CDC’s health department funding approach, which will be in place for 2012, aims to achieve a higher level of impact with federal HIV prevention dollars. Following the release of the National HIV/AIDS Strategy (NHAS) in 2010, this new, five-year health department funding cycle provided an ideal opportunity for CDC to update its geographic funding allocations to eliminate resource inequities. NHAS specifically requires that CDC (and other HHS agencies as appropriate) “develop policy recommendations for revising funding formulas and policy guidance to ensure that federal HIV prevention funding allocations go to the jurisdictions with the greatest need.” Given that the health department FOA is CDC’s largest single investment in HIV prevention, CDC responded to this NHAS imperative by revising the method it uses to allocate HIV prevention funds among health departments. This new approach will allow CDC to better keep pace with changes in the domestic HIV epidemic and maximize the impact of federal HIV prevention funding on the national epidemic.

CDC’s new health department funding approach represents a new direction and embodies CDC’s commitment to High-Impact Prevention—using scalable interventions with demonstrated potential to reduce new infections, in the right populations to yield a major impact on the epidemic. High-impact prevention is essential to achieving the ambitious goals of the National HIV/AIDS Strategy (NHAS).

In the U.S., 56,000 new infections continue to occur each year, which is unacceptable. To reduce annual new HIV infections, prevention efforts need to have a bigger impact. To achieve this, the new FOA not only improves the geographic allocation of resources according to the burden of the epidemic, but also provides important new guidance to health departments about the specific prevention strategies to prioritize.

The majority of funding will be directed to strategies with demonstrated ability to reduce new HIV infections, including HIV testing, prevention for people living with HIV, condom distribution, and other proven strategies. In addition, health departments will be able to apply for competitive funding to conduct demonstration projects that test innovative new approaches to maximizing the impact of HIV prevention funding

State and local health departments are key to making the vision of NHAS a reality. The health department FOA is CDC’s largest single investment in HIV prevention, and will help maximize health departments’ collective impact by directing resources to jurisdictions with the greatest needs. This redirection supports scalable, high-impact interventions with the most potential to reduce new HIV infections on a national level.

The new health department FOA directs resources to the areas of greatest need by allocating funding in proportion to the number of people reported to be living with an HIV diagnosis in each jurisdiction at the end of 2008. These data can be found in Table 21 and Table 23 of the 2009 HIV Surveillance Report.

CDC believes that the unadjusted number of people living with an HIV diagnosis is the best available indicator of the burden of HIV across all jurisdictions and, consequently, offers the most appropriate measure of morbidity to use in CDC’s allocation of HIV prevention resources among health departments. This measure is also consistent with formulas used by the Health Resources and Services Administration (HRSA) for distribution of care and treatment dollars under the Ryan White HIV/AIDS Treatment Extension Act of 2009.

By prioritizing HIV prevention strategies that are highly effective, scalable, and cost-effective, the FOA will enable health departments to better directs federal HIV prevention dollars to achieve a higher level of impact and meet the needs of their jurisdictions. Under Category A, core prevention programs, 75% of funds will be directed to required activities which have demonstrated potential to reduce new HIV infections. These activities include HIV testing, prevention with positives, condom distribution, and structural policy initiatives. Additional, recommended activities (up to 25%) include evidence-based interventions for people at high risk for HIV; social marketing, media and mobilization; syringe services, and supportive services for PrEP/nPEP. Health departments will also be able to apply for competitive funding to conduct demonstration projects that test innovative new approaches. At a national level, we believe this approach will result in a greater collective impact and allow health departments to more effectively meet the HIV prevention needs of their jurisdictions.

We recognize that health departments already face tough choices about how to make the best use of limited funds, and we are committed to helping them navigate any necessary transitions as a result of this funding opportunity. Some areas with heavy HIV burdens will receive needed increases in funding (e.g. southern states and some cities), while other areas will experience decreases. To minimize disruption and help jurisdictions plan, all funding changes will be phased in over the course of a five-year period. Additionally, a jurisdiction will not lose more than one-quarter of its previous year’s funding and funding floors will ensure that all states can continue to provide basic prevention services.

CDC will also provide technical assistance to health departments throughout this period to help them adjust to shifts in funding and to ensure successful implementation of the high-impact strategies supported by the FOA. Specifically:

• CDC will hold a series of technical briefings beginning two weeks after the FOA is published.
• Project officers, Prevention Training Centers, and CDC-supported capacity-building assistance providers are prepared to advise on infrastructure, implementation, and financial management.
• NASTAD and UCHAPS will facilitate peer-to-peer support.
• For health departments that will receive a decrease in funding, CDC will offer post-award site visits and more in-depth assistance to help identify changes that can help health departments achieve the greatest impact from available funds.
• More broadly, the FOA’s focus on supporting high-impact prevention activities will help ensure that available funding has the maximum possible impact in every jurisdiction.

In previous funding cycles, CDC’s ability to directly work with cities to test and evaluate programs reduced the administrative burden and yielded effective and innovative programs and practices, which could be translated to other areas.

In the new FOA, CDC will directly fund up to ten cities, an increase of four from the last cycle of funding. Together, these ten cities represent approximately 37% of the U.S. HIV epidemic, thus allowing CDC to directly target funds to the most highly affected jurisdictions. Direct funding of a small number of cities also enables CDC to quickly respond to needs of these jurisdictions.

Funding allocations to cities were determined based on the number of cases either in the city’s Metropolitan Statistical Area (MSA) or Metropolitan Division (MD), as appropriate. Direct funding to cities is optional and contingent upon a written agreement between the city and its state. If a city opts to provide prevention services to the city area only, rather than the MSA or MD, the state can apply to provide services for the non-city portion of the funding.

Under previous health department funding announcements, CDC directly funded six cities: Los Angeles, San Francisco, Chicago, New York City, Philadelphia, and Houston. Under this program announcement, CDC expanded the list of eligible cities to include Atlanta, Baltimore, Ft. Lauderdale, and Miami.

Yes. Input from partners proved essential in developing the new approach. To ensure that the new FOA reflected the full range of prevention needs across the country, CDC consulted with and received input from many key partners including the National Association of State and Territorial AIDS Directors (NASTAD), Urban Coalition for HIV/AIDS Prevention Services (UCHAPS), National Minority AIDS Council (NMAC), National Association of County and City Health Officials (NACCHO), The AIDS Institute, AIDS United and local, state, and territorial health departments.

Specifically, key input from partners that is reflected in the FOA includes:

• Consolidation of multiple funding announcements for health departments
• “Floor” funding levels to ensure that all jurisdictions can provide basic HIV prevention services
• Five-year FOA period
• Option for competitive funding to conduct innovative demonstration projects
• Continuation of direct funding for key cities heavily affected by HIV

We are confident that this approach reflects the input of many different parties and represents the best course of action.

The FOA prioritizes HIV prevention strategies that are highly effective, scalable and cost effective.

Core Prevention Programs ($284M, Category A)
The majority of this core funding (75%) will be directed to required activities with demonstrated potential to reduce new HIV infections. Some of these activities include:

• HIV testing in health care and community settings; prevention with positives; and condom distribution
• Policy initiatives are also a new area of focus in this FOA. Grantees will be asked to  include efforts to address structural HIV policies/regulations aimed at enabling access to HIV prevention and care (e.g., reducing structural barriers to routine HIV testing or availability of other interventions)

Additional recommended activities (up to 25%) include evidence-based interventions for people at high risk for HIV infection; social marketing, media, and mobilization; syringe services; and supportive services for PrEP/nPEP. Activities must be guided by a new local planning process, which will be based on CDC’s revised HIV Prevention Planning Guidance. This revised guidance will afford health department’s greater flexibility to set priorities in consultation with local communities and other stakeholders (e.g., Community Health Centers, substance abuse and mental health, care providers).

Expanded HIV Testing for Disproportionately Affected Populations ($54.8M, Category B)

States and eligible cities with large numbers of African American and Latino persons living with HIV are eligible for additional funding to provide HIV testing services for populations at high risk for HIV. The 36 jurisdictions with at least 3,000 African Americans and Latinos living with an HIV diagnosis are eligible. This category is modeled on CDC’s highly successful Expanded Testing Initiative, a $111million initiative conducted in 25 cities from 2007 to 2010, which provided 2.8 million HIV tests and identified more than 18,000 previously undiagnosed HIV infections.

Demonstration Projects ($20M, Category C)

All eligible states and cities will have the opportunity to apply for competitive funding to undertake innovative demonstration projects addressing a wide range of prevention approaches.

The FOA was informed by input from CDC’s partners in the HIV prevention community and reflects the views of many different parties. Since its release, CDC has received and carefully reviewed comments and recommendations from its state, local, territorial, and other partners. To address some of these recommendations, we worked within administrative protocols and have amended the FOA with a number of changes. We believe that the amended FOA will allow our collective prevention community to achieve the ambitious goals of the National AIDS Strategy while addressing some of the suggestions from partners.

Amendments to the FOA:

CDC extended the application deadline from August 30, 2011 to September 14, 2011 to allow eligible jurisdictions additional time to prepare their applications for funding opportunity announcement (FOA) PS12-1201.  Applications must be received in the CDC Procurement and Grants Office by 5:00 p.m. Eastern Standard Time on the deadline date. Applicants should submit one single application, to include separate sections for each Category to which the applicant is applying.  This is the longest extension possible that would allow the budget period to start in January 2012. 

CDC also extended the submission date for the required Letter of Intent for Category C from July 14, 2011 to July 21, 2011.  Additional information about the items to be included in a complete application is available online.

CDC amended the FOA to include a range of funding available for the floor amounts each jurisdiction may receive.  Every jurisdiction presently slated to receive the minimum funding level can request and be considered for funding of no less than $750,000 and no more than $1,000,000 for a final award amount.  This span of amount would be considered the “minimum funding range.”  However, the increase above $750,000 would be dependent upon budget review.

The FOA now provides additional information about Category C.  In an effort to ensure a wide distribution in the size, scope, and geographic diversity of Category C demonstration projects, and encourage maximum participation from the 69 eligible entities, awards for Category C will be distributed in the following manner:

If not enough applications are submitted in any range to comprise the estimated number of awards, the estimated number of awards for the other ranges may be increased.  Jurisdictional applicants are limited to submitting up to two applications per year in Category C.  These applications must be submitted to different focus areas.

CDC changed the implementation of the funding algorithm for Category A from a three-year phase-in to a five-year phase-in.  No state will lose more than 25% from their previous year’s budget.  Revised funding tables are available online online.

Additionally, CDC will continue to host a series of webcast conference calls to provide technical assistance and respond to any questions regarding the FOA application process.  Additional information about the webcast conference call series is available online.

CDC’s new funding opportunity represents a new direction that aims to achieve a greater impact on reducing new HIV infections, and we look forward to continuing this work with support from our prevention partners.