Researchers looking for common factors associated with declining HIV infections in four diverse jurisdictions observed that strong leadership within state and local health departments was the most notable unifying factor critical to programmatic success in each of the two states and two cities studied: North Carolina, San Francisco, Massachusetts and Seattle.
These four jurisdictions have very different epidemics, levels of financial resources and political commitment, and operate within divergent health care systems, yet each of them offer some signs, if not always clear epidemiological proof, of success at lowering HIV infections, the study authors say.
The researchers conducted in-depth interviews with a variety of stakeholders from the four jurisdictions, including individuals from health departments, academic institutions and community-based organizations, health systems staff, medical providers and community advocates.
Hypotheses generated by this project, published in the February issue of AIDS Education and Prevention, provide policy and programmatic recommendations for other jurisdictions that merit further study, the researchers say.
“Whereas public policy research is often driven by what is going wrong, this study attempted an alternative approach and asked what is going right,” says Jeffrey S. Crowley, program director of the National HIV/AIDS Initiative Program at the O’Neill Institute for National and Global Health Law at Georgetown University and lead author of the study. “As we seize the opportunities created by the Affordable Care Act and the National HIV/AIDS Strategy, the country can look at these jurisdictions and see that tangible progress is possible.”
Crowley, who served as director of the White House Office of National AIDS Policy from 2009 to 2011, says the time is now for all health departments, providers, and community stakeholders to ask what new steps they can take to meet the twin goals of reducing HIV infections and supporting all people with HIV in effective systems of care.
San Francisco has reported an estimated drop in new HIV cases from 2.6% in 2004 to 1% in 2011. Massachusetts has had consistent declines in HIV diagnoses and deaths from 2002-2011, while Seattle reported declining HIV diagnoses and deaths over 1993-2012 (with slight upticks in 2011 to 2012). North Carolina’s data is less clear, but shows two periods of decline followed by increases in diagnoses with 2012 representing the lowest number of new cases reported following a peak in 2008.
Crowley and his colleagues point out that leadership success was not solely contingent upon financing. Based on their surveys, they outlined eight strategies that appear to contribute to success in the four jurisdictions studied, including:
- Extending access to health care insurance;
- Using an array of approaches to increase knowledge of serostatus;
- Investing in services to retain people in care;
- Collecting and using data more effectively;
- Translating data into policy change and public health practice;
- Developing targeted programming for vulnerable populations;
- Minimizing administrative policies that attenuate program success; and
- Availability of diversified funding sources.
“The jurisdictions examined here provide important snapshots into challenges facing individuals living with HIV, communities heavily impacted by HIV, and public health officials,” says David R. Holtgrave, PhD, chair of the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health and a study co-author. “We hope that these strategies are ones that might be evaluated and possibly incorporated in other areas to help lower HIV incidence.”
In addition to Crowley and Holtgrave, other authors of this study were Shari Feirman of the Bloomberg School and Chris Collins formerly with amfAR.
Support for the study was provided by amfAR to Georgetown and Johns Hopkins funded through a grant to amfAR from the Elton Johns AIDS Foundation.
The researchers report having no personal financial interests related to the study.
Generating Hypotheses to Explain Declining HIV Infection in Four U.S. Jurisdictions, Jeffrey S. Crowley, Shari Feirman, Chris Collins, David R. Holtgrave, AIDS Education and Prevention, doi: 10.1521/aeap.2015.27.1.84, published February 2015.
Source: O’Neill Institute