Council of the District of Columbia
Committee on Health
1350 Pennsylvania Ave., NW, Suite 115, Washington, D.C. 20004 Twelve for 2012: A Plan for Action (DRAFT) The International AIDS Conference, AIDS 2012 presents the District of Columbia with a unique opportunity to engage the world leadership in the area of HIV/AIDS. This conference will bring the world to our doorstep and as a result, we as a government and as a community need to do everything possible to ensure we take full advantage of this opportunity. AIDS 2012 will allow the District to highlight the innovative and cutting edge programs already in place and develop new and ground-breaking approaches to the epidemic. It also presents an opportunity to make further inroads in a number of areas already underway. In order to achieve this overarching goal, the District must have a clear set of objectives and deliverables that we can accomplish over the next year, and a firm timeline for monitoring our progress. With a firm strategy in place we can ensure that not only does the work get done, but that such a plan provides the government, community groups, advocates, and residents with a common strategy to rally behind as we prepare for this critical event. In developing the draft for this strategy, the Committee wanted to find a common theme that would resonate with all parties involves. The Committee sought a theme that would be catchy, easy to remember, and tied back directly to the conference – Twelve for ’12. The twelve goals indicated in the name would encompass six programmatic goals and six data goals. The programmatic goals cover a range of areas where the District already has or is beginning to make significant progress. Ranging from effective testing to improved outreach and reducing stigma these goals represent areas of potential significant improvement with a guided focus and attentive oversight. The objectives under each goal were derived from a variety of sources including existing District programs, conversations with experts in the field, programs in other jurisdictions, as well as national and international HIV/AIDS efforts. The data goals are not simply options for new types of data that we would like to have. While the goals do include that, many of them are focused on improving the accuracy and quality of the data that we receive. They are not all what is traditionally thought of as data, but rather they will allow us to measure progress as well whether programs are being administered correctly and are truly having their intended effects. Ultimately, these data goals seek to improve the quality of data we possess in order to truly take an evidence-based approach to combating the epidemic. By laying out these clear goals for the next year, the District will be able to carefully monitor the progress that is being made. In addition, these goals and the progress that is made towards them will provide further guidance in the creation of a blueprint that showcases how the District is leading the charge against this epidemic. This blueprint would not only highlight the District’s progress to the world, but can guide other cities and jurisdictions as they battle their epidemic. Below is a draft plan that breaks down six potential programmatic goals and six potential data goals that fit the Twelve for ’12 framework. This represents the Committee’s internal efforts to identify potential goals, and a set of objectives that could be used to achieve them. The Committee wanted to make sure in developing this draft plan that all possible areas were covered so that we could work cooperatively to decide upon the best approach to a final plan within this framework. Therefore, the draft plan outlined below contains a wide variety of potential objectives that could be included in any final plan.
Twelve for ’12: A Plan for Action (DRAFT)
PROGRAMMATIC GOAL 1: “ENSURE EFFECTIVE TESTING” Improve the frequency of and access to effective testing. Require academic detailers to educate doctors on “get the test, offer the test” Continue efforts that force routine testing in medical settings Continue to improve and expand the current testing program at the DMV Provide testing in other non-traditional settings like the current DMV program, i.e. at IMA, homeless shelters, mental health clinics, etc. 5) Create a Project WAVE DC modeled off the successful programs in Houston and NYC a. Originally started in Houston and expanded to NYC, this program brings together local radio stations, community based organizations, and the health departments to raise awareness about the importance of knowing one’s HIV status. This program encourages radio personalities to act as public service announcers both on the air at their local community events. PROGRAMMATIC GOAL 2: “COMBAT MISINFORMATION” Combat misinformation that prevents access to care. 1) Develop a WrapMC type program that educates those individuals in the Ambassador program 2) Expand the ambassador program to empower those who take part in programs to teach others in their communities 3) Improve the effectiveness of the ambassador program by making these services marketable and available throughout the District 4) Develop information and education efforts to reach the often misinformed elderly and youth populations PROGRAMMATIC GOAL 3: “POPULATION SPECIFIC RESPONSES” Ensure appropriate, population specific responses to the epidemic. 1) Expand outreach efforts to traditionally non-at risk populations especially middle aged adults 2) Allow for routine testing in nursing home and other long-term care programs 3) Expand the ambassador program to reach the elderly population 4) Expand efforts to provide clean needles 5) Partner with DMH and other government agencies to link substance abuse and HIV related services 6) Develop prevention services for women and women with families/children 7) Educate nursing home staff and administrators about HIV/AIDS and provide supportive services both for new transmissions and the potential aging of individuals living with HIV/AIDS 8) Development of HIV special needs plans under Medicaid managed care a. These plans are offered as managed care plans to the Medicaid eligible population living with HIV/AIDS and offers a wide spectrum of services. 1) 2) 3) 4)
PROGRAMMATIC GOAL 4: “GOVERNMENTAL COOPERATION AND SUPPORT” Expand government wide support and social services. 1) Develop an IAS commission leading up to 2012 to coordinate a government-wide effort to combat the epidemic leading into 2012 2) Develop a long-term district-wide cooperation effort to ensure all possible government agencies are coordinating a response 3) Provide for affordable housing for those living with HIV/AIDS 4) Promote cooperation between community based organizations 5) Empower non HIV/AIDS community based organizations that work with at-risk populations with the knowledge needed to support HIV/AIDS prevention, testing, and treatment 6) Work with the DMH to establish counseling and other mental health services for those who test positive or are living with HIV/AIDS 7) Creations of AIDS adult day care facilities 8) Comprehensive Medicaid case management (and in community based settings) 9) Enhanced Medicaid reimbursements for HIV primary care visits PROGRAMMATIC GOAL 5: “ACCESS ISN’T ENOUGH” Bridge the gap between access to care and usage of quality care. 1) Develop an “access isn’t enough campaign” a. Oftentimes having a clinic in a specific area is not enough to allow for quality of care. This campaign would educate individuals about the availability of care throughout the District. This knowledge will allow those who don’t seek treatment for a variety of reasons (especially stigma) the option to access care throughout the District. 2) Subsidize transportation costs for those individuals who wish to go to a clinic outside their geographic location for stigma reasons 3) Reduce the price of ARV drugs to improve access and expand the reach of the ADAP budget 4) Treatment adherence initiatives (combat the notion that a positive diagnosis is a means there is no treatment and you cannot live a full life) a. This initiative is designed to teach the importance (and successes) of adhering to the specified treatment plan. This encompasses everything from education to providing facilities in which to stick to the treatment and empowering people to know that others do care if they don’t stick to their regimen. 5) Nutrition education initiative a. In addition to having a stable source of housing, nutrition is also important to the success of treatment. 6) HIV Quality of Care Program a. Based off of the successful New York program, these “quality improvement activities include the development of clinical performance measures derived from practice guidelines, on-site quality of care reviews, and promotion of quality improvement activities, peer learning opportunities for HIV providers, and
consultations to support on-site quality improvement efforts. The ultimate objective for each HIV program in New York State remains the development of a sustainable independent quality management program that reflects the capacity to dynamically analyze and continuously improve HIV treatment, care, and supportive services.” 7) Development of clinical practical guidelines specifically tailored for the District’s epidemic 8) HIVQAL a. This is a program originally designed by the New York State Department of Health to serve as a model for building capacity for quality management for persons living with HIV/AIDS. This is achieved through four methods; coaching, performance measurement, implementation, and peer learning. PROGRAMMATIC GOAL 6: “REDUCE STIGMA AND IMPROVE OUTREACH” Reduce the impact of HIV-related stigma on linkages to and quality of care by improving outreach to all affected communities. 1) Develop baseline data to measure improvements to HIV-related stigma in the District 2) Harness the power of social media to provide information to individuals who might otherwise not possess full knowledge 3) Persons living with HIV/AIDS Leadership Training Institute a. This training program is designed specifically for persons living with HIV/AIDS. It seeks to turn these individuals into community leaders by empowering them with the training and skills needed to not just live with their disease but aid others as well. 4) Work with UDC to develop training courses specifically for those medical and social workers who handle HIV/AIDS cases DATA GOAL 1: Ensure that studies being conducted match current and best methodologies used around the world 1) Viral load studies 2) Biomarker studies DATA GOAL 2: Guarantee that outreach advocates are armed with accurate knowledge. 1) Test ambassadors and other outreach advocates on their knowledge 2) Study community based organizations to test their knowledge DATA GOAL 3: Improve responses to and information gathered from the Youth Risk Behavioral Study 1) Retool the study to focus on District-specific questions and responses 2) Provide incentives to improve response rates
DATA GOAL 4: Gather data on rapidly expanding at-risk populations 1) Develop a study to gather data on the epidemic as it is growing in the elderly population DATA GOAL 5: Study overall sexual health knowledge 1) Expand behaviors that are examined under the study to test overall DATA GOAL 6: Lay the basis for longitudinal studies and other long-term progress measures 1) Identify areas where longitudinal studies would provide a basis for understanding where holes exist in the current District response.