CDR Planning and Oversight
CDR planning and oversight activities should include experts in diverse topics. Involving leaders who can address gaps in HIV-related prevention and care is essential for successful CDR.
All health departments should:
- Bring together a CDR leadership and coordination group with staff from relevant programs.
- Create a CDR plan and update it at least annually.
- Partner with community members and organizations for CDR planning and implementation.
- Analyze data to identify and prioritize clusters of rapid HIV transmission for investigation and response.
- Develop and implement actions to investigate and respond at individual, network, and systems levels.
- Communicate about CDR to a variety of audiences.
- Ensure data protections for CDR activities.
- Report cluster information to CDC.
- Participate in CDC-organized meetings.
Health departments can also enhance their CDR activities. For example:
- Hire dedicated staff for response activities.
- Routinize and automate analysis and data integration from multiple sources, including HIV and related disease areas.
- Engage with communities through a subcommittee or dedicated session of an existing planning group to collaborate on CDR activities.
- Conduct planning exercises to refine CDR plans and improve processes.
- Create a dedicated CDR fund to address needs identified through response efforts.
Many staffing arrangements can successfully support CDR activities. Staff may work on CDR full-time, part-time, or as needed. It is important to first identify health department staff who are responsible for CDR oversight and implementation.
All health departments should establish a CDR LCG to oversee CDR activities. The group should include staff from multiple health department programs. Staff should have the expertise, authority, and skills to contribute to CDR LCG activities, which include:
- Planning for response
- Reviewing available data and prioritizing clusters
- Determining the amount and type of information to collect
- Identifying gaps and inequities in prevention and care
- Deciding on and implementing response actions
- Guiding, monitoring, and evaluating cluster response
- Ensuring data protections for CDR activities
We recommend the group meet routinely to review and prioritize clusters and determine how best to respond. For health departments without clusters or with low HIV rates, collaboration can occur during regular meetings or as needed.
Figure. Role of CDR leadership and coordination group in review, prioritization, investigation, and response
At minimum, the CDR LCG should include HIV prevention, surveillance, and partner services leadership and staff. Group members should include staff with diverse expertise and leaders with authority to implement change across programs.
|Table. Example Staffing Model for CDR LCG
|Identify and address gaps in HIV testing, pre-exposure prophylaxis/post-exposure prophylaxis (PrEP/PEP), syringe service programs (SSPs), and evaluate cluster response outcomes. Lead or co-lead CDR LCG.
|Detect and monitor clusters, ensure data quality, and evaluate cluster response outcomes. Lead or co-lead CDR LCG.
|Partner services and Disease Intervention Specialists
|Guide partner notification and referrals for HIV testing, PrEP/PEP, sexually transmitted infection (STI) testing and treatment, and other services. Detect clusters and identify patterns among cluster and network members.
|HIV care and treatment
|Link people to clinical and supportive services. Identify and address gaps in HIV care and treatment.
|Health department leadership with decision-making authority
|Ensure support from all program areas for prioritizing cluster response activities, guide cluster prioritization, and coordinate cross-program efforts. Identify and guide interventions at individual, network, and system levels.
Other health department programs also have important roles in CDR, including sharing information and providing or addressing gaps in services. These programs may include sexual transmitted infections (STIs), hepatitis, substance use, housing, mental health, harm reduction, or informatics. Include people from these programs in the CDR LCG, as appropriate.
External partners are involved with CDR at different stages. These partners may include local health departments, state health departments, CBOs, HIV planning groups, health care organizations, or social service providers.
Whole Person Approach to Care
CDR requires collaboration across health department programs to deliver HIV-related services to people who need them, regardless of HIV status. People with HIV need access to treatment and people without HIV need access to prevention services.
Communities affected by rapid HIV transmission may benefit from services for related conditions. This includes STI testing; viral hepatitis immunization, testing, and treatment; and other sexual health services. They may also benefit from other clinical and social services related to substance use, mental health, housing, or other needs.
To prepare for a scaled-up response, health departments should connect with their preparedness program to discuss options, processes, and training. In addition, health departments can identify staff to provide temporary assistance for surge capacity, including staff from other programs.
In most cases, state health departments should develop a CDR plan for the entire state. The plan should be updated at least annually. CDC offers a CDR plan template that health departments can tailor. Components include:
- Defined roles for key internal and external partners
- Processes for cluster detection, prioritization, and monitoring
- Processes for deciding on and implementing investigation and response actions
- Plans for identifying more resources and staffing when response needs exceed routine capacity
HIV clusters and outbreaks often highlight unmet service needs for preventing HIV and other related conditions. Thus, a variety of funding sources may be available to support CDR, including:
- CDC funding for HIV prevention and surveillance
- Public health funding for STIs, viral hepatitis, or other related conditions
- Behavioral health and opioid response funding
- Ryan White HIV/AIDS Program and Bureau for Primary Health Care funding
- Housing Opportunities for Persons With AIDS (HOPWA) and other U.S. Department of Housing and Urban Development (HUD) funding
- Substance Abuse and Mental Health Services (SAMHSA) funding
- CDC Public Health Emergency Preparedness funding
Depending on response needs, other funding from federal, state, or local governments, or public-private partnerships may be available.
Local populations experiencing rapid HIV transmission can change over time. Funding mechanisms should support starting or expanding activities for different subpopulations or geographic regions in cluster response.
Funding agreements with local health departments and community and health care partners should allow flexibility to shift resources when needed. For example, one health department offers mini-grants up to $10,000 for local health authorities and tribes to support CDR activities. Additionally, health departments should identify funding from multiple sources and talk with their CDC project officer if they need to redirect funds for cluster response.