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VI. Appendices

A. DHAP Background

The Division of HIV/AIDS Prevention is one of four divisions in CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Organizationally, DHAP is structured in two divisions—one focused on intervention, research, and support and the other on surveillance and epidemiology. However, functionally DHAP operates as one division that includes 10 branches, making it the largest division in NCHHSTP and one of the largest in CDC.

1. Mission

DHAP – Intervention, Research, and Support (IRS): The mission of the Division of HIV/AIDS Prevention – Intervention, Research, and Support is to provide national leadership and support for HIV prevention research and the development, implementation, and evaluation of evidence-based HIV prevention programs serving populations affected by or at risk for HIV infection.

DHAP – Surveillance and Epidemiology (S&E): The mission of the Division of HIV/AIDS Prevention – Surveillance and Epidemiology is to provide national leadership and support for epidemiologic research and surveillance of the behaviors and determinants of HIV transmission and disease progression. The purpose of these activities is to guide the development, implementation, and evaluation of evidence-based HIV prevention programs serving persons affected by or at risk for HIV infection.

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2. Division Goals and Priorities: The CDC HIV Prevention Strategic Plan

The primary goal of the Division is to decrease HIV incidence, focusing particularly on eliminating racial/ethnic disparities. CDC's HIV Prevention Strategic Plan through 2005 (2001–2005 Plan) has served as a valuable guide for CDC action. CDC has used the 2001–2005 Plan to identify needs for new and expanded prevention programs and initiatives, establish priorities, and direct and target resources. Importantly, the 2001–2005 Plan established a vision not only for CDC, but for the nation as a whole. The plan set an overarching public health goal of decreasing the number of new HIV infections by half—providing a vision of what could be accomplished with a significantly expanded investment in HIV prevention in the United States and with the full implementation of the activities outlined. The 2001–2005 Plan was never fully implemented and progress did not accelerate at the desired rate through 2005; however, CDC remains committed to the aspirational goal of major reductions in HIV infection. CDC will, therefore, work with a range of partners to update the 2001–2005 Plan and its overarching goals and develop a new long-range plan to guide the nation through 2015. The new plan will be based on currently available resources but will articulate what could also be achieved with additional resources.

In the interim, CDC has developed the HIV Prevention Strategic Plan: Extended through 2010 (Extended Plan) to guide the agency's efforts for the next 3 years and to define a realistic, short-term goal at a time when challenges have increased and resources for prevention are not proportionate with prevention needs. Since 2001, HIV diagnoses and risk behaviors have increased among MSM, syphilis rates have increased nationally, and more people are living with HIV than ever before—many of whom are unaware of their infection—which increases the potential for continued HIV transmission. While prevention needs have actually increased, treatment advances have unfortunately contributed to a sense of complacency about the seriousness of HIV/AIDS. An extended strategic plan to address these challenges was essential. The short-term goal and milestones in this Extended Plan were endorsed by the CDC/HRSA Advisory Committee on HIV and STD Prevention and Treatment (CHAC).

The Extended Plan maintains the focus on core prevention priorities expressed in the 2001–2005 Plan: reducing the number of new HIV infections, increasing knowledge of HIV status, and promoting linkages to care, treatment, and prevention services. In addition, new objectives were added to make urgent priorities more explicit, including preventing new HIV infections among MSM and African Americans; addressing stigma and discrimination; promoting the use of rapid HIV tests; addressing the role of acute infection in HIV transmission; and increasing routine HIV testing in medical settings.

CDC is dedicated to helping people live longer, healthier lives by preventing new HIV infections and protecting the health of those already infected. While continuing to challenge us as a nation, CDC believes the short-term goal and milestones outlined in the Extended Plan can be achieved through the implementation of refined and targeted approaches.

The short-term goal, milestones, and accompanying objectives are based on general and specific recommendations from CHAC, formerly known as the Advisory Committee for HIV and STD Prevention. The Extended Plan serves as CDC's strategic guide for HIV prevention through 2010.

The Extended Plan includes an expanded set of objectives that make priorities more explicit and ensure that key issues are effectively addressed. Twelve new objectives have been added, 20 existing objectives have been modified, and one objective was deleted (42 objectives total, compared to 27 in the 2001–2005 Plan).

Short-Term Goal

Reduce the number of new HIV infections in the United States by 5 percent per year, or at least by 10 percent through 2010, focusing particularly on eliminating racial and ethnic disparities in new HIV infections.

Short-Term Milestone 1
By 2010, decrease by at least 10 percent the number of persons in the United States at high risk for acquiring or transmitting HIV infection by delivering targeted, sustained, and evidence-based HIV prevention interventions.

Short-Term Milestone 2
By 2010, through voluntary testing, increase from the current estimated 75 percent to 80 percent the proportion of HIV-infected people in the United States who know they are infected.

Short-Term Milestone 3
By 2010, increase from the current estimated 50 percent to 65 percent the proportion of newly diagnosed HIV-infected people in the United States who are linked to appropriate prevention, care, and treatment services.

Short-Term Milestone 4
By 2010, strengthen the capacity nationwide to monitor the epidemic and develop and implement effective HIV prevention interventions and evaluate prevention programs.

To view the Strategic Plan in its entirety, see Appendix F. HIV Prevention Strategic Plan: Extended through 2010.

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3. DHAP Organizational Structure

Organization Chart:

1st Level: Director

2nd Level: Associate Directors ofScience
Policy and Issues Management HIV/AIDS Disparities Communications

3rd Level: Deputy Director of 
Public Health Operations

3rd Level: Deputy Director of
Prevention Programs Oversees the
Prevention Programs Branch
Capacity Building Branch

3rd Level: Deputy Director of
Surveillance, Epidemiology, and Laboratory Science
Oversees the
HIV Incidence and Case Surveillance Branch
Behavioral and Clinical Surveillance Branch
Epidemiology Branch
Laboratory Branch

3rd Level: Deputy Director of
Behavioral and Social Science
Oversees the
2nd Level: Associate Deputy Director of
Data Management
Prevention Communications Branch
Prevention Research Branch
Program Evaluation Branch
Quantitative Sciences and Data Management Branch

4. Staffing

FTEs

DHAP has a total of 442 FTE positions: 18 GS-15; 91 GS-14; 162 GS-13; 61 GS-12 and below; 44 United States Public Health Service (USPHS) Commissioned Corps officers; 8 other; and 58 vacant. The most prevalent FTE job series in DHAP are public health advisor/analyst; epidemiologist; behavioral scientist; medical officer; mathematical statistician; microbiologist and biologist; medical technician; funding resource specialist; health education specialist; and health communication specialist.

Contractors

DHAP also employs 163 contractors using over 18 different contract agencies to obtain technical services that are essential to the Division being able to achieve its scientific and programmatic objectives.

Other
In addition to FTE employees and contractors, DHAP employs 43 other employees. These employees are mostly in training and post-graduate fellowship programs designed to develop the next generation of HIV prevention workers and scientists, especially those dedicated to working in communities of color.

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5. Budget

DHAP's entire annual budget in FY2008 was just under $653 million. These funds were used to support intramural and extramural activities for domestic HIV Prevention programs through DHAP partners.

Within the DHAP Office of the Director (OD), the Extramural Program Management Office (EPMO) provides resource management and analysis, technical assistance, and liaison services to assist the OD and branches in funding and implementing their projects and activities more efficiently. This office works closely with Division leadership, Branch leadership, the CDC Financial Management Office (FMO) and the CDC Procurement and Grants Office (PGO) to manage and allocate DHAP funds as well as ensure compliance with federal fiscal and procurement regulations.

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6. Discretionary & Non-Discretionary

Extramural federal funds are categorized as discretionary funds and non-discretionary funds. To better understand how these funding sources play a role in programming or allocating funding for HIV prevention activities, it is important to define these terms.

The official definition for discretionary funding from the U.S. Congress is as follows: Discretionary funding refers to spending set by annual appropriation levels made by decision of Congress. This spending is optional, and in contrast to entitlement programs for which funding is mandatory. By the Congressional definition, all DHAP funding is discretionary.

However, the Congressional definition is not the definition used to describe the DHAP budget breakdown. DHAP's definition of discretionary funding is all funding that does not have a predetermined spending directive.

For DHAP, non-discretionary funding is funding that has a predetermined allocation and cannot be used for anything other than its Congressional mandate. There are a number of ways that these funds are predetermined to be spent, below are several examples:

  • Congressional language directing how the funds are to be spent
  • Specific earmarks in a budget appropriation
  • Long-term commitment (3–5 years) to project that makes appropriate annual progress
  • Long-term commitment (5+ years) to studies that contribute to longitudinal knowledge of HIV/AIDS
  • Intramural salary and operating costs

The chart below depicts how DHAP's budget is distributed between discretionary and non-discretionary funding. As shown, most of DHAP's funds are non-discretionary.

FY 2008 Budget (Pie Chart)

The chart depicts how the Division of HIV/AIDS Prevention (DHAP's) budget is distributed between discretionary and nondiscretionary funding. As shown, Non-Discretionary funds total $551,279,650, about 94% of the budget. Discretionary funds totaled $35,580,460, about 6%.

 

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7. Intramural & Extramural Funding

Within the budgeting process, two categories of funds are used to administer all activities: intramural and extramural funds.

Below is a chart that depicts how DHAP's 2008 budget is distributed between intramural and extramural funding. As shown, most of DHAP's funds are expended extramurally.

FY 2008 Budget Intramural and Extramural (Pie Chart)

The chart depicts how Division of HIV/AIDS Prevention (DHAP's) 2008 budget is distributed between intramural and extramural funding. As shown the Intramural budget was $65,001,548 about
10% of the annual budget. The Extramural budget was $586,860,110 about 90% of the budget.

 

Intramural Funds are used for activities in which the primary objective is to enhance DHAP's internal capacities and conduct research within the Division, for example, costs associated with personnel (e.g., FTEs). In addition, intramural funds are used to cover administrative overhead costs. These are costs that are spread throughout the branches and division, which are not typically aligned to strategic planning indicators. These are the funds used to support DHAP and CDC operations. The chart below shows the distribution of intramural funds.

FY 2008 Intramural Budget (Pie Chart)

The chart shows the distribution of intramural funds.  Personnel were about 72% of the total intramural budget; Non-Personnel Travel was 4%, Non-Personnel were 7%, Research was 17% and Other Expenses were 7%.

 

Extramural Funds are used for activities in which the primary objective is to build capacity and implement activities external to CDC. This funding provides support in the administration of extramural programs comprising cooperative agreements, grants, contracts, small purchases, Interagency Agreements (IAA), and memoranda of understanding (MOU). The Division works closely with the CDC Financial Management Office (FMO) and the CDC Procurement and Grants Office (PGO) to administer these external funds and ensure compliance with federal procurement regulations. DHAP uses these funds to support external HIV prevention activities for its partners.

Extramural Funds, by Mission Category

The chart below shows how DHAP's extramural budget is divided by mission categories. It is important to note that the proportion shown for program evaluation represents only the cost of special evaluation projects (e.g., outcome evaluation of interventions delivered by CBOs). It does not include funds that health departments and CBOs receive to conduct routine monitoring of their cooperative agreement programs; these funds are included in the portion shown for intervention/implementation.

FY 2008 Extramural Budget by Mission Category (Pie Chart)

The chart shows how Division of HIV/AIDS Prevention (DHAP's) extramural budget is divided by mission categories.   It is important to note that the proportion shown for program evaluation represents only the cost of special evaluation projects (e.g., outcome evaluation of interventions delivered by CBOs). It does not include funds that health departments and CBOs receive to conduct routine monitoring of their cooperative agreement programs; these funds are included in the portion shown for intervention/implementation which totaled $410,225,216, about 71% of the budget. Policy Development was $956,687 about 0%, Program Evaluation was $12,128,064 about 2%, Research was $36,741,453 about 6%, Surveillance was $72,111,780 about 12%, and Technical Assistance was $63,255,930 about 11%.

 

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B. Guiding Questions for Review Panels

Steering Committee

Topics to be addressed:

  • Current mix of activities across populations and mission areas
  • Current resource allocation across populations and mission areas
  • Translation and dissemination of research findings

Guiding questions:

  1. How proportional is the current mix of DHAP's programs and activities to the needs of its priority populations?
  2. How appropriate is the current mix of activities across mission areas (i.e., surveillance, research, program, capacity building/technical assistance, and evaluation?
  3. How appropriate is DHAP's current allocation of resources across mission areas?
  4. How adequate are DHAP's efforts at translating and disseminating research findings and incorporating new knowledge into action?
  5. To what extent does DHAP have adequate capacity and sufficient resources to address its mission, goals and priorities?
  6. What are the principal gaps in DHAP's programs, overall?

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Panel 1: Planning, Prioritizing, and Monitoring Panel

Topics to be addressed:

  • Strategy development and planning
  • Priority setting (including Resource Allocation Model)
  • Results monitoring (esp. DHAP monitoring and evaluation plan)

Guiding questions:

Planning, strategy development, and priority setting

  1. To what extent are DHAP's processes for planning, strategy development, and priority setting explicit and technically valid?
  2. To what extent do these processes make adequate and appropriate use of data?
  3. Is there a need for DHAP to better incorporate external input into its planning, strategy development, and priority setting? If so, how?
  4. What are the strengths and weaknesses of these planning, strategy development, and priority-setting processes and what are your recommendations for improving them?
  5. How appropriate are the substance and scope of DHAP's strategic priorities relative to the Division's mission? How might this be improved?
  6. How clear and focused are DHAP's strategic priorities, and have they been articulated and communicated adequately? How might this be improved?
  7. How appropriate and relevant are DHAP's strategic priorities to the current epidemic with respect to populations and strategies? How might this be improved?
  8. How well do DHAP's strategic priorities support 1) collaboration among HIV, STD, viral hepatitis, and TB programs and 2) integration of HIV, STD, viral hepatitis, and TB prevention services at the client level?
  9. How well do DHAP's strategic priorities support reduction of health disparities?
  10. What are the principal gaps in DHAP's strategic priorities?

National Results monitoring

  1. To what extent is DHAP's national monitoring and evaluation plan explicit and technically valid?
  2. To what extent are the data sources included in the plan adequate and appropriate, and what other data sources should be included?
  3. How adequate and appropriate are the outcome and impact measures described in the plan in terms of their ability to assess DHAP's programs and their public health impact?
  4. What are the strengths and weaknesses of the plan and what are your recommendations for improving it?

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Panel 2: Surveillance Panel

Topics to be addressed:

  • HIV case surveillance
  • Incidence surveillance
  • Drug resistance surveillance
  • Behavioral surveillance
  • Clinical surveillance

Guiding questions:

  1. To what extent are the surveillance methods and resulting data of high scientific quality?
  2. To what extent are the objectives of each DHAP surveillance system adequately described; clearly linked to, and consistent with, the Division mission, goals, and priorities?
  3. To what extent do the surveillance systems and products adequately meet the needs of CDC's constituencies?
  4. To what extent are the surveillance systems adequately evaluated and the results effectively disseminated?
  5. To what extent does DHAP have adequate capacity and sufficient resources devoted to surveillance, consistent with Division mission, goals, and priorities?
  6. To what extent is the mix and balance of surveillance activities relevant to the current epidemic?
  7. What are your recommendations for changes (e.g., enhancements, additions, activities that can be de-emphasized), future directions, and priorities for the program?

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Panel 3: Biomedical Interventions, Diagnostics, Laboratory, and Health Services Research Panel

Topics to be addressed:

  • Biomedical interventions
  • Diagnostics and testing
  • Laboratory research
  • Health services research (including cost-effectiveness)
  • Research-to-program translation and dissemination

Guiding questions:

  1. To what extent are the biomedical, laboratory, and health services research projects and resulting data of high scientific quality?
  2. To what extent are the objectives of each biomedical, laboratory, and health services research project adequately described and clearly linked to and consistent with the Division mission, goals, and priorities?
  3. To what extent do the biomedical, laboratory, and health services research activities adequately meet the needs of CDC's constituencies?
  4. To what extent are the biomedical, laboratory, and health services research products adequately evaluated and the results effectively disseminated?
  5. To what extent does DHAP have adequate capacity and sufficient resources devoted to biomedical, laboratory, and health services research consistent with the Division's mission, goals and priorities?
  6. Are the Laboratory Branch's diagnostics reference functions appropriate in scope, consistent with DHAP's mission and goals, and adequately staffed?
  7. Do DHAP's biomedical, laboratory, and health services research activities reflect the appropriate mix of basic and applied research, and to what extent is the mix and balance of activities relevant to the current epidemic?
  8. To what extent does the biomedical, laboratory, and health services research portfolio adequately advance the current state of science?
  9. What are your recommendations for changes (e.g., enhancements, additions, activities that can be de-emphasized), future directions, and priorities for the biomedical, laboratory, and health services research programs?

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Panel 4: Behavioral, Social, and Structural Interventions Research Panel

Topics to be addressed:

  • Behavioral, social, and structural interventions
  • Communications and social marketing research
  • Operational research (including cost-effectiveness)
  • Linkage to care, retention in care, ART adherence
  • Research-to-program translation and dissemination

Guiding questions:

  1. To what extent is the behavioral research portfolio of high scientific quality?
  2. To what extent are the objectives of the behavioral research portfolio adequately described; clearly linked to and consistent with the Division mission, goals, and priorities?
  3. To what extent do the behavioral research findings/products meet the needs of CDC's constituencies and inform programmatic efforts?
  4. To what extent are the prevention interventions and strategies within our research portfolio adequately evaluated (adequacy of research methods) and effectively disseminated?
  5. To what extent does DHAP have adequate capacity and sufficient resources devoted to behavioral research, consistent with the Division mission, goals, and priorities, and consistent with the mission of our other federal partners?
  6. To what extent are the strategies, and mixture and balance of these strategies, within the behavioral research portfolio appropriate and relevant to the current epidemic (with respect to various strategies or tactics, various populations or risk groups, and individual, social, structural, or other risk determinants)?
  7. To what extent does the behavioral research portfolio advance the current state of science?
  8. To what extent is the research translation model effective and efficient in moving proven interventions and strategies into practice?
  9. What are your recommendations for changes (e.g., enhancements, additions, activities that can be de-emphasized), future directions, and priorities for the behavioral research portfolio?

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Panel 5: Prevention Programs, Capacity Building, and Program Evaluation Panel

Topics to be addressed:

  • Community planning
  • Counseling and testing
  • HIV Screening
  • Partner services
  • Prevention interventions (behavioral, structural, biomedical)
  • Communications and social marketing
  • Capacity building
  • Program evaluation

Guiding questions:

  1. To what extent are the Division's prevention programs, capacity building activities, and program monitoring and evaluation approaches evidence-based, of high scientific quality, and consistent with the current state of HIV prevention science?
  2. To what extent are the objectives of the Division's prevention program, capacity building, and program monitoring and evaluation portfolios adequately described, clearly linked to, and consistent with the Division mission, goals, and priorities?
  3. To what extent do the Division's prevention program, capacity building, and program monitoring and evaluation activities meet the needs of CDC's constituencies (e.g., training and technical assistance activities sufficiently address growing and evolving needs of public health workforce; program monitoring and evaluation activities result in sufficient accountability, least burden to constituents, and best utilization of data to inform programmatic efforts)?
  4. To what extent are the Division's prevention program, capacity building, and program monitoring and evaluation activities adequately evaluated, and to what extent are the interventions and tools within the capacity building portfolio effectively disseminated?
  5. To what extent does DHAP have adequate capacity and sufficient resources devoted to prevention programs, capacity building, and program monitoring and evaluation, consistent with the Division mission, goals, and priorities?
  6. To what extent is the mix and balance of prevention program, capacity building, and program monitoring and evaluation activities appropriate and relevant to the current epidemic?
  7. To what extent are the current nine essential components of comprehensive state and local HIV prevention programs still appropriate, based upon current surveillance, research, laboratory, epidemiological, and program evaluation data?
  8. To what extent does HIV prevention community planning effectively inform programmatic efforts and meet the needs of constituents, affected populations and other partners?
  9. To what extent do the Division's HIV prevention programs address the goals of reducing health disparities; supporting program collaboration; and facilitating integration of HIV, STD, viral hepatitis, and TB services at the client level?
  10. To what extent are effective mechanisms in place to ensure that programmatic needs and perspectives are informing the Division's surveillance and research agenda?
  11. What are your recommendations for changes (e.g., enhancements, additions, activities that can be de-emphasized), future directions, and priorities for the prevention program, capacity building, and program monitoring and evaluation portfolios?

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