Burden Statement
General Instructions
Compiling the Intervention Plan Data

Burden Statement

Public reporting burden of this collection of information is estimated to be 0.83 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number.

Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road, NE, MS D-24, Atlanta, Georgia, 30333; ATTN: PRA (0920-0497).

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General Instructions

The intervention plan reflects basic characteristics of interventions for specific risk populations as they are proposed at the beginning of a funding cycle in the jurisdiction. These data provide a timely snapshot of the distribution and coverage of HIV prevention services scheduled to occur in the next year.

CDC requests that health departments provide aggregate data from their jurisdiction for each of the seven types of interventions⁵ for each risk population (defined here as a risk exposure category). The jurisdiction-level aggregate data for all intervention types requested by CDC includes

• a count of the agencies providing the interventions, by type (e.g., minority-owned CBO, local health department)
• a projection of the number of clients to be served

For some types of interventions, health departments will be requested to provide

• a categorization of the funded interventions based on
  • the adequacy of the evidence or theory used to support the development and implementation of the intervention in addition to the providers’ experience with the intervention and their constituent population
  • the extent to which the service provider explained how and why the intervention will achieve its intended effects in their setting
  • the adequacy of the service plan for implementing the intervention

Each individual intervention plan—which may be in the form of contracts, workplans, or other agreements between the health department and the provider—may include much more information than is requested here. For instance, each intervention plan likely includes process and outcome objectives, detailed plans for implementing the intervention, and descriptions of quality assurance systems.

The data requested here constitute a minimal standard description of the HIV prevention services that can be used by CDC for accountability and program improvement. Health departments may want to collect additional information for their own management, accountability, and program improvement purposes. In addition, the data asked for here are an aggregate reflecting a type of intervention in the jurisdiction for a particular population (e.g., all outreach in the jurisdiction for injection drug users). Each health department will have more detailed information on each separate intervention to be used for management and evaluation purposes. Data at the separate intervention level are not being asked for by CDC through this reporting system.

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Compiling the Intervention Plan Data

In order to aggregate data for reporting to CDC, each jurisdiction will need a mechanism to obtain the relevant data from each provider (either a contracted agency or the health department itself). Once the data are available for each separate intervention, they can be compiled and aggregated for reporting to CDC.

Each jurisdiction is asked to report the data elements in the manner defined on the example report form for each type of intervention. Reports should ensure that the data are presented in the same format (e.g., using the same terms, categories, etc.) as that shown in the example. However, these data may be collected, managed, analyzed, and reported using the technology that is most convenient for the health department. In other words, these data may be submitted as hard-copy on these example forms, or they can be submitted as an electronic file, with the data formatted to match that used on the forms.

Each aggregate intervention plan report consists of descriptive data for one of seven particular types of interventions that will be provided for a specific risk population in the jurisdiction. The table on the following pages defines each of these seven types of interventions. An aggregate intervention plan compiles the data describing all of a single type of intervention for one risk population.

For example, one intervention plan report should include all the outreach that is funded for MSM throughout the jurisdiction. If the health department funds or provides 10 outreach interventions for MSM, then the one outreach intervention plan report should reflect all 10 of those. Another report would cover all outreach funded for IDUs, and a third would include all outreach targeting people with heterosexual risks.

Similarly, a separate report would be used to describe all individual-level interventions for MSM, another for health communications or public information for MSM, and another for prevention case management for MSM.

Data Elements Found on All Forms

The intervention plan data elements are the same for all interventions except for health communications/ public information (HC/PI) and other interventions; HC/PI and other interventions each has one section that differs from the standard set of data elements. The next section of this document discusses the common data elements found in the intervention plans for the seven types of interventions. Where appropriate, the intent of particular items is examined, and definitions of the terms used are provided. The final sections of this document describe the unique data elements for HC/PI and other interventions.

The following categories reflect the major sections of the jurisdiction aggregate form for all intervention types. The italicized numbers and words correspond to the accompanying form. The material that follows provides additional explanation or guidance for obtaining and aggregating the requested data.

Item #1 Jurisdiction ID

This field should be completed with the name of the grantee jurisdiction (state, territory, or directly funded city).

Item #2 Number of interventions this form describes

Report the number of interventions of this type funded by the health department (including those implemented by health department staff) for a particular risk population. It will be assumed that all other data elements on the form will be based on that number of interventions.

Item #3 and #4 Risk Population: Mark the primary risk population this form describes on the list in the left column. If an intervention serves multiple risk populations, choose one primary and one secondary risk population.

Each jurisdiction aggregate intervention plan form is designed to capture data about interventions funded to provide HIV prevention services addressing distinct risk behaviors. The risk populations used here (with the exception of General Population) reflect the routes of potential exposure to HIV that correspond to particular risk behaviors. In this section, the health department notes which risk population(s) is served by the interventions that the current form is describing. Operational definitions for these categories are shown in the following table.

Primary vs. Secondary: CDC recognizes that a single intervention may address more than one exposure risk population. If more than one exposure risk is addressed, a distinction between the primary and secondary risk populations may be necessary.

The first way to make this distinction is to consider if one of the populations is the major focus of the interventions. For example, an intervention serving female sex partners of male IDUs and focusing on their sexual behaviors may also provide some needle-related prevention services to their IDU partners. In this case, Heterosexual would be the primary risk population and IDU would be the secondary because sexual behavior is the primary emphasis of the intervention.

However, some interventions may address more equally two different risk behaviors. For instance, an intervention may be targeted to women who are at risk because of their own injection drug use and their sex partner’s drug use. The content of the intervention may emphasize both drug-related transmission and heterosexual transmission. In this case, the intervention should be reported twice—in the two reports appropriate for each population. While this may slightly inflate the count of unique service units, it will provide a more accurate picture of the prevention efforts being made for particular risk populations. This latter concern is viewed as the more important of the two for CDC’s purposes.

There are two particular exceptions to this general rule. First, interventions serving men with both a history of sexual contact with other men and injection drug use make up a separate category: MSM/IDU. Second, interventions targeting the general population should be categorized using that label, even if people with more specific risks may be reached. Examples of this include school-based interventions where young MSM or IDUs may be reached or education/informational interventions for a particular group in which the risk status of particular audience members may be unknown.

Item #5 Number of interventions for this risk population to be provided by the following types of agencies (sum should equal total interventions this form describes).

Within the jurisdiction, health departments may fund many types of agencies to provide a particular type of intervention for one risk population. In addition, health department staff may implement that type of intervention. This item will describe the array of service providers offering those interventions for a risk population. An example, using “Jurisdiction K,” is provided below. Jurisdiction K has a total of 10 individual-level interventions for MSM. The example shows how these 10 ILIs are distributed over various types of providers.

Example: Counting the agencies providing 10 individual-level interventions for MSM in the jurisdiction.

Four individual-level interventions for MSM are provided by several CBOs. One CBO with a minority board provides one of these interventions, and it is entered on the first line below.

The other three interventions conducted by CBOs are provided by two different non-minority board organizations. Therefore, a “3” is entered on the second line below.

The State Health Department provides one of the individual-level interventions. On the appropriate line, a “1” is entered.

Number of ILIs for this risk population provided by the following types of agencies (sum should equal total interventions this form describes): CBO - Minority Board  1  State Health Department  1  Academic Institution  1  Other Agency __ CBO - Non-Minority Board  3  Local Health Department  4  Research Center Individual __ (please specify) ____________ Faith Community __ Other Government __       Total 10

The state also funds three local health departments to provide MSM individual-level interventions. One of the local health departments delivers two of these, and the other two local health departments provide one each, for a total of 4 interventions on the “local health department” line above.

A school of public health at a university in the jurisdiction provides the remaining individual-level intervention, and it is entered in the appropriate line above.

The category research center is used here to describe a stand-alone research facility, a facility so designated within a university or other academic institution, or a for-profit research organization. A research center within a health department should identify themselves as a health department (either state, county, or city) rather than as a research center.

Item #6 Clients to be served with CDC funds

These fields are for estimated numbers of clients expected to be served during the ensuing year. The required column and row totals are found at far right of the table. However, if data are available for the cross tabs (age by sex by race/ethnicity) and the jurisdiction chooses to report these, then the last group of cells titled “age data not available” should be left blank. Instead, the first three groups of cells should be completed, entering the number of clients to be served with this type of intervention in each of the following age bracket X sex X race categories. Per guidelines from the Office of Management and Budget (OMB), Hispanic ethnicity is requested separately from other racial and ethnic categories. Regardless of the extent of data available, the column and row totals should be completed, and the sum of the row totals should equal the total number of clients expected to be served with this intervention.

Age: If age breakdowns are not available or the jurisdiction chooses not to report these data, complete the group of cells in the far right section of the table. If these data are available and the jurisdiction chooses to report these data, note the ages of clients of each race/ethnicity to be served by this type of intervention using the first three groups of cells and complete the column and row totals at the far right end of the table.

Ethnicity and Race: The racial and ethnic categories are those used by the U.S. Census Bureau and OMB. All data collected on clients’ race and ethnicity should be in compliance with OMB requirements, which give clients the opportunity to identify themselves with more than one race. Therefore, the “More Than One Race” category should be used to aggregate data on clients who report that they are members of more than one race. When interventions do not target particular racial and ethnic groups, use the “NT” (not targeted) rows.

Sex: If interventions do not target a particular sex, then enter the number of clients to be served in the “NT” (not targeted) columns.

Transgender (also referred to as transsexual) refers to those individuals who have undergone or who are undergoing a physical and psychological sex change. This category should be used when interventions target the Transgender population or when people known to identify as transgender are part of the population served. Typically, this designation is used when it is reported by the client. In some cases, a client’s transgender status will not be known, and they will identify as the sex to which they have changed.

The purpose of this section is to determine the extent to which the development of and plans for funded interventions are based on a strong foundation of scientific evidence or theory (as called for in the supplemental guidance for community planning) and have adequate plans to help ensure that they can be implemented well to achieve their outcome objectives. The three criteria are scientific or empirical evidence, justification of this intervention to the target population and setting, and sufficient detail in the plans for implementing the intervention.

These sections are designed to be completed by a health department grantee staff person who is familiar with these categories and the interventions that are being proposed. It is assumed that service providers will furnish the underlying information, in some form, to the health department. The information for each of these characteristics is likely to be found in proposals, contracts, or other supporting documents that providers make available to the health department.

Interventions developed by local providers are often the result of multiple sources of information. Their professional and community experience is a critical source of important, practical information about “what works.” In addition to practical experience, it is important that interventions have a basis in evidence or theory. This item calls for grantee staff to make a determination about the sufficiency of the evidence used in the development of each intervention. That is, someone must decide whether activities based on scientific evidence have been adequately integrated into the proposed intervention. The resulting determination is a simple designation of “Evidence Provided” or “Evidence Not Provided.”

There are multiple types of evidence or theory that can be used to support a provider’s proposed intervention. These include, but are not limited to:

• Data from an evaluation of their own intervention
• Data from an evaluation of a similar intervention
• A theoretical basis from the scientific literature
• A fully articulated informal theory

Care must be taken in making this assessment to determine the extent to which the evidence has actually been used and not just referred to in the proposal. For example, there may be cases in which a proposal contains a long discussion about a behavioral theory (e.g., the Health Belief Model) or another agency’s previously evaluated intervention. However, a careful reading of the proposed intervention suggests that the provider did not actually include substantial program elements based on that theory. Similarly, another intervention may be based solely on a provider’s past experience, with little incorporation of scientific principles or methods that have been evaluated and found to be effective.

STEP 2. Assessing the intervention’s justification for application to this target population and setting

In addition to a description of the basis for the intervention (scientific or otherwise), an intervention plan should also make clear how they believe the proposed intervention activities are expected to lead to the outcome objectives stated for it. In particular, the plan should discuss how the intervention is expected to work with the target population and in the provider’s specific setting. This logic can be described with words and it can be depicted graphically with a logic model that depicts the proposed relationship between the intervention and expectations concerning its outcomes or effects.

This assessment will also result in a judgment to designate the justification to the particular target population and setting as “Sufficient” or “Insufficient.”

STEP 3. Determine the ONE cell in item #7 that best describes each intervention with respect to these two characteristics

When the sufficiency of the evidence or theory and of the justification for the setting (Steps 2 and 3) have been determined, each intervention can be categorized into one cell of the table shown (see example on next page). Each cell represents different combinations of the two alternatives for each characteristic (i.e. sufficient vs. insufficient evidence, sufficient vs. insufficient justification). Therefore, only one of the four options should be selected for each intervention.

For example, if you have examined one intervention and found that it has sufficient evidence or theory but inadequate justification for its current target population and setting, you would place it in the bottom left-hand cell (see the following example table).

Example with 1 intervention

STEP 4. On Item #7 below, enter the total number of interventions per cell that correspond to these characteristics.

To determine the aggregate counts across the jurisdictions, total the number of interventions in each cell. If there are, for example, 10 interventions of a particular type that you are assessing, each one must be categorized and the sum of each cell reflected in the table that is reported. While calculating the aggregate for this table, you may find it easier to make tally marks as you are entering these data.

In the following example, two interventions were determined to have both sufficient evidence or theory and justification for their target population and setting. Another three were justified for their target population and setting, but were deemed to have insufficient scientific evidence. Four had adequate scientific evidence but were not justified for their current target population and setting. Finally, one intervention was judged to have fallen short on both criteria.

STEP 5. Determining the sufficiency of the service plan

The final decision that grantee staff are asked to make is a determination of the sufficiency of the service plan for implementing the intervention. The service plan should address a variety of logistical issues, including

• format, setting, content, and delivery of the intervention
• a realistic plan for reaching the proposed number and type of clients
• provider training and supervision
• quality assurance and accountability mechanisms (including the methods for collecting the necessary process and outcome monitoring data)

Once again, it is important to note that there are no absolute criteria for what constitutes sufficiency. This section requires a judgment on the part of grantee staff as to whether the resources and plans will allow the intervention to be successfully executed given its current context within the jurisdiction.

A determination of “sufficient” or “insufficient” should be made for each intervention.

STEP 6. On Item #8 below, enter the total number of interventions with sufficient service plans and the total number of interventions with insufficient service plans. The sum of the two cells should equal the number of interventions the form describes.

Enter the total number of interventions of this type that have sufficient and insufficient service plans.

Item #9 Notes/Comments field

This optional field provides the grantee with an opportunity to provide explanation, clarification, or additional information that it believes is necessary for understanding the categorical and numeric data provided on this form. This field is to be used at the discretion of the jurisdiction and may be left blank if irrelevant or not needed.

This item is similar to the Interventions by Type of Agency data element present for the other types of interventions. The difference for HC/PI is that there are spaces for the four different types of HC/PI interventions (electronic and print media, hotlines, and clearinghouses). Thus, this item will describe the array of service providers who are funded to offer those four types of HC/PI interventions for a risk population during the previous year.

This item should be used to characterize the type of other interventions that are funded in the jurisdiction that cannot be described by using the intervention categories found on example forms A - F. Please note that because this category does not describe one discrete type of intervention, a separate data set (or the optional example form) should be completed for each type of intervention characterized as an “Other Intervention.”

If the intervention cannot be characterized by one of the five common types shown on the example form, check Additional Intervention and use the following line to briefly describe this intervention. If additional space is necessary when using the example form, please attach additional sheets as necessary. A narrative description should be provided here to help CDC clarify the additional kinds of interventions that are being implemented across the nation that cannot be captured by one of the major categories of intervention types.

Counseling and Testing

Item #12 Please describe any expected changes in the number or characteristics of clients who will receive counseling and testing services in the next year. The following is a partial list of issues that may affect your services; please address any issues you believe to be relevant.

• Priorities in areas of high rates of HIV seroprevalence or AIDS incidence
• Priorities in areas serving clientele known to have high rates of HIV infection or risk behaviors that place them at risk of HIV infection
• Changes due to HIV reporting
• Changes due to managed care activities in the jurisdiction

There are no new reporting requirements related to Counseling and Testing. However, CDC needs to be able to estimate anticipated service levels for this type of intervention. As noted on the example form, CDC staff will use data from the last year’s “HIV Counseling and Testing Report Form” to estimate the number and characteristics of clients you anticipate serving in the coming year.

If substantive changes from your previous year’s service are expected, you can report these anticipated differences with this item.

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