Components of High-Impact Prevention
In the High-Impact Prevention approach, HIV prevention efforts are guided by five major considerations:
- Effectiveness and cost. While all proven interventions may have a place in HIV prevention programs, High-Impact Prevention prioritizes those that are most cost-effective at reducing overall HIV infections. Available cost-effectiveness data strongly supports interventions such as HIV testing and condom distribution, as well as many others. Programs to help people living with HIV avoid transmitting HIV to others are also cost-effective, since this group can be more efficiently served than the much larger population of people at risk for becoming infected.
- Feasibility of full-scale implementation: To make a substantial difference in new infections, priority should be placed on interventions that are practical to implement on a large scale, at reasonable cost. More time- and resource-intensive interventions, such as one-on-one or group counseling, should be reserved for people at the very highest risk of transmitting or becoming infected with HIV.
- Coverage in the target populations: Prevention planners should select interventions based in part on how many people can be reached once the intervention is fully implemented. For example, CDC recommends routine, opt-out HIV testing in health care settings for people regardless of risk, as research has shown that this approach can identify many people with undiagnosed HIV infection. Additionally, CDC supports targeted HIV testing in non-health care settings among people at higher risk, as this is a cost-effective tool for helping those individuals learn their HIV status.
- Interaction and targeting: It is also important to consider how different interventions interact, and how they can most effectively be combined to reach the most-affected populations in a given area. For example, expanding HIV testing can amplify the impact of efforts to increase adherence to treatment, particularly in areas where large numbers of people remain undiagnosed.
- Prioritization: To put the above considerations into practice, prevention planners need to rigorously assess the potential impact on HIV infections of combining different interventions for specific populations. This will allow for prioritizing the interventions that will have the greatest overall potential to reduce infections.
At the national level, CDC has recently taken important steps to establish clear priorities for directing resources to the geographic areas and interventions that could have the greatest impact on HIV rates and health equity. These include a new approach to health department funding, expanded HIV testing efforts, and combination prevention demonstration projects in the areas and populations most heavily affected by HIV. (For examples, see boxes below.)
Real-world examples of CDC’s approach to HIV prevention
Health Department Funding
CDC funding: $359 million annually, FY2012-FY2016 (assumes level funding)
A new approach to health department funding that better matches prevention dollars to the HIV burden in every state, territory, and heavily affected city, focusing on high-impact interventions.
Expanded Testing Initiative
CDC funding: $111 million total, FY2007-FY2010
Targeted funding for HIV testing in communities at risk. Between 2007 and 2010, provided 2.8 million tests; resulted in more than 18,000 new HIV diagnoses; and helped avert $1.2 billion in direct medical costs.
Enhanced Comprehensive HIV Prevention Planning (ECHPP)
CDC funding: $34.8 million anticipated total, FY2010-FY2012
Innovative demonstration projects implementing combination prevention in 12 cities with the highest AIDS burden. For example, the Houston ECHPP project brought together a diverse range of government agencies to create new links between prevention, care, substance abuse, and other services that can reduce new HIV infections.
Community-Based HIV Prevention for Young MSM and Transgender Persons of Color
CDC funding: $50 million total, FY2012-FY2016 (assumes level funding)
Support for local HIV prevention efforts to reach young MSM and transgender people of color with HIV testing and linkages to care, support, and prevention services, as well as targeted behavioral interventions and other effective approaches.