU
African American
MSM
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Setting

• 59 health departments
• 50 states
• District of Columbia
• Puerto Rico
• U.S. Virgin Islands
• 6 cities
• Chicago, Houston, Los Angeles, New York City,
  Philadelphia, and San Francisco

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Project Methods
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Project Methods

• Collaboration among CDC, the National Alliance of
  State and Territorial AIDS Directors (NASTAD) and
  the Urban Coalition on HIV/AIDS Prevention
  Services (UCHAPS)
• CDC provided all health departments a template
  form to collect and report allocation information
• Information collected was retrospective

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Project Methods

• Allocations for 2005
• template provided in 7/07
• information received from 8/07 to 12/07
• Allocations for 2006 and 2007
• template provided in 10/08
• information received from 11/08 to 12/08
• Quality assurance during and after reporting
• feedback to grantees for any incomplete or
  inconsistent information
• subsequently reported information was reviewed
• for feedback

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Project Methods

• Allocations under PA 04012 were requested for the
  following
• prevention with HIV infected persons
• HIV prevention program activities
• community planning (CP)
• evaluation
• health education and risk reduction (HE/RR)
• counseling, testing, referral, and partner
  notification (CTRPN)
• other

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Project Methods

• Health departments reported HE/RR allocations by
  race/ethnicity and by HIV risk group
• CTR allocations for both race/ethnicity and HIV
  risk were estimated, using CDCs HIV Counseling
  and Testing System data

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Project Methods

• Race/Ethnicity
• American Indian/Alaskan Native (AI/AN)
• Asian/Pacific Islander (A/PI)
• African American (non-Hispanic)
• Hispanic
• White (non-Hispanic)
• Other
• for HE/RR other race/ethnicity or not targeted
  by any race/ethnicity
• for CTR other race/ethnicity, multiple races,
  undetermined, or unknown

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Project Methods

• HIV risk group
• MSM
• injection drug use (IDU)
• MSM/IDU
• heterosexual contact
• for HE/RR all heterosexuals
• for CTR high-risk heterosexuals
• other
• for HE/RR other HIV risk or not targeted by
  risk
• for CTR other HIV risk or risk not acknowledged

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Results
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Budget Allocations for HIV Infected Persons
2005-2007
N 59 health departments each year
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Budget Allocations for Prevention Activities
2005-2007
N 59 health departments each year
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Budget Allocations for HE/RRby race/ethnicity,
2007
N 59 health departments
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Budget Allocations for HE/RR by HIV risk group,
2007
N 59 health departments
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Budget Allocations for CTR by race/ethnicity,
2007
N 54 health departments
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Budget Allocations for CTR by HIV risk group,
2007
N 54 health departments
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Summary of Findings

• Largest budget allocations for HE/RR and CTRPN
• From 2005 to 2007, budget allocations
• increased slightly for HIV infected persons (9
  to13)
• increased slightly for CTRPN (31 to 36)
• decreased slightly for HE/RR (41 to 38)

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Summary of Findings

• Differences between national HIV epidemic and
  national level allocations of health department
  HIV prevention funds
• In 2007, differences for MSM
• 53 of new HIV/AIDS cases
• 29 of HE/RR allocations
• 11 of CTR allocations
• In 2007, differences for African Americans
• 51 of new HIV/AIDS cases
• 39 of HE/RR allocations
• 36 of CTR allocations

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Lessons Learned/Limitations and Discussion
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Lessons Learned/Limitations

• Funding allocations provide proxy measure of
  populations served and services provided
• PA 04012 represents only part of total HIV
  prevention funding, thus does not include
• CDC funding for specific initiatives (e.g., 7768)
• CDC direct funding (e.g., CBOs, Pacific Island
  jurisdictions)
• funding from other federal agencies
• funding from state or local governments
• private sources

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Lessons Learned/Limitations

• Information was collected retrospectively
• Overall CTR allocation was a true allocation
  however, CTR allocations by race/ethnicity and
  risk were estimates
• High percentages of other or not targeted

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Discussion

• Understanding funding allocations helps CDC and
  stakeholders make policy decisions and program
  improvements
• Additional measures that determine allocations
  should be considered
• Other methods to compare allocations with
  epidemic may be needed

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Discussion

• More detailed allocation data collection may be
  useful
• e.g., Black MSM, high-risk Hispanic heterosexuals
• Documenting actual expenditures should be
  considered
• Determining whether and to what degree programs
  are underfunded for MSM and African Americans is
  warranted

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Acknowledgments

• 59 health departments
• NASTAD
• - David Kern, Julie Scofield, Murray
  Penner, Natalie Cramer
• UCHAPS
• - Israel Nieves
• DHAP, Office of the Director
• - Rich Wolitski, Janet Cleveland, Craig
  Studer, Chris Cagle, Jono Mermin
• DHAP, Prevention Program Branch
• - Project Officers
• - Wendy Lyon
• DHAP, Program Evaluation Branch
• - National Monitoring and Evaluation Team
• - Data Systems and Analysis Team
• - Dale Stratford, Gene Shelley, Jessica
  Gardom