[Federal Register Volume 63, Number 96 (Tuesday, May 19, 1998)]
[Notices]
[Pages 27628-27643]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-13307]



[[Page 27627]]

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Part II





Department of Health and Human Services





_______________________________________________________________________



Centers for Disease Control and Prevention



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Human Immunodeficiency Virus (HIV) Prevention Projects and HIV 
Prevention Community Planning Guidance; Notice









Federal Register / Vol. 63, No. 96 / Tuesday, May 19, 1998 / 
Notices

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention
[Announcement Number 99004]


Human Immunodeficiency Virus (HIV) Prevention Projects and HIV 
Prevention Community Planning Guidance

AGENCY: Centers for Disease Control and Prevention (CDC), Department of 
Health and Human Services.

ACTION: Request for comments.

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SUMMARY: CDC is preparing to announce the availability of fiscal year 
1999 funds to provide support for HIV prevention projects through State 
and local health departments. This program announcement will assist the 
Nation's disease prevention efforts by supporting HIV prevention 
activities and the community planning process to best target resources 
and activities. CDC invites comments from organizations and individuals 
on the draft of this announcement which is included. Based on comments 
received, the final announcement will be published later this year. 
Also included for comment is the HIV prevention community planning 
guidance document. This document will be included in the application 
kit for applicants for HIV prevention funding.

Dates: Submit written comments in response to this notice to: Jessica 
Gardom, Division of HIV/AIDS Prevention, National Center for HIV/STD/TB 
Prevention (NCHSTP), Centers for Disease Control and Prevention (CDC), 
Mailstop E-58, 1600 Clifton Road, NE., Atlanta, GA 30333.
    Comments must be received on or before June 18, 1998.
Supplementary Information: The following is a complete text of the 
draft program announcement for HIV Prevention and HIV Prevention 
Community Planning Guidance.

Human Immunodeficiency Virus (HIV) Prevention Projects

Purpose

    The Centers for Disease Control and Prevention (CDC) announces the 
availability of fiscal year (FY) 1999 funds for cooperative agreement 
programs for Human Immunodeficiency Virus (HIV) Prevention. This 
program addresses the Healthy People 2000 priority area of HIV 
Infection. The purpose of this program is to assist public health 
departments (1) to reduce or prevent the transmission of HIV by 
reducing or preventing behaviors or practices that place persons at 
risk for HIV infection; and (2) to reduce associated morbidity and 
mortality of HIV-infected persons by increasing access to early medical 
intervention.

Eligible Applicants

    Eligible applicants are health departments of States and their bona 
fide agents that currently receive CDC HIV prevention funds under 
Program Announcement 804. This includes the 50 States, six cities 
(Chicago, Houston, Los Angeles, New York, Philadelphia, and San 
Francisco), the District of Columbia, Puerto Rico, American Samoa, the 
Virgin Islands, the Federated States of Micronesia, Guam, the Northern 
Mariana Islands, the Republic of the Marshall Islands, and the Republic 
of Palau.

Availability of Funds

    Approximately $250 million is expected to be available in FY 1999 
to fund 65 awards. It is expected that the awards will range from 
approximately $60,000 to approximately $24,000,000. It is expected that 
the awards will begin on or about January 1, 1999. Awards will be 
funded for a 12-month budget period within a project period of 5 years.
    Continuation awards within an approved project period will be made 
on the basis of satisfactory progress as evidenced by required reports 
and the availability of funds. Funding estimates may change. Should 
funds available for this program either increase or decrease 
significantly during the project period, funding may be awarded 
competitively.
A. Direct Assistance
    You may request Federal personnel, equipment, or supplies as direct 
assistance, in lieu of a portion of financial assistance.
B. Use of Funds
    Funds may not be used to supplant State or local health department 
funds available for HIV Prevention. Funds may not be used to provide 
direct medical care (e.g., ongoing medical management, medications, 
etc.). With documented opportunity for comment by the HIV Community 
Planning Groups (CPGs), funds awarded for HIV Prevention activities may 
be used to support HIV/AIDS Surveillance and HIV Sero epidemiology 
projects. CDC must approve the use of prevention funds for surveillance 
and the activities supported must directly improve and support HIV 
prevention activities or the community planning process. The CPG 
comments on the use of prevention funds may be addressed in the overall 
letter of concurrence submitted with the application. A separate 
letter(s) of concurrence must be submitted if the request to use 
prevention funds for these activities occurs at a later time.
C. Funding Preferences
    In 1999, current levels of funding will be maintained for all 
project areas. Priority will be given to funding activities and 
interventions identified through the HIV Prevention Community Planning 
process.

Program Requirements

    A comprehensive HIV prevention program includes the following 
components:
    A. A participatory HIV prevention community planning process, in 
accordance with the guidelines and requirements in the HIV Prevention 
Community Planning Guidance;
    B. Epidemiologic and behavioral HIV/AIDS surveillance, as well as 
collection of other health and demographic data relevant to HIV risks, 
incidence, or prevalence;
    C. HIV prevention counseling, testing, referral, and partner 
notification (CTRPN), with strong linkages to medical care, treatment, 
and other needed services;
    D. Health education and risk reduction (HE/RR) activities, 
including individual-, group-, and community-level interventions;
    E. Increasing access to diagnosis and treatment of other STDs;
    F. School-based efforts for youth;
    G. Public information programs;
    H. Quality assurance and training;
    I. Laboratory support for HIV prevention;
    J. HIV prevention capacity-building activities, including expansion 
of the public health infrastructure by contracting with non-
governmental organizations, especially community-based organizations;
    K. An HIV prevention technical assistance assessment and plan;
    L. Evaluation of major program activities, interventions, and 
services.
    All of these components except B, E, and F are funded under this 
announcement. In conducting activities to achieve the purpose of this 
program announcement, the recipient will be responsible for the 
activities under A and CDC will be responsible for conducting the 
activities under B.
A. Required Recipient Activities
1. HIV Prevention Community Planning
    All recipients must:
    <bullet> Develop a comprehensive HIV Prevention Plan for their 
jurisdictions

[[Page 27629]]

through a participatory process as described in the Guidance on HIV 
Prevention Community Planning (included in application kit).
    <bullet> Justify discrepancies between the plan and the proposed 
program activities.
    HIV prevention community planning is an ongoing, iterative planning 
process that is (1) evidence-based (i.e., based on HIV/AIDS and other 
epidemiologic data, including STD and behavioral surveillance data; 
qualitative data; ongoing program experience; program evaluation; and a 
comprehensive needs assessment process) and (2) incorporates the views 
and perspectives of the groups at risk for HIV infection, as well as 
providers of HIV prevention services. In HIV prevention community 
planning, recipients share responsibilities for developing a 
comprehensive prioritized HIV prevention plan with other State and 
local agencies, non-governmental organizations, and representatives of 
communities and groups at risk for HIV infection.
    Persons at risk for HIV infection and persons with HIV infection 
should play a key role in identifying prevention needs not adequately 
met by existing programs and in planning culturally competent services. 
Priority setting accomplished through a participatory process will 
result in programs that are responsive to high priority, community-
validated needs within defined populations. Refer to the Guidance on 
HIV Prevention Community Planning in the application kit.
2. Counseling, Testing, Referral, and Partner Notification (CTRPN)
a. General
    All recipients must:
    <bullet> Provide CTRPN services consistent with the current CDC HIV 
Counseling, Testing, and Referral Standards and Guidelines.
    The major functions of CTRPN programs are to provide individuals a 
convenient opportunity to: (1) Learn their current HIV sero status; (2) 
participate in counseling to help initiate and maintain behavior change 
to avoid infection or, if already infected, to prevent transmission to 
others; (3) obtain referral to additional prevention, medical care, and 
other needed services; and (4) provide prevention services and referral 
for sex and needle-sharing partners of infected persons.
b. Counseling and Testing
    All recipients must:
    <bullet> Routinely offer, on a voluntary basis with informed 
consent, confidential client-centered HIV prevention counseling and HIV 
laboratory testing services.
    <bullet> Provide, unless prohibited by law or regulation, anonymous 
opportunities for persons to receive client-centered HIV prevention 
counseling and HIV laboratory testing.
    <bullet> Implement and maintain a written policy for contacting 
clients, especially those who are infected with HIV or at high risk of 
becoming infected, but have not returned to receive their HIV test 
results and post-test counseling.
    <bullet> Develop, implement, and maintain a mechanism for assessing 
the proportion of tested clients who return to receive HIV test results 
and post-test counseling in both confidential and anonymous testing 
programs.
    <bullet> When low return rates (e.g., less than 90% return for sero 
positives or less than 75% return for sero negatives) are identified, 
reasons for the low rate must be documented and steps must be taken to 
correct factors that are contributing to the low rates.
    HIV prevention counseling must be client-centered; i.e., tailored 
to the behaviors, circumstances, and special needs of the person being 
served. Client-centered counseling is conducted in an interactive 
manner, responsive to individual client needs. The focus is on 
developing realistic prevention goals and strategies rather than simply 
providing information. HIV prevention counseling should be:
    <bullet> Culturally competent;
    <bullet> Sensitive to issues of sexual identity;
    <bullet> Developmentally appropriate; and
    <bullet> Linguistically specific.
    Recipients are encouraged to give priority to providing services in 
areas with high rates of HIV sero prevalence or AIDS incidence and 
sites serving clientele known to have high rates of HIV infection or 
risk behavior.
    The availability of anonymous services may encourage some persons 
at risk for HIV infection to seek services that they would otherwise be 
reluctant to access. Counseling for clients who test positive in 
anonymous testing sites should include information about the benefits 
of receiving follow-up services under a confidential system, 
information about how to enter such a system, and strong encouragement 
to access such services.
    Some clients who are HIV infected or at high risk of infection may 
require prevention case management, which includes multiple counseling 
sessions. Recipients should provide additional prevention counseling to 
meet the needs of these clients. Funds awarded through the cooperative 
agreement can be used to support such ongoing counseling and prevention 
case management in coordination with patient care systems such as the 
Ryan White funded early intervention services.
    If recipients opt to charge for services, they should do so on a 
sliding scale. No one should be denied services because of an inability 
to pay. Funds generated from charging clients should be used to support 
HIV prevention program activities and services.
    For additional guidance on the implementation of these services, 
refer to the attachments.
c. Referral and Linkages With Other Service Providers
    All recipients must:
    <bullet> Develop, implement, and maintain a system to ensure 
clients who are HIV positive receive appropriate counseling, and are 
entered and maintained in an appropriate system of care, which includes 
prevention services.
    <bullet> Develop, implement, and maintain a mechanism for assessing 
the proportion of HIV-seropositive persons referred for specific 
additional services who complete their referrals (i.e., are seen by and 
receive services from the persons or organizations to which they are 
referred).
    Clients who are at increased risk for HIV infection and clients who 
are infected with HIV often need many services such as further HIV 
prevention counseling, evaluation of immune system function, early 
medical intervention for HIV infection, STD screening and treatment, 
substance abuse counseling and treatment, tuberculosis testing and 
treatment, and family planning. These services should be provided at 
the testing site, if possible.
    All clients who are found to be HIV-infected at any CTRPN service 
site should receive:
    <bullet> A CD4+ cell test, an initial viral load staging, or the 
current recommended test to determine stage of illness; and appropriate 
medical management;
    <bullet> An assessment of medical eligibility for treatment;
    <bullet> Counseling about the benefits of early medical treatment 
opportunities, either on-site or through referral, to receive 
appropriate medical therapies including STD diagnosis and treatment and 
TB skin testing;
    <bullet> Prevention case management;
    <bullet> Referral for substance abuse treatment, if indicated;
    <bullet> Referrals for all indicated services;
    <bullet> Follow-up to ensure that referrals have been successfully 
accomplished.
    If these services are not available at the HIV testing site, 
individuals must be referred to another service provider.

[[Page 27630]]

    Information about services available through referral should be 
regularly updated so that counselors can refer clients for services 
currently available in the local area. A system that (1) links 
counseling and testing sites with other health, medical, and 
psychosocial service providers and (2) provides feedback to the health 
department on completion of referrals is an essential component of 
current HIV prevention program standards of care.
    Funds provided through this cooperative agreement cannot be used to 
provide ongoing clinical and therapeutic care of HIV-infected persons. 
Support for such services should be obtained from other sources of 
funding, or the services should be obtained through referral to local 
providers.
d. Partner Notification
    All recipients must:
    <bullet> Establish standards, implement, and maintain procedures 
for confidential voluntary notification of sex and needle-sharing 
partners of HIV-infected persons, consistent with the CDC Partner 
Notification Guidance, to be published.
    <bullet> Maintain their good faith effort to notify spouses of 
infected persons as required by law and as certified to CDC.
    <bullet> Develop, implement, and maintain a mechanism to determine 
that notification and appropriate follow up of partners has been 
completed.
    <bullet> Develop, implement, and maintain a system to assess the 
partner notification program and improve its function.
    In a comprehensive HIV prevention program, partner notification is 
essential for ensuring that sex and needle-sharing partners of HIV-
infected persons are notified about their risk and offered HIV 
prevention counseling, testing, and referrals. Partner notification is 
a primary prevention service with the following objectives:
    (1) To confidentially inform partners of their possible exposure to 
HIV;
    (2) To provide partners with client-centered prevention counseling 
that assists and supports them in their efforts to reduce their risks 
of acquiring HIV or, if infected, of transmitting HIV infection; and
    (3) To minimize or delay disease progression by identifying HIV 
infected partners as early as possible in the course of their HIV 
infection and assisting them in obtaining appropriate preventive, 
medical, and other support services.
    Partner notification programs should include the following 
components, ensuring that they are consistent with State and Federal 
laws:
    (1) Client Referral: In client-referral, the HIV-infected person 
notifies his or her sex or needle-sharing partners of their exposure to 
HIV. Program staff will provide the client with counseling and support 
on techniques to confidentially notify and refer their sex or needle-
sharing partners to client-centered HIV prevention counseling.
    (2) Provider Referral: In provider referral, a health professional 
who has been specially trained to provide the service notifies the HIV-
infected individual's sex or needle-sharing partners of their exposure 
to HIV. In situations where the HIV-infected person chooses provider 
referral, program staff will offer assistance in confidentially 
notifying those partners and offering them counseling, testing, and 
referral services.
    (3) Spousal Notification: The Ryan White CARE Re-authorization Act 
of 1996, Pub. L. 104-146, Section 8(a), requires that States take 
administrative or legislative action to require a good faith effort be 
made to notify a spouse of a known HIV-infected patient that such a 
spouse may have been exposed to the human immunodeficiency virus and 
should seek testing. The statute defines a spouse as any individual who 
is the marriage partner, as defined by State law, of an HIV-infected 
person, or who has been the marriage partner of that person at any time 
within the 10-year period prior to the diagnosis of HIV infection. All 
HIV Prevention Cooperative Agreement recipients must comply with these 
requirements. Currently, all States and territories have certified to 
CDC that they will require a good faith effort as required by law.
    The partner notification program should be evaluated periodically 
to do the following:
    <bullet> Help identify barriers and gaps in service delivery, as 
well as define the HIV-infected population, so that services can be 
better directed towards target populations;
    <bullet> Plan, refine, and target program intervention strategies;
    <bullet> Analyze and refine resource allocation;
    <bullet> Provide population-specific feedback to health 
departments, community-based organization staff, community planning 
groups, and other community prevention partners; and
    <bullet> Identify technical assistance needs including training.
    All individual data will be maintained at the State and local 
jurisdiction to assist in developing and monitoring local services. The 
jurisdiction must adhere to strict protection and confidentiality of 
client and partner records.
3. Health Education/Risk Reduction (HE/RR)
    All recipients must:
    <bullet> Implement an array of HE/RR activities, and provide 
resources to minority and other community-based organizations (CBOs) to 
implement HE/RR activities, in accordance with the priority target 
populations and interventions identified in their Comprehensive HIV 
Prevention Plan.
    <bullet> Ensure interventions are culturally competent, 
developmentally appropriate, linguistically specific, and sensitive to 
sexual identity.
    <bullet> Briefly report to CDC the rationale (e.g., scientific or 
programmatic basis) for each of the HE/RR interventions implemented.
    HE/RR programs and services are efforts to reach persons at 
increased risk of becoming HIV-infected or, if already infected, of 
transmitting the virus to others, with the goal of reducing the risk of 
these events occurring. These programs should be directed to persons 
whose behaviors or personal circumstances place them at high risk. 
Examples of high risk groups include men who have or have had sex with 
men; persons who exchange sex for drugs, money, housing, or food; 
persons with a newly diagnosed STD; youth who are engaging or are 
likely to engage in high-risk behavior; women who are sex partners of 
persons who engage in high-risk behavior; persons in the correctional 
and criminal justice systems; or homeless persons in high-risk 
situations.
    High priority interventions (as identified by the community 
planning group) at the individual, group, and community levels should 
have priority for support with funds awarded through this cooperative 
agreement. The following are brief descriptions of these programs:
    a. Individual Level Interventions include a range of one-on-one 
client services. Individual prevention counseling assists clients in 
assessing their own behavior and planning individual behavior change, 
supports and sustains behavior change, and facilitates linkages to 
services that support behaviors and practices that prevent the 
transmission of HIV. Project areas are encouraged to provide, either 
onsite or through referral, additional prevention counseling, as 
appropriate to the needs of these clients.
    Prevention case management is an individual level intervention 
directed at persons who need highly individualized support, including 
substantial

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psychosocial, interpersonal skills training, and other support, to 
remain sero negative or to reduce the risk of HIV transmission to 
others. HIV prevention case management services are not intended to be 
substitutes for medical case management or extended social services.
    Prevention case management services should complement ongoing HIV 
prevention services such as HIV antibody counseling, testing, referral, 
and partner notification and early medical intervention programs. 
Coordination with HIV counseling and testing clinics, STD clinics, TB 
testing sites, substance abuse treatment programs, and other health 
service agencies is essential to successfully recruiting or referring 
persons at high risk who are appropriate for this type of intervention. 
See the HIV Prevention Case Management Guidance, September 1997.
    b. Group Level Interventions shift the delivery of service from the 
individual to groups of varying sizes. Group level interventions are 
intended for persons at increased risk of becoming infected or, if 
already infected, of transmitting the virus to others. They provide 
education and support in group settings to promote and reinforce safer 
behaviors and to provide interpersonal skills training in negotiating 
and sustaining appropriate behavior change. The content of the group 
session should be consistent with the format, i.e., groups can meet one 
time or on an on-going basis. One-time sessions can provide 
participants an opportunity to hear and learn from one another's 
experiences, role play with peers, and offer and receive support. 
Ongoing sessions may offer stronger social influence with potential for 
developing emergent norms that can support risk reduction. Multiple 
sessions may be needed for persons at high risk of HIV infection. A 
group level intervention can include more tailored individual level 
interventions with some of the group members.
    c. Community Level Interventions are directed at changing community 
norms to increase community support of behaviors known to reduce the 
risk for HIV infection and transmission. While individual and group 
level interventions also may be taking place within the community, 
interventions that target the community are unique in their purpose and 
are likely to lead to different strategies than other types of 
interventions. Community level interventions aim to reduce risky 
behaviors by changing attitudes, norms, and practices through health 
communications, social (prevention) marketing, community mobilization 
and organization, and community-wide events.
    The primary goals of these programs are to promote healthy 
behaviors, to change factors that affect the health of community 
residents, and ultimately, to improve health status. The community may 
be defined in terms of a neighborhood, region, or some other geographic 
area, but only as a mechanism to access the social networks that may be 
located within those boundaries. These networks may be changing and 
overlapping, but should represent some degree of shared communications, 
activities, and interests.
    Community level interventions are designed to affect social norms 
or shared beliefs held by members of the community. Specific activities 
include, for example:
    <bullet> Identifying and describing (through needs assessments and 
ongoing feedback from the community) structural, environmental, 
behavioral, and psycho social facilitators and barriers to risk 
reduction in order to develop plans to enhance facilitators and 
minimize or eliminate barriers;
    <bullet> Persuading community members who are at risk of acquiring 
or transmitting HIV infection to accept and use HIV prevention 
measures; and
    <bullet> Informing community members--regardless of their personal 
risk level--of their important role in HIV prevention in their 
communities.
    d. Street and community outreach programs are one type delivery 
method for the interventions described above. They are defined by their 
locus of activity and by the content of their offerings. These programs 
reach persons at high risk, individually or in small groups, on the 
street or in community settings. The programs provide them with 
prevention messages, information materials, and other services, and 
assist them in obtaining other HIV prevention services such as HIV-
antibody counseling and testing, HIV risk-reduction counseling, STD and 
TB treatment, substance abuse prevention and treatment, family planning 
services, tuberculin testing, and HIV medical intervention. Refer to 
Guidelines for Health Education and Risk Reduction Activities, U.S. 
Department of Health and Human Services, Public Health Service, April 
1995.
4. Public Information (PI) Programs
    The purposes of public information programs and activities funded 
through this cooperative agreement are to build general support for 
safe behavior, to dispel myths about HIV/AIDS, to address barriers to 
effective risk reduction programs, and to support efforts for personal 
risk reduction. In addition to informing general audiences, public 
information programs should assist in informing persons at risk of 
infection of how to obtain specific prevention and treatment services, 
such as CTRPN and STD screening and treatment. Public information 
programs and messages should be based on an assessment of needs in each 
State and local area. Messages to communicate through public 
information programs may include how HIV is and is not transmitted; how 
to avoid becoming infected; what the impact of other STDs is on the 
risk of HIV transmission; what to do if you think you might be 
infected; the benefits of knowing your sero status, including early 
diagnosis and treatment for HIV disease; and how to talk to your 
children, friends, and neighbors about HIV prevention.
    Give priority to materials directed to hard-to-reach audiences and 
populations heavily affected by the HIV epidemic. Submit any newly 
developed public information resources and materials to the National 
AIDS Information Clearinghouse so that they can be incorporated into 
the current database for access by other organizations and agencies.
5. Quality Assurance and Staff Training
    All recipients must:
    <bullet> Develop and implement a mechanism for assessing the 
performance and training needs of staff providing HIV prevention 
services, especially those staff providing HIV prevention counseling 
and partner notification. Staff training should be guided by the 
assessment.
    <bullet> Develop comprehensive written quality assurance procedures 
and staff performance standards and make them available to all program 
staff. Management should ensure these policies and procedures are 
followed.
    <bullet> Develop and implement a quality assurance system for all 
counseling and testing providers, with special attention to assuring 
that seropositive clients learn their test results.
    <bullet> Develop and implement a mechanism for assessing the 
proportion of HIV-seropositive persons referred for additional services 
who complete their referrals. Review data and improve process as 
necessary.
    <bullet> Develop and implement a mechanism to determine that 
notification and follow up of partners has been completed. Review data 
and improve process as necessary.
    <bullet> Develop and implement a mechanism to assure HE/RR 
activities

[[Page 27632]]

are culturally competent, developmentally appropriate, linguistically 
specific, and sensitive to sexual identity.
    <bullet> Develop and maintain a mechanism to ensure the 
consistency, accuracy, and relevance of information provided to the 
public through local hotlines including information about referral 
services.
    Quality assurance is essential to make certain that delivery of 
quality HIV prevention services is consistent and to ensure 
interventions are delivered in accordance with established standards. 
Quality assurance programs include measures to maintain high 
performance expectations of staff and that appropriate, competent, and 
sensitive methods are used for counseling, referral of clients, and 
providing other risk reduction messages. These quality assurance 
procedures and staff training should extend to the organizations 
providing HIV prevention activities through contracts.
    Quality assurance and staff training is an ongoing process. An 
important component of this process is routine, periodic observation 
during counseling sessions and subsequent feedback to reinforce 
specific strengths noted and address any deficiencies detected. 
Performance standards that define expectations for the context and 
delivery of the counseling massages should be developed.
    Feedback from client satisfaction surveys should be used routinely 
as a factor in assessing the services provided.
6. HIV Prevention Capacity-Building Activities
    Recipients must:
    <bullet> Develop, implement, and maintain a plan to provide 
financial assistance to CBOs and other HIV prevention providers that 
includes provisions for ensuring that funds are awarded on a timely 
basis.
    <bullet> Issue Requests for Proposals (RFPs) within 90 days of the 
receipt of the notice of grant award. Multi-year assistance is 
allowable, provided the initial award was made competitively.
    In order to build capacity, health departments should provide 
financial and technical assistance to strengthen their own 
infrastructure and that of non-governmental organizations to deliver 
effective HIV prevention interventions. Some examples of capacity 
building activities are implementing systems to ensure quality and 
integration of services (particularly HIV, STD, TB, and drug 
treatment), strengthening laboratory capacity, improving community 
needs assessments, funding community-based organizations to provide 
services, and providing technical assistance in all aspects of program 
planning and operations.
7. HIV Prevention Technical Assistance Assessment and Plan
    Recipients must:
    <bullet> Assess their own needs, as well as the needs of community-
based organizations in their jurisdiction, for technical assistance in 
the areas of HIV prevention program planning, implementation, and 
evaluation.
    <bullet> Develop, implement, and maintain a plan to provide the 
technical assistance indicated by the assessment.
    Recipients should identify their own current and projected 
technical assistance needs and the needs of the jurisdiction's 
community-based providers, for program planning, implementation, and 
evaluation. Recipients should develop and implement a plan to provide 
ongoing technical assistance for HIV prevention and early medical 
intervention services in their communities, as indicated by the 
assessment. These should include planning, implementing, and evaluating 
prevention programs, activities, and services. Technical assistance 
should include the active monitoring of services and programs provided 
by CBOs.
    Program management, strategies for meeting the HIV prevention needs 
of populations at high risk, and strategies for overcoming barriers to 
prevention should be priority areas for technical assistance programs.
8. Evaluation of Major Program Activities, Interventions, and Services
    Evaluation is essential to monitor progress, measure program 
success, and strengthen programs and program activities. To this end, 
recipients need to conduct evaluation activities that will assess their 
progress in HIV prevention efforts and will contribute to the planning, 
implementation, and evaluation of effective HIV prevention programs.
    The evaluation activities described here are listed as six phases. 
It is expected that there will be a range in recipient capacity and 
resources to conduct evaluations and that some recipients will have 
already conducted some of the phases. Therefore, although the phases 
are listed in an idealized sequence, recipients should implement the 
phases in a manner that reflects their current evaluation achievements, 
capacity, activities, resources, and needs. Each year, in their annual 
CDC funding applications, recipients should submit progress reports and 
data pertaining to the phases they implemented during the previous year 
and establish objectives for the upcoming year. As grantees implement 
new phases of evaluation, those phases that were previously initiated 
should be continued.
    CDC is creating a CDC Evaluation Guidance that will be disseminated 
to recipients. The guidance is designed to assist recipients in 
preparing their application and implementing evaluation activities 
described in this announcement. To this end, the guidance provides an 
overview of CDC's evaluation model, upon which this announcement is 
based; describes recipient evaluation activities and data collection 
for each phase; lists references for technical assistance and training 
to build recipient capacity to implement these activities; and contains 
definitions of key terms.
    All recipients should include the following evaluation activities 
in their programs:
a. Phase I: Development of a Comprehensive Evaluation Plan
    Recipients should develop a comprehensive plan for evaluation of 
health department and health department-funded HIV program services and 
interventions. The plan should describe what will be done each year 
over the next five years. Phases II through IV describe the five types 
of evaluation in which grantees should engage. The plan should be 
clear, specific, and realistic.
b. Phase II: Evaluation of HIV Prevention Community Planning
    Recipients should track and keep records on an ongoing basis in the 
following areas pertaining to the community planning process and 
development and implementation of the Comprehensive HIV Prevention 
Plan, using the Evaluation Guidance tools.
    (1) Recruitment of community planning group members and 
representation of affected communities and areas of expertise on the 
community planning group (Community Planning Core Objectives 1 and 2).
    (2) Application of a needs assessment and an epidemiologic profile 
to determine target groups and HIV prevention strategies (Community 
Planning Core Objective 3).
    (3) Application of scientific knowledge in the selection and 
formulation of intervention strategies (Community Planning Core 
Objective 4).
    (4) Developing goals and measurable objectives for the planning 
process and monitoring progress on the objectives.
    (5) Assessing the cost of the process.

[[Page 27633]]

    (6) Assessing the extent to which resources allocated by the health 
department match the epidemiologic profile.
    (7) Assessment of the extent to which the final version of the 
Comprehensive HIV Prevention Plan is used in the recipient health 
department's budget decisions and in the health department's planning 
and development of HIV prevention program activities (Community 
Planning Core Objective 5).
c. Phase III: Program Design Evaluation
    Prior to launching new program activities, recipients should assess 
the quality of program activity designs to ensure that the proposed 
interventions are scientifically sound, the implementation system is 
well organized, and stated goals are clear and feasible. (Factors to be 
evaluated are discussed in the section on Evaluation Reporting Format.)
d. Phase IV: Process Evaluation of HIV Prevention Programs
    Conduct process evaluation through:
    <bullet> Ongoing data collection and monitoring regarding the 
implementation of health department and health department-funded 
program activities.
    <bullet> Assessment of the congruency between the intended and 
actual implementation of health department and health department-funded 
program activities.
    <bullet> Use evaluation findings in order to improve program 
activities as indicated by the data.
e. Phase V: Outcome Evaluation
    Outcome evaluation for this announcement is defined as the 
assessment of the effects of an intervention on the individuals who 
were targeted in the intervention. For example, changes in knowledge, 
attitudes, or behavior are usually outcome variables.
    Recipients whose award is more than $1 million are expected to 
carry out at least one outcome evaluation during the five-year period. 
Outcome evaluation may be most easily achieved for the following types 
of interventions: HIV counseling and testing, referral, individual-
level counseling, group-level counseling, and institution-based 
programs. CDC Evaluation Guidance (to be published) will describe 
recommended outcome evaluation designs and emphasize those designs that 
are cost-efficient and practically feasible to implement.
f. Phase VI: Impact Evaluation
    Impact evaluation is the assessment of the effects beyond the 
outcome. For example, assessment of the cumulative effect of all HIV 
prevention activities in the jurisdiction is an impact evaluation.
    CDC plans to conduct national impact evaluation studies using HIV/
AIDS surveillance and other public health data sets. Recipients are not 
required to perform their own impact evaluation (but may do so if they 
wish and resources permit); however, recipients must participate in 
CDC's HIV prevention effectiveness indicators project.
9. Other Activities
    Recipients must:
    a. Have the capability to access the Internet and to download 
documents about HIV from CDC and other sites.
    b. Ensure participation of appropriate representatives 
(governmental and non-governmental) in national or regional planning 
and implementation meetings.
    Recipients should budget funds provided through this cooperative 
for these efforts. For example, travel funds should be available for 
community planning co-chairs to travel to the HIV Co-chairs meeting.
B. CDC Activities
    1. Provide consultation and technical assistance in all aspects of 
the comprehensive HIV prevention program, including the community 
planning process, and planning, conducting, and evaluating HIV 
prevention and intervention activities.
    2. Provide up-to-date information including diffusion of best-
practices in all areas of the diagnosis, treatment, surveillance, and 
prevention of HIV.
    3. Provide assistance to improve systems that monitor disease and 
reporting trends.
    4. In consultation with recipients, assess training needs and 
determine how best to meet those needs. For HIV Prevention, CDC, in 
concert with State and local health departments, will provide training, 
either directly or through its network of STD/HIV prevention training 
centers, for persons who supervise, manage, and perform partner 
notification and other outreach activities and for staff who provide 
direct patient care.
    5. Facilitate the adoption and adaptation of effective prevention 
intervention models among project areas through workshops, conferences, 
written communications.
    6. Assist recipients in evaluating their program performance, in 
meeting their objectives, and in complying with cooperative agreement 
requirements.
    7. Coordinate multi State approaches to HIV prevention and 
intervention.
    8. Support individual project areas by providing technical 
assistance in the development of new or innovative models for 
behavioral and clinical interventions and the evaluation of them.

Application Content

A. General

    Develop applications in accordance with CDC 0.1246E, information 
contained in the program announcement, and the instructions and format 
provided below.
    Sequentially number all pages in the application and attachments, 
include a table of contents reflecting major categories and 
corresponding page numbers. Submit the original and each copy of the 
application unstapled and unbound. Provide only those attachments 
directly relevant to this application. All materials must be single 
spaced, printed in 12 CPI font, unreduced, on 8\1/2\'' by 11'' paper, 
with at least 1'' margins, and printed on one side only.

B. Cross-Program Activities

    Submit a brief statement addressing major HIV, STD, and TB cross-
program issues. In this statement summarize progress made in the last 
12 months and the current level of shared activities across HIV, STD, 
and TB programs. Discuss plans to improve coordination across HIV, STD, 
and TB programs over the next 12 months, including plans to increase 
collaboration in surveillance and any other efforts to improve program 
coordination.

C. HIV Prevention Community Planning (Not To Exceed 20 Pages)

1. National Community Planning: Progress Report and 1999 Objectives
    Provide a brief summary of progress in accomplishing the following 
national community planning core objectives. Also, please summarize 
steps that will be taken over the next 12 months to accomplish the 
national core objectives.
    a. Fostering the openness and participatory nature of the community 
planning process.
    (1) Describe any efforts in the past 12 months in recruiting, 
training, and supporting community planning group members, and methods 
used to obtain input from outside group membership. Briefly profile the 
number of HIV prevention community planning groups convened in the 
jurisdiction. If the jurisdiction convenes other county or regional 
groups that provide input to a community planning group, please

[[Page 27634]]

describe this structure. Briefly describe any changes in the planning 
structure of your jurisdiction. Also briefly describe any mechanisms 
used during the past 12 months for coordination with other planning 
activities, e.g., Ryan White Title I and II, STD, TB.
    (2) Describe any new or additional steps to be taken in each of 
these areas in the next 12 months to foster the openness and 
participatory nature of the community planning process.
    b. Ensuring that the community planning groups reflect the 
diversity of the epidemic in your jurisdiction, and that expertise in 
epidemiology, behavioral science, health planning and evaluation are 
included in the process.
    (1) Summarize the characteristics and expertise represented by 
members of the community planning groups over the past 12 months. 
Discuss any gaps in representation and approaches that have been used 
during the past 12 months to address the gaps. Briefly describe any 
methods used to obtain input from outside group membership. Do not 
include any information that might link HIV status to any individual.
    (2) Please describe planned activities for the next 12 months 
including plans for addressing any gaps in representation.
    c. Ensuring that priority HIV prevention needs are determined based 
on an epidemiologic profile and a needs assessment.
    (1) Briefly describe the process that was used or steps that were 
taken over the past 12 months to develop or modify the epidemiologic 
profile and the needs assessment. Briefly describe how priority 
populations were identified from the epidemiologic profile and needs 
assessment.
    (2) Describe plans for updating or modifying the Epi profile and 
needs assessment over the next 12 months.
    d. Ensuring that interventions are prioritized based on explicit 
consideration of priority needs, outcome effectiveness, cost 
effectiveness, social and behavioral science theory, and community 
norms and values.
    (1) Briefly describe the process that was used to prioritize 
interventions over the past 12 months.
    (2) Describe any changes planned in the prioritization process in 
the next 12 months.
    e. Fostering strong, logical linkages between the community 
planning process, plans, application for funding and HIV prevention 
resources.
    (1) Briefly describe the linkage between this application for 
funding and allocation of CDC HIV prevention resources and the HIV 
Prevention Plan.
    (2) Describe any changes planned in the next 12 months.
    (3) Describe linkages between planned expenditures (as reported in 
the budget tables), epidemiological statistics, and plans for 
addressing any gaps between budget levels and epidemiologic statistics.
2. Community Planning Technical Assistance and Evaluation
a. Technical Assistance
    (1) Briefly describe any technical assistance provided to the 
community planning group in the past 12 months.
    (2) Describe areas of needed technical assistance and planned 
methods for obtaining this assistance in the next 12 months.
b. Evaluation
    (1) Briefly describe how the community planning process was 
evaluated over the past 12 months and the major conclusions of the 
evaluation.
    (2) Describe plans to evaluate the community planning process over 
the next 12 months.
3. Comprehensive HIV Prevention Community Plan
    Please provide as an attachment, the current version of your 
Comprehensive HIV Prevention Plan. For areas without a jurisdiction-
wide planning group, include regional plans and a jurisdiction-wide 
summary of recommendations and conclusions. If the jurisdiction has 
developed a separate document that updates and describes refinements or 
changes to the original Comprehensive HIV Prevention Plan, please 
attach both the original Plan and the supplementary document that 
updates the Plan. Include the proposed activities for 1999, letters of 
concurrence/non-concurrence from each community planning group in the 
jurisdiction, a line item budget and narrative justification, and 
relevant attachments. (The Comprehensive Plan or the jurisdiction-wide 
summary are attachments to the application and are not included in the 
page limit for this section.)
    a. Priority populations and interventions. List the populations 
identified in the HIV Prevention Community Plan in rank order. For each 
of these populations list the recommended interventions (e.g., CTRPN, 
HE/RR) in rank order. For each intervention, list goals recommended in 
the plan. Please use the following format:

Population #1
Intervention #1
    Goals
Intervention #2
    Goals
Population #2

D. HIV Prevention Program (Not to Exceed 30 Pages)

1. Progress Report for 1998
    Summarize progress during the past year in achieving objectives 
related to each of the programmatic activities listed below. For each 
activity, describe progress toward achieving program objectives, 
related training and quality assurance activities, program evaluation 
findings, changes or adjustments resulting from evaluation findings, 
and reasons for not attaining an objective.
    a. HIV CTRPN;
    b. HE/RR (including individual level interventions, group level 
interventions, community level interventions, and street and community 
outreach);
    c. Public Information Programs;
    d. Evaluation Activities;
    e. HIV prevention capacity building activities;
    f. Quality assurance and training;
    g. Other activities.
2. Budget Tables
    Complete the Table of Estimated Expenditures for 1998 HIV 
Prevention funding, indicating 1998 HIV prevention allocations by 
intervention, population, and race/ethnicity. This is used to report to 
Congress and Office of Management and Budget on use of tax dollars, 
targeted programs, and to justify need for additional support.
3. Program Goals, Objectives, and Activities
a. 5-Year Programmatic Goals
    Based on the past 5 years' activities, provide overall programmatic 
goals for the next five-year period. These are intended to provide a 
general framework-objectives and activities will be developed annually, 
when each of the next budget period program applications are written.
b. 1999 Priority Populations and Interventions
    List the priority populations identified by the recipient in rank 
order. For each of these populations, list the interventions the 
grantee plans to fund in rank order. For each intervention list the 
goals. For each goal, state realistic, specific, time-phased, and 
measurable objectives to be achieved during the next 12 months. Outline 
strategies and activities to be undertaken and services to be provided 
to achieve objectives. Include, as needed, training, quality assurance, 
and capacity-building objectives related to each intervention. Please 
use the following format:


[[Page 27635]]


Population #1
Intervention #1
    Goals
    Objectives
    Activities
Intervention #2
    Goals
    Objectives
    Activities
Population #2
Intervention #1
c. Linkages Between Primary and Secondary HIV Prevention Activities
    Briefly describe the linkages that will be developed and maintained 
between primary and secondary prevention services in the jurisdiction. 
Provide goals and realistic, specific, time phased, and measurable 
objectives for the next 12 months. Outline strategies and activities to 
be undertaken to achieve these objectives.
d. Linkages With Other HIV Prevention Related Activities
    Briefly describe the program's proposed linkages with other HIV 
prevention-related activities (e.g., epidemiologic and behavioral 
surveillance; research; substance abuse, STD, and family planning 
programs; and program evaluation activities) and the prevention program 
strategies proposed in this application. Provide goals and realistic, 
specific, time phased, and measurable objectives for the next 12 
months. Outline strategies and activities to be undertaken to achieve 
these objectives.
e. Coordination of HIV Prevention Services and Programs
    Briefly describe the program's plans for coordination among public 
and non-governmental agencies to provide HIV prevention services and 
programs. Provide goals and realistic, specific, time phased, and 
measurable objectives for the next 12 months. Outline strategies and 
activities to be undertaken to achieve these objectives.
f. Technical Assistance
    Briefly describe your need, as well as the needs of the community-
based organizations in your jurisdiction, for technical assistance in 
the areas of HIV prevention program design, implementation, and 
evaluation. Describe plans for addressing these technical assistance 
needs. Provide goals and realistic, specific, time phased, and 
measurable objectives for the next 12 months. Outline strategies and 
activities to be undertaken to achieve these objectives.
g. Program Evaluation
    Each year, in their annual CDC funding applications, recipients 
should submit progress reports and data pertaining to the phases they 
implemented during the previous year and establish objectives for the 
upcoming year. As grantees implement new phases of evaluation, those 
phases that were previously initiated should be continued.
4. Explain Any Differences Between the Priority Populations, 
Interventions, and the Proposed Program Activities and Those 
Recommended in the Comprehensive HIV Prevention Plan (e.g., other 
funding sources are supporting an activity, other providers are meeting 
a need, public health interest, legal constraints)

E. Concurrence of HIV Prevention Community Planning Groups

    Recipients must submit letters of concurrence or non-concurrence 
from each HIV prevention community planning group convened within the 
jurisdiction. The letters should indicate the extent to which the 
recipient and the HIV prevention community planning groups have 
successfully collaborated in developing the comprehensive HIV 
prevention plan and have reviewed and agree upon the program priorities 
contained in this application. The letter should describe the process 
used to obtain concurrence, including a description of the process used 
for review of the application by the community planning group, the time 
frame allotted for the review, who from the community planning group 
reviewed it (co-chairs, members, subcommittee chairs), and the quality 
of the concurrence (e.g., without reservation, with minor concerns, 
with important concerns). At a minimum, the letters should be signed by 
the co-chairs on behalf of the groups. There should be letters from 
each of the community planning groups described above. If a letter of 
concurrence includes reservations or a statement of concern/issues, 
address those concerns in the application. Letters of non-concurrence 
must cite specific reasons for the non-concurrence. In situations where 
the community planning group does not concur with the program 
priorities identified in the funding application and the recipient is 
proposing to implement activities or allocate Federal resources based 
on other priorities, a justification must be provided by the recipient 
as to why the priorities identified through the community planning 
process are not being implemented.
    Instances of planning group concerns or non-concurrence will be 
evaluated on a case-by-case basis. After consultation, CDC will 
determine what action, if any, may be appropriate.

F. Budget Information

    In accordance with Form CDC 0.1246E, provide a line item budget and 
narrative justification for all requested costs that are consistent 
with the purpose, objectives, and proposed program activities. Within 
this budget, please provide the documentation requested for each cost 
category:
    1. Line item breakdown and justification for all personnel, i.e., 
name, position title, annual salary, percentage of time and effort, and 
amount requested.
    2. Line item breakdown and justification for all contracts, 
including: (1) Name of contractor, (2) period of performance, (3) 
method of selection (e.g., competitive or sole source), (4) description 
of activities, (5) target population and (6) itemized budget.
    3. Requests for any new Direct Assistance Federal assignees, 
include:
    a. The number of assignees requested;
    b. A description of the position and proposed duties;
    c. The ability or inability to hire locally with financial 
assistance;
    d. Justification for request;
    e. An organizational chart and the name of the intended supervisor;
    f. The availability of career-enhancing training, education, and 
work experience opportunities for the assignee(s) and;
    g. Assignee access to computer equipment for electronic 
communication with CDC.
    4. Complete CDC budget tables. Note: Following receipt of your 1999 
award, additional budgetary information may be requested.

Submission and Deadline

(To be provided with final version)

Evaluation Criteria

    A. All applications will be reviewed by CDC program consultants for 
determination of progress toward stated objectives and for compliance 
with program guidance. In addition, each application will also receive 
an external review by an independent team of governmental and non-
governmental representatives to determine technical acceptability. The 
purposes of this external review will be to evaluate each application 
individually against to the following criteria:
    1. The need for support as documented in the Epidemiologic Profile 
and Needs Assessment including

[[Page 27636]]

(1) the degree to which trends in reported AIDS cases and HIV sero 
prevalence show the need for increased HIV prevention activities and 
services, and (2) the extent of unmet prevention needs as identified 
through the needs assessment in the Comprehensive HIV Prevention Plan.
    2. Determine progress and continued compliance with the Community 
Planning Guidance and this document.
    3. The extent to which the short-term and long-term objectives are 
realistic, measurable, time-phased, and related to the project's 
Comprehensive HIV Prevention Plan.
    4. The quality of the recipient's plan for conducting program 
activities, the potential effectiveness of the proposed methods in 
meeting the stated objectives, and previous success in implementing 
activities and services. This includes the degree to which the proposed 
program activities and methods are science-based (i.e., theory-
predicted or based on findings of scientific research) and the 
likelihood that the recipient can effectively implement the proposed 
activities and services.
    5. The quality of the proposed evaluation plan.
    6. The extent to which the budget request is clearly explained, is 
adequately justified, and is consistent with the intended use of 
Federal funds.
    7. The degree to which the applicant has met the CDC Policy 
requirements regarding the inclusion of women, ethnic, and racial 
groups in the proposed research. This includes:
    a. The proposed plan for the inclusion of both sexes and racial and 
ethnic minority populations for appropriate representation.
    b. The proposed justification when representation is limited or 
absent.
    c. A statement as to whether the design of the study is adequate to 
measure differences when warranted.
    d. A statement as to whether the plans for recruitment and outreach 
for study participants include the process of establishing partnerships 
with communities) and recognition of mutual benefits.
    B. In addition, the external review will:
    1. Recommend specific actions for CDC to ensure that project areas 
are developing, implementing, and refining technically acceptable 
prevention plans.
    2. Recommend technical assistance or other support to further a 
project area's progress in implementing community planning.
    3. Identify innovative or promising practices in HIV prevention and 
community planning and recognize successes.
    4. Determine national progress in implementing HIV prevention 
community planning and potential technical assistance needs in 1999.

Other Requirements

A. Technical Reporting Requirements

    A report describing progress in HIV prevention community planning 
and HIV prevention program activities is required annually with the 
application for funding.
    An original and two copies of a financial status report (FSR) are 
required no later than 90 days after the end of each budget period and 
a final report after the project period. Submit the all reports to the 
Grants Management Branch, CDC.
    Statistical reports of HIV-antibody counseling and testing 
activities (OMB [Office of Management and Budget] Approval No. 0920-
0280) are required 45 days after the end of each quarter. Project areas 
are required to collect and report data for each episode of counseling 
or testing funded by CDC on all of the following variables: Project 
area, site type, site number, date of visit, sex, race/ethnicity, age, 
reason for visit, risk for HIV infection, whether test is anonymous or 
confidential, whether client accepted testing, results of test, whether 
post-test counseling occurred, date of post-test counseling and state, 
county, and zip code of client residence. Data should be collected in a 
manner consistent with and not in place of client-centered counseling. 
Project areas may collect other information to meet local data and 
evaluation needs. Project areas may use CDC scan form for reporting or 
a local form with data reported electronically. Project areas are 
encouraged to report data at client record level. Project areas may 
request technical assistance to achieve this.
    For other requirements, see the following attachments.

B. AR98-1  Human Subjects Requirements

C. AR98-2  Requirements for Inclusion of Women and Racial and Ethnic 
Minorities in Research

D. AR98-4  HIV/AIDS Confidentiality Provisions

E. AR98-5  HIV Program Review Panel Requirements

F. AR98-6  Patient Care

G. AR98-7  Executive Order 12372 Review

H. AR98-8  Public Health System Reporting Requirements

I. AR98-9  Paperwork Reduction Act Requirements

J. AR98-10  Smoke-Free Workplace Requirements

K. AR98-11  Healthy People 2000

L. AR98-12  Lobbying Restrictions

Authority and Catalog of Federal Domestic Assistance Number

    This program is authorized under sections 317, 301, and 311 of the 
Public Health Service Act (42 U.S.C. 241(a) and 247(b)), (42 U.S.C. 
241) and (42 U.S.C. 243), as amended. The Catalog of Federal Domestic 
Assistance (CFDA) number for this project is 93.940.

Where To Obtain Additional Information

    Please refer to Program Announcement 99004 when you request 
information. For a complete program description, information on 
application procedures, an application package, and business management 
technical assistance, contact: Kevin Moore, Grants Management 
Specialist, Grants Management Branch, Procurement and Grants Office, 
Announcement Number 99004, Centers for Disease Control and Prevention 
(CDC), Room 300, Mailstop E-15, 255 East Paces Ferry Road, NE., 
Atlanta, GA 30305-2209; Telephone (404) 842-6550; Email address 
<a href="/cdn-cgi/l/email-protection" class="__cf_email__" data-cfemail="0b404c463a4b484f48254c445d">[email protected]</a>; See also the CDC home page on the Internet: <a href="http://
www.cdc.gov">http://
www.cdc.gov</a>.
    For program technical assistance, contact your project officer or 
Jessica Gardom, Division of HIV/AIDS Prevention, National Center for 
HIV/STD/TB Prevention (NCHSTP), Centers for Disease Control and 
Prevention (CDC), Mailstop E-58, 1600 Clifton Road, NE., Atlanta, GA 
30333; Telephone (404) 639-5248; Email address <a href="/cdn-cgi/l/email-protection" class="__cf_email__" data-cfemail="1a50595d295a595e59345d554c">[email protected]</a>.


[[Page 27637]]


    Dated: May 13, 1998.
Joseph R. Carter,
Acting Associate Director for Management and Operations, Centers for 
Disease Control and Prevention (CDC).

Guidance: HIV Prevention Community Planning for HIV Prevention 
Cooperative Agreement Recipients

Essential Components of a Comprehensive HIV Prevention Program

    To implement a comprehensive HIV prevention program, State, local, 
and territorial health departments that receive HIV Prevention 
Cooperative Agreement funds should assure that efforts in their 
jurisdictions include all of the following essential components:
    1. A community planning process, known as HIV prevention community 
planning, in accordance with this guidance;
    2. Epidemiologic and behavioral surveillance, as well as 
compilation of other health and demographic data relevant to HIV risks, 
incidence, or prevalence;
    3. HIV counseling, testing, referral, and partner notification 
(CTRPN) with strong linkages to medical care, treatment, and other 
needed services;
    4. Health education and risk reduction (HE/RR) activities, 
including individual-, group-, and community-level interventions;
    5. Accessible diagnosis and treatment of other sexually transmitted 
diseases;
    6. Accessible diagnosis and treatment of tuberculosis and other 
opportunistic infections;
    7. School-based efforts for youth;
    8. Public information programs;
    9. Training and quality assurance;
    10. Laboratory support;
    11. HIV prevention capacity-building activities, including 
expansion of the public health infrastructure by contracting with non-
governmental organizations, especially community-based organizations;
    12. An HIV prevention technical assistance assessment and plan; and
    13. Evaluation of major program activities, interventions, and 
services.
    This guidance addresses the first of these components, HIV 
prevention community planning, and outlines the minimum standards that 
CDC requires of its health departments in the implementation of the 
community planning process. Definitions and programmatic standards and 
guidelines referenced in this guidance are further described in the 
materials included with the 1999 HIV prevention cooperative agreement 
program announcement number 99004.

Financial Support of HIV Prevention Community Planning

    HIV prevention cooperative agreement funds should be used to 
support all aspects of the community planning process, including:
    1. Supporting planning group meetings, public meetings, and other 
means for obtaining community input;
    2. Facilitating involvement of all community planning group members 
in the planning process, particularly those persons with and at risk 
for HIV infection;
    3. Supporting capacity development for inclusion,* representation** 
and parity*** of community representatives and other planning groups 
members to participate effectively in the process;
---------------------------------------------------------------------------

    * Inclusion, representation, and parity are fundamental tenets 
of HIV prevention community planning. Inclusion is defined as the 
assurance that the views, perspectives, and needs of all affected 
communities are included and involved in a meaningful manner in the 
community planning process. This is the assurance that the community 
planning process is inclusive of all the needed perspectives.
    ** Representation, is the assurance that those who are 
representing a specific community truly reflect that community's 
values, norms, and behaviors. This is the assurance that those 
representatives who are included in the process are truly able to 
represent their community. At the same time, these representatives 
should be able to participate as group members in objectively 
weighing the priority prevention needs of the jurisdiction.
    *** Parity, is the condition whereby all members of the HIV 
prevention community planning group have the skills and knowledge 
for input and participation, as well as equal voice in voting and 
other decision-making activities. This is ensuring that those 
representatives who are included in the process can participate 
equally in the decision-making process.
---------------------------------------------------------------------------

    4. Providing technical assistance to health departments and 
community planning groups;
    5. Supporting infrastructure for the HIV prevention community 
planning process;
    6. Collecting, analyzing, and disseminating relevant data; and
    7. Evaluating the community planning process.

Goal of HIV Prevention Community Planning

    The goal of HIV prevention community planning is to improve the 
effectiveness of State, local, and Territorial health departments' HIV 
prevention programs by strengthening the scientific basis, relevance, 
and focus of prevention interventions. CDC monitors progress in meeting 
this goal through the following five core objectives:
    Core Objectives:
    1. Fostering the openness and participatory nature of the community 
planning process.
    2. Ensuring that the community planning group(s) reflects the 
diversity of the epidemic in the jurisdiction, and that expertise in 
epidemiology, behavioral science, health planning, and evaluation are 
included in the process.
    3. Ensuring that priority HIV prevention needs are determined based 
on an epidemiologic profile and a needs assessment.
    4. Ensuring that interventions are prioritized based on explicit 
consideration of priority needs, outcome effectiveness, cost and cost 
effectiveness, theory, and community norms and values.
    5. Fostering strong, logical linkages between the community 
planning process, application for funding, and allocation of CDC HIV 
prevention resources.

Definition of HIV Prevention Community Planning

    HIV prevention community planning is an ongoing, iterative planning 
process that is (1) evidence-based (i.e., based on HIV/AIDS and other 
epidemiologic data, including STD and behavioral surveillance data; 
qualitative data; ongoing program experience; program evaluation; and a 
comprehensive needs assessment process) and (2) incorporates the views 
and perspectives of groups at risk for HIV infection for whom the 
programs are intended, as well as providers of HIV prevention and STD 
treatment services. Together, representatives of affected populations, 
epidemiologists, behavioral scientists, HIV/AIDS prevention service 
providers, STD treatment providers, health department staff, and others 
analyze the course of the epidemic in their jurisdiction, assess HIV 
prevention needs, determine their priority prevention needs, identify 
HIV prevention interventions to meet those needs, and develop 
comprehensive HIV prevention plans that are directly responsive to the 
epidemics in their jurisdictions. These comprehensive HIV prevention 
plans address all the essential components of a comprehensive HIV 
prevention program described in the section Essential Components of a 
Comprehensive HIV Prevention Program, or explain why a particular 
component is missing.
    Prioritizing HIV prevention needs is a critical part of program 
planning. Community planning group members are expected to follow a 
logical, evidence-based process in order to determine the highest 
priority prevention needs in their jurisdiction. These prioritized 
prevention needs are particularly important to the health department in 
allocating prevention

[[Page 27638]]

dollars. Specific high priority HIV prevention needs (both populations 
and interventions) identified in the comprehensive HIV prevention plan 
are then operationalized in the health department's application to CDC 
for Federal HIV prevention funds. There should be strong, logical 
linkages between the community planning process, the comprehensive HIV 
prevention plans, the health department's application for Federal 
funds, and the allocation of Federal HIV prevention resources by the 
health department.
    To meet this definition, community planning groups must focus 
primarily on the tasks of planning. Once a comprehensive plan has been 
developed, the community planning group should periodically review it 
to determine whether or not it is necessary to:
    1. Seek additional information to clarify and focus prevention 
priorities;
    2. Define potential methods for obtaining needed additional 
information;
    3. Give additional attention to strengthening specific 
recommendations in the plan, such as
    a. The linkages between primary prevention activities and secondary 
prevention, STD treatment, drug treatment, and medical services;
    b. Development of an in-depth plan for coordination of health 
department HIV prevention activities with the prevention activities of 
other governmental and non-governmental agencies in the jurisdiction;
    c. Conducting an assessment of technical assistance needs in the 
jurisdiction and developing a plan for meeting the needs;
    4. Review program implementation information that would inform the 
planning process and potentially affect the priorities in the plan, 
e.g., progress reports from contractors, process evaluation data from 
other program activities;
    5. Monitor any shifts in incidence;
    6. Conduct new or additional needs assessment, resource 
inventories, focus groups, etc.;
    7. Review new research findings on intervention effectiveness and 
determine the impact, if any, on the plan; and
    8. Consider how new biomedical or prevention technologies might 
best be utilized.
    These reviews may result in additional objectives for the community 
planning group in the upcoming year and an updated or revised 
comprehensive plan. Community planning groups may choose to take a 
long-term approach to their planning process, in one year reviewing the 
plan and developing action steps to strengthen it; in the next, 
focusing on implementing the steps and revising the plan; in the next, 
focusing on a particular population for which more information is 
needed; in the third, returning to the basic community planning steps. 
The planning process should be flexible, taking a long-term approach 
and negotiating meaningful tasks for the planning group that contribute 
and enhance the comprehensive plan. The important, overall goal of HIV 
prevention community planning is to have in place a comprehensive HIV 
prevention plan that is current, evidence based, adaptable as new 
information becomes available, tailored to the specific needs of each 
jurisdiction, and widely distributed in an effort to provide a road map 
for prevention that can be used by all prevention providers in the 
jurisdiction.

Principles of HIV Prevention Community Planning

    The following principles trace their origins to several sources: 
HIV prevention program assessments conducted by CDC staff; CDC's 
Planned Approach to Community Health (PATCH) program; CDC's Assessment 
Protocol for Excellence in Public Health (APEX/PH) project; the ASTHO/
NASTAD/CSTE State Health Agency Vision for HIV Prevention; the June 
1994 External Review of CDC's HIV Prevention Strategies by the CDC 
Advisory Committee on the Prevention of HIV Infection; experience and 
recommendations of health departments and non-governmental 
organizations; the health promotion, community development, behavioral 
and social sciences literature; and CDC and its partners' experience in 
implementing community planning since 1994.

All Grantees Are Required To Adhere to the Following Principles

    1. HIV prevention community planning reflects an open, candid, and 
participatory process, in which differences in cultural and ethnic 
background, perspective, and experience are essential and valued.
    2. HIV prevention community planning is characterized by shared 
priority setting between health departments administering and awarding 
HIV prevention funds and the communities for whom the prevention 
services are intended.
    3. Priority setting accomplished through a community planning 
process produces programs that are responsive to high priority, 
community-validated needs within defined populations. Persons at risk 
for HIV infection and persons with HIV infection play a key role in 
identifying prevention needs not adequately met by existing programs 
and in planning for needed services that are culturally appropriate. 
HIV prevention programs developed with input from affected communities 
are likely to be successful in garnering the necessary public support 
for effective implementation and in preventing the transmission of HIV 
infection.
    4. Representation on a community planning group includes:
    a. Persons who reflect the characteristics of the current and 
projected epidemic in that jurisdiction (as documented by the 
epidemiologic profile) in terms of age, gender, race/ethnicity, 
socioeconomic status, geographic and metropolitan statistical area 
(MSA)-size distribution (urban and rural residence), and risk for HIV 
infection. In addition to reflecting the characteristics outlined 
above, these representatives should articulate for, and have expertise 
in understanding and addressing, the specific HIV prevention needs of 
the populations they represent. At the same time, these representatives 
should be able to participate as group members in objectively weighing 
the priority prevention needs of the jurisdiction.
    b. State and local health departments, including the HIV prevention 
and STD treatment programs.
    c. State and local education agencies.
    d. Other relevant governmental agencies (e.g., substance abuse, 
mental health, corrections).
    e. Experts in epidemiology, behavioral and social sciences, program 
evaluation, and health planning.
    f. Representatives of key non-governmental and governmental 
organizations providing HIV prevention and related services (e.g., STD, 
TB, substance abuse prevention and treatment, mental health services, 
HIV care and social services) to persons with or at risk for HIV 
infection.
    g. Representatives of key non-governmental organizations relevant 
to, but who may not necessarily provide, HIV prevention services (e.g., 
representatives of business, labor, and faith communities).
    5. The HIV prevention community planning process attempts to 
accommodate a reasonable number of representatives without becoming so 
large that it cannot effectively function. To assure needed input 
without becoming too large to function, HIV prevention community 
planning group(s) seek additional avenues for

[[Page 27639]]

obtaining input on community HIV prevention needs and priorities, such 
as holding well-publicized public meetings, conducting focus groups, 
and convening ad hoc panels. This is especially important for obtaining 
input relevant to marginalized populations that may be difficult to 
recruit and retain as members of the planning group (e.g., injecting 
drug users).
    6. Nominations for membership are solicited through an open process 
and candidates are selected, based on criteria that has been 
established by the health department and the community planning group. 
The nomination and selection of new community planning group members 
occurs in a timely manner to avoid vacant slots or disruptions in 
planning. In addition, the recruitment process for membership in the 
HIV prevention community planning process is proactive to ensure that 
socioeconomically marginalized groups, and groups that are under served 
by existing HIV prevention programs, are represented.
    7. All members of the HIV prevention community planning group(s) 
are offered a thorough orientation, as soon as possible after 
appointment. The orientation includes:
    a. Understanding the roles and responsibilities outlined in this 
document,
    b. Understanding the procedures and ground rules used in all 
deliberations and decision making,
    c. Understanding the specific policies and procedures for decision-
making, resolving disputes, and avoiding conflict of interests that are 
consistent with the principles of this guidance and are developed with 
input from all parties. These policies and procedures address:
    1. Process for making decisions within the planning group (vote, 
consensus, etc.),
    2. Conflict(s) of interest for members of the planning group(s),
    3. Disputes within and among planning group(s),
    4. Differences between the planning group(s) and the health 
department in the prioritization and implementation of programs/
services, and
    5. A process for resolving these disputes in a timely manner when 
they occur.
    d. Understanding HIV prevention interventions and comprehensive 
prevention programs.
    Orienting new members is an ongoing process that may include 
mentoring new members throughout the year.
    8. Health departments assure that HIV prevention community planning 
group(s) have access to current information related to HIV prevention 
and analyses of the information, including potential implications for 
HIV prevention in the jurisdiction. Sources of information include 
evaluations of program activities, programmatic research, social and 
behavioral sciences, and other sources, especially as it relates to the 
at-risk population groups within a given community and the priority 
needs identified in the comprehensive plan.
    9. Identification, interpretation, and prioritization of HIV 
prevention needs reflect the epidemiologic profile, needs assessment, 
and culturally relevant and linguistically appropriate information 
obtained from the communities to be served, particularly persons with 
or at risk for HIV infection.
    10. Priority setting for specific HIV prevention strategies and 
interventions is based on specific criteria outlined in this document 
and each criterion should be formally considered by the HIV prevention 
community planning group(s) during priority-setting deliberations.
    11. The HIV prevention community planning process produces a 
comprehensive HIV prevention plan, jointly developed by the health 
department and the HIV prevention community planning group(s), which 
includes specific, high priority HIV prevention strategies and 
interventions targeted to defined populations. Each health department's 
application for CDC funds addresses the plan's high priority elements 
that are most appropriately met by HIV prevention cooperative agreement 
funds. The comprehensive plan includes the essential elements listed in 
the section Essential Elements of a Comprehensive HIV Prevention Plan.
    12. Because the plan is comprehensive, it should be distributed 
widely as a resource to guide programmatic activities and resources 
outside of those supported with CDC Federal HIV prevention funds.
    13. The HIV prevention community planning process is evaluated to 
ensure that it is meeting the core objectives of community planning.

Steps in the HIV Prevention Community Planning Process

    The steps of the HIV prevention community planning process follow:
    1. Epidemiologic Profile: Assess the extent, distribution, and 
impact of HIV/AIDS and other STDs in defined populations in the 
community, as well as relevant risk behaviors. In defining at-risk 
populations, special attention should be paid to distinguishing 
behavioral, demographic, and racial/ethnic characteristics. This is the 
starting point for defining future HIV prevention needs in defined, 
targeted populations within the health department's jurisdiction. Other 
methods for segmenting audiences for prevention messages may also be 
used.
    2. Needs Assessment/Resource Inventory: Assess existing community 
resources for HIV prevention and STD treatment to determine the 
community's capability to respond to the epidemic. These resources 
should include fiscal, personnel, and program resources, as well as 
support from public (Federal, State, county, municipal), private, and 
volunteer sources. This inventory should attempt to identify HIV 
prevention and STD treatment programs and activities according to the 
high-risk populations defined in the epidemiologic profile. The needs 
assessment/resource inventory should be based on a variety of sources 
(both qualitative and quantitative), should be collected using 
different assessment strategies (e.g., surveillance; survey; formative, 
process, and outcome evaluation of programs and services; outreach and 
focus group(s); public meetings), and should incorporate information 
from both providers and consumers of services. Techniques such as over 
sampling may be needed to collect valid information from certain at-
risk populations.
    3. Gap Analysis: Identify met and unmet HIV prevention and STD 
treatment needs within the high-risk populations defined in the 
epidemiologic profile and needs assessment/resource inventory. Findings 
from the needs assessment about high-risk populations (e.g., size of 
population, impact of HIV/AIDS, risk behaviors) and from the resource 
inventory about existing services should assist in identifying priority 
prevention needs. For example, if a large number of clients are turned 
away each day from an STD clinic that has a high HIV sero positivity 
rate, then there is clearly a gap in HIV prevention services.
    4. Intervention Inventory: Identify potential strategies and 
interventions that can be used to prevent new HIV infections within the 
high-risk populations defined in the needs assessment;
    5. Prioritization: Prioritize (rank order) HIV prevention needs in 
terms of: (1) High-risk populations; and (2) interventions and 
strategies for each high-risk population based on the following 
criteria:
    a. Documented HIV prevention needs based on the current and 
projected impact of HIV/AIDS and other STDs in

[[Page 27640]]

defined populations in the health department's jurisdiction;
    b. Outcome effectiveness of proposed strategies and interventions 
(either demonstrated or probable);
    c. Available information on the relative costs and effectiveness of 
proposed strategies and interventions (either demonstrated or 
probable);
    d. Sound scientific theory (e.g., behavior change, social change, 
and social marketing theories) when outcome effectiveness information 
is lacking;
    e. Values, norms, and consumer preferences of the communities for 
whom the services are intended;
    f. Availability of other governmental and non-governmental 
resources (including the private sector for HIV prevention); and
    g. Other State and local determining factors.
    Each criterion should be considered by the HIV prevention community 
planning group(s) during priority-setting deliberations. At a minimum, 
the community planning groups must provide a clear, concise, logical 
statement as to why each population and intervention given high 
priority was chosen.
    6. Plan Development: Develop a comprehensive HIV prevention plan 
consistent with the high priority needs identified through the 
community planning process. The plan must contain all of the elements 
described in the following section, Essential Elements of a 
Comprehensive HIV Prevention Plan. CDC does not require a new plan each 
year. Plans may cover more than one year. However, project areas are 
expected periodically to review, revise, and refine the plans, as 
indicated by any new or enhanced surveillance data, intervention 
research, needs assessment, program policy, or technology. (See 
Definition of HIV Prevention Community Planning)
    7. Evaluation: Evaluate the effectiveness of the planning process. 
Health departments should track and keep records on an ongoing basis in 
the following areas pertaining to the community planning process and 
development and implementation of the comprehensive HIV prevention 
plan:
    a. Recruitment of community planning group members and 
representation of affected communities and areas of expertise on the 
community planning group (Community Planning Core Objectives 1 and 2).
    b. Application of a needs assessment and an epidemiologic profile 
to determine target groups and HIV prevention strategies (Community 
Planning Core Objective 3).
    c. Application of scientific knowledge in the selection and 
formulation of intervention strategies (Community Planning Core 
Objective 4).
    d. Developing goals and measurable objectives for the planning 
process and monitoring progress on the objectives.
    e. Assessing the cost of the process.
    f. Assessing the extent to which resources allocated by the health 
department match the epidemiologic profile.
    g. Assessment of the extent to which the final version of the 
Comprehensive HIV prevention plan is used in the health department's 
budget decisions and in the planning and development of HIV prevention 
program activities (Community Planning Core Objective 5).
    8. Update: Use program evaluation data and updated or revised 
epidemiologic, needs assessment, intervention research, program policy, 
and technologic data to improve the next year's planning process and to 
update, as appropriate, the comprehensive plan. (See Definition of HIV 
Prevention Community Planning)

Essential Elements of a Comprehensive HIV Prevention Plan

    The HIV prevention community planning process should produce a 
comprehensive HIV prevention plan, jointly developed by the health 
department and the HIV prevention community planning group(s), which 
includes specific, high priority HIV prevention strategies and 
interventions targeted to defined populations.
    The necessary elements of a comprehensive HIV prevention plan 
include the following:
    1. Epidemiologic Profile: An HIV/AIDS epidemiologic profile that 
outlines the epidemic in that jurisdiction. The profile includes data 
from a variety of sources (demographic and socioeconomic data, reported 
AIDS cases, reported HIV infections from areas with confidential 
reporting, HIV sero prevalence and sero incidence surveys/studies 
(where available], HIV risk behaviors, and surrogate markers for HIV 
risk behaviors, e.g., sexually transmitted disease (STD) and teen 
pregnancy rates and information on drug use.) Furthermore, the profile 
includes a narrative explanation of all data provided.
    2. Needs Assessment/Resource Inventory/Gap Analysis: A description 
of met and unmet HIV prevention needs in target populations to be 
reached by primary HIV prevention interventions, and barriers in 
reaching populations. The description of target populations may include 
age group, gender, race/ethnicity, socioeconomic status, geographic 
area, sexual orientation, risk for HIV infection, primary language, and 
significant cultural factors.
    3. Prioritization: The populations at high risk for HIV in rank 
order (i.e., prioritization), and the culturally and linguistically 
appropriate individual-, group-, and community-level strategies and 
interventions to reach each. These high-risk populations should include 
defined target populations whose sero status is unknown, negative, or 
positive. The strategies and interventions should include the 
interventions described in the section Essential Components of a 
Comprehensive HIV Prevention Program, as well as school-based programs, 
and other HIV prevention activities. Both existing and proposed 
interventions should be described. A clear, concise, logical statement 
of the reason each prioritized intervention was selected should be 
included.
    4. Linkages: A description of how activities proposed in the 
comprehensive plan to prevent transmission or acquisition of HIV 
(primary prevention activities) are linked to activities to prevent or 
delay the onset of illness in persons with HIV infection (secondary 
prevention activities), to STD treatment, drug treatment, and Ryan 
White Comprehensive AIDS Resources Emergency (CARE) Act planning.
    5. Goals: Short and long term goals for HIV prevention in defined 
populations being reached with defined interventions.
    6. Surveillance and Research: A description of ongoing HIV 
prevention surveillance and research activities (e.g., epidemiologic 
and behavioral surveillance, research, and program evaluation 
activities), how these are linked to prevention program strategies in 
the plan, and any additional surveillance and research that is needed.
    7. Coordination: A description of how governmental and non-
governmental agencies will coordinate to provide comprehensive HIV 
prevention services and programs within the area for which the plan is 
developed.
    8. Technical Assistance Needs Assessment and Plan: An HIV 
prevention technical assistance needs assessment identifying needs of 
the health department, community planning group(s), and community-based 
providers in the areas of program planning, implementation, and 
evaluation, and a plan of activities that addresses the technical 
assistance needs.
    9. Community Planning Evaluation Plan: An evaluation plan for the 
HIV prevention planning process.

[[Page 27641]]

Letters of Concurrence/Nonconcurrence

    Each health department, in its application, must include a letter 
of concurrence or nonconcurrence from every HIV prevention community 
planning group convened within the health department's jurisdiction. At 
a minimum, the letter(s) should be signed by the co-chairs on behalf of 
the group(s).
    HIV prevention community planning group members should carefully 
review the comprehensive HIV prevention plan and the health 
department's entire application to CDC for Federal funds (including the 
proposed budget). Because the community planning process requires 
prioritization of HIV prevention needs and because prioritization 
directly corresponds to resource allocation, it is critical that the 
community planning group review the proposed allocation of resources in 
the health department's application (and, especially, to review 
expenditure levels in light of the epidemiologic profile). Community 
planning groups are not asked to review and comment on internal health 
department issues, such as salaries of individual health department 
staff, but instead to indicate:
    1. The extent to which the health department and the HIV prevention 
community planning group(s) have successfully collaborated in 
developing, reviewing, or revising the comprehensive HIV prevention 
plan;
    2. The extent to which the activities, programs, and services, for 
which the health department is requesting CDC funds, are responsive to 
the priorities in the comprehensive plan;
    3. The process used for obtaining concurrence, including
    a. A description of the process used for review of the application 
by the community planning group,
    b. The time frame allotted for the review,
    c. Who from the community planning group reviewed it (co-chairs, 
members, subcommittee chairs), and
    d. The quality of the concurrence (e.g., without reservation, with 
minor concerns, with important concerns).
    Letter(s) of concurrence may include reservations or a statement of 
concern/issues. The health department should address these reservations 
or concerns in an addendum to the HIV prevention application.
    Letter(s) of nonconcurrence indicate that an HIV prevention 
community planning group disagrees with the program priorities 
identified in the health department's application. The letter should 
cite specific reasons for nonconcurrence. In instances of 
nonconcurrence and when a health department does not concur with the 
recommendations of the HIV prevention community planning group(s) and 
believes that public health would be better served by funding HIV 
prevention activities/services that are substantially different, the 
health department must submit a letter of justification in its 
application. CDC will assess and evaluate these justifications on a 
case-by-case basis and determine what action may be appropriate. A 
letter of nonconcurrence does not necessarily mean that the 
jurisdiction will lose any portion of its CDC funding. These actions 
can range from:
    1. Obtaining more input/information regarding the situation;
    2. Meeting with the health department and co-chairs;
    3. Negotiating with the health department regarding the issues 
raised;
    4. Recommending local mediation;
    5. Approving the health department's application as is;
    6. Requesting that a detailed plan of corrective action be 
developed to address the areas of concern and to be executed within a 
specified time frame;
    7. Conducting an on-site comprehensive program assessment to 
identify and propose action steps to resolve areas of concern;
    8. Conducting an on site program assessment focused on a specific 
area(s);
    9. Developing a detailed technical assistance plan for the project 
area to help systematically address the situation; and
    10. Placing conditions or restrictions on the award of funds 
pending a future submission by the applicant.

Roles and Responsibilities--Health Departments

    State, local, and territorial health departments are responsible 
for the health of the populations in their jurisdictions. States have a 
broad responsibility in surveillance, prevention, overall planning, 
coordination, administration, fiscal management, and provision of 
essential public health services. The role of the health department in 
the community planning process is to:
    1. Establish and maintain at least one HIV prevention community 
planning group that meets the principles described in the section 
Principles of HIV Prevention Community Planning. Health departments are 
required to determine how best to achieve and integrate statewide, 
regional, and local community planning within their jurisdictions. In 
those jurisdictions where CDC has direct cooperative agreements with 
both State and local health departments, health departments are 
expected to have systems and procedures in place to facilitate 
coordination and communication between the State and local health 
departments and their community planning groups.
    2. Identify a health department employee, or a designated 
representative, to serve as co-chair of each HIV prevention community 
planning group in the project area; if State health departments 
implement more than one planning group within their jurisdiction, they 
may wish to designate local health department representatives as co-
chairs of these planning groups.
    3. Assure collaboration between HIV prevention community planning 
group(s) and other relevant planning efforts, particularly the process 
for allocating Titles I, II, and IIIb of the Ryan White Comprehensive 
AIDS Resources Emergency Act and the STD prevention program. Health 
departments may consider merging the HIV prevention community planning 
process with other planning bodies/processes already in place. If such 
mergers are undertaken, health departments must adhere to the 
principles of HIV prevention community planning, as contained in this 
document.
    4. Provide an epidemiologic profile of the HIV prevention community 
planning group's jurisdiction to assist the group in establishing 
program priorities based on the extent, distribution, and impact of the 
HIV/AIDS epidemic. The profile should compile, analyze, and synthesize 
data from a variety of sources (demographic and socioeconomic data, 
reported AIDS cases, reported HIV infections from areas with 
confidential reporting, HIV sero prevalence and sero incidence surveys/
studies [where available], HIV risk behaviors and surrogate markers for 
HIV risk behaviors, e.g., sexually transmitted disease (STD) and teen 
pregnancy rates and information on drug use.) Further, the profile 
should include a narrative explanation of all data provided and a 
summary of key findings.
    5. Provide expertise and technical assistance, including ongoing 
training on HIV prevention planning, STD treatment and the 
interpretation of epidemiologic, behavioral, and evaluation data, to 
ensure that the planning process is comprehensive and evidence based.
    6. Distribute widely the comprehensive HIV prevention plan and 
utilize existing networks to promote linkages and coordination among 
local

[[Page 27642]]

HIV prevention service providers, public health agencies, STD treatment 
clinics, community planning groups, and behavioral and social 
scientists who are either in the local area or who are familiar with 
local prevention needs, issues, and at-risk populations.
    7. Develop an application for HIV prevention cooperative agreement 
funds, based on the comprehensive HIV prevention plan(s) developed 
through the HIV prevention community planning process, seek review of 
the application and letter(s) of concurrence/nonconcurrence from the 
community planning group(s), and allocate resources based on the plan's 
priorities.
    8. Operationalize and implement HIV prevention services/activities 
outlined in the comprehensive plan including awarding and administering 
HIV prevention funds.
    9. Administer HIV prevention funds awarded under the cooperative 
agreement, ensuring that funds are awarded to contractors within 90 
days of the time that the health department receives notice of grant 
award from CDC. Monitor contractor activities and document contractor 
compliance.
    10. Ensure that technical assistance is provided to assist health 
departments and community-based providers in the areas of program 
planning, implementation, and evaluation as identified in the 
comprehensive HIV prevention plan. Health departments should meet these 
needs by drawing on expertise from a variety of sources (e.g., the CDC-
supported TA network, health departments, academia, professional and 
other national organizations, and non-governmental organizations).
    11. Administer and coordinate public funds from a variety of 
sources, including Federal, State, and local agencies, to prevent HIV 
transmission and reduce associated morbidity and mortality.
    12. Ensure program effectiveness through specific program 
monitoring and evaluation activities. This may include conducting or 
contracting for process and outcome evaluation studies, providing 
technical assistance in evaluation, or ensuring the provision of 
evaluation technical assistance to funding recipients.
    13. Provide periodic feedback to the community planning group on 
the successes and barriers encountered in implementing HIV prevention 
interventions.

HIV Prevention Community Planning Groups

    The role of the planning group(s) in the HIV prevention community 
planning process is to:
    1. Elect a community co-chair to work with the co-chair designated 
by the health department.
    2. Determine the technical assistance needs of the community 
planning group to enable them to execute an effective community 
planning process.
    3. Carefully review available epidemiologic, evaluation, behavioral 
and social science, cost and cost-effectiveness, and needs assessment 
data and other information required to prioritize HIV prevention needs.
    4. Identify unmet HIV prevention needs within defined populations.
    5. Prioritize HIV prevention needs by target populations and 
propose high priority strategies and interventions.
    6. Identify the technical assistance needs of community-based 
providers in the areas of planning, implementing, and evaluating 
prevention interventions.
    7. Assess how well the priorities outlined in the plan are 
represented in the health department's application to CDC for Federal 
HIV prevention funds.
    8. Community planning groups must focus primarily on the tasks of 
planning, as described above. Whether or not community planning groups 
take on additional tasks beyond those described in this document is 
determined locally by the health department and the community planning 
group (see Definition of HIV Prevention Community Planning). The 
planning process should be flexible, taking a long-term approach and 
negotiating meaningful tasks for the planning group that contribute and 
enhance the comprehensive plan. The important, overall goal of HIV 
prevention community planning is to have in place a comprehensive HIV 
prevention plan that is current, evidence based, adaptable as new 
information becomes available, tailored to the specific needs of each 
jurisdiction, and widely distributed in an effort to provide a road map 
for prevention that can be used by all prevention providers in the 
jurisdiction.

Shared Responsibilities Between Health Departments and HIV 
Prevention Community Planning Groups

    Together, the health department and the community planning group 
should:
    1. Develop and implement policies and procedures that clearly 
address and outline systems for regularly re-examining:
    a. Planning group composition, selection, appointment, and terms of 
office to ensure that all planning group(s) reflect, as much as 
possible, the population characteristics of the epidemic in State and 
local jurisdictions in terms of age, race/ethnicity, gender, sexual 
orientation, geographic distribution, and risk for HIV infection;
    b. Roles and responsibilities of the community planning group, its 
members, and its various components (e.g., subcommittees, workgroups, 
regional groups, etc.);
    c. Methods for reaching decisions; attendance at meetings; 
resolution of disputes identified in planning deliberations; and 
resolution of conflict(s) of interest for members of the planning 
group(s).
    2. Develop and apply criteria for selecting the individual members 
of the HIV prevention community planning group(s) within the 
jurisdiction. Special emphasis should be placed on procedures for 
identifying representatives of socioeconomically marginalized groups 
and groups that are under served by existing HIV prevention programs.
    3. Determine the most effective mechanisms for input into the HIV 
prevention community planning process. The process must be structured 
in such a way that it incorporates and addresses needs and priorities 
identified at the community level (i.e., the level closest to the 
problem or need to be addressed).
    4. Provide a thorough orientation for all new members, as soon as 
possible after appointment. New members should understand:
    a. The roles, responsibilities, and principles outlined in this 
document;
    b. The procedures and ground rules used in all deliberations and 
decision making; and
    c. The specific policies and procedures for resolving disputes and 
avoiding conflict of interests that are consistent with the principles 
of this guidance and are developed with input from all parties.
    5. Determine the distribution of planning funds to (a) support 
planning group meetings, public meetings, and other means for obtaining 
community input; (b) facilitate involvement of all participants in the 
planning process, particularly those persons with and at risk for HIV 
infection; (c) support capacity development for inclusion, 
representation, and parity of community representatives and for other 
planning group members to participate effectively in the process; (d) 
provide technical assistance to health departments and community 
planning groups by outside experts; (e) support planning infrastructure 
for the HIV prevention community planning process; (f) collect, 
analyze, and disseminate relevant data; and (g) evaluate the community 
planning process.

[[Page 27643]]

    6. Consider what additional data are needed for decision-making 
about priority needs, and propose methods for obtaining the data.
    7. Develop goals for HIV prevention strategies and interventions in 
defined target populations.
    8. Develop, update annually, and disseminate the comprehensive HIV 
prevention plan.
    9. If there are multiple community planning groups in the 
jurisdiction, integrate multiple HIV community prevention plans into a 
project-wide comprehensive HIV prevention plan.
    10. Foster integration of the HIV prevention community planning 
process with other relevant planning efforts. Consider how the 
following are addressed within the Comprehensive HIV prevention plan:
    a. HIV prevention interventions;
    b. Early intervention, primary care, and other HIV-related 
services;
    c. STD, TB, and substance abuse prevention and treatment;
    d. Women's health services;
    e. Mental health services; and
    f. Other public health needs.

Centers for Disease Control and Prevention

    The role of CDC in the HIV prevention community planning process is 
to:
    1. Provide leadership in the national design, implementation, and 
evaluation of HIV prevention community planning.
    2. Collaborate with health departments, community planning groups, 
national organizations, Federal agencies, and academic institutions to 
ensure the provision of technical/program assistance and training for 
the HIV prevention community planning process. The CDC project officer 
is key to this collaboration. He/she works with the health department 
and the community co-chairs to provide technical/program assistance for 
the community planning process, including discussing roles and 
responsibilities of community planning participants, disseminating CDC 
documents, and responding to direct inquiries to ensure consistent 
interpretation of the guidance.
    3. Provide technical/program assistance through a variety of 
mechanisms to help recipients understand how to (a) ensure parity, 
inclusion, and representation of all members throughout the community 
planning process; (b) analyze epidemiologic, behavioral and other 
relevant data to assess the impact and extent of the HIV/AIDS epidemic 
in defined populations; (c) conduct needs assessments and prioritize 
unmet HIV prevention needs; (d) identify and evaluate effective and 
cost-effective HIV prevention activities for these priority 
populations; (e) provide access to needed behavioral and social science 
expertise; (f) identify and manage dispute and conflict of interest 
issues; and (g) evaluate the community planning process.
    4. Require that application content submitted by HIV prevention 
cooperative agreement recipients for HIV prevention community planning 
funds is in accordance with the principles and the roles and 
responsibilities outlined in this guidance.
    5. Monitor the HIV prevention community planning process, 
especially around the five core objectives.
    6. Require as a condition for award of cooperative agreement funds 
that recipients' applications are in accordance with the comprehensive 
plan developed through the HIV prevention community planning process or 
include an acceptable letter of justification.
    7. Identify the essential components of a comprehensive HIV 
prevention program.
    8. Collaborate with health departments in evaluating HIV prevention 
programs.
    9. Collaborate with other Federal agencies (particularly the 
National Institutes of Health, the Substance Abuse and Mental Health 
Services Administration, and the Health Resources and Services 
Administration) in promoting the transfer of new information and 
emerging prevention technologies or approaches (i.e., epidemiologic, 
biomedical, operational, behavioral, or evaluative) to health 
departments and other prevention partners, including non-governmental 
organizations.
    10. Compile annually a report on the projected expenditures of HIV 
prevention cooperative agreement funds by specific strategies and 
interventions. Collaborate with other prevention partners in improving 
and integrating fiscal tracking systems.

Accountability

    CDC is committed to the concept of HIV prevention community 
planning as outlined in this guidance. In summary, CDC expects that:
    1. Health departments will support and facilitate the community 
planning process;
    2. Community planning groups will develop plans in which they have 
prioritized (rank ordered) HIV prevention needs, including populations 
and interventions;
    3. Health departments will reflect these priorities in their 
applications to CDC and implement effective HIV prevention programs 
based on the comprehensive HIV prevention plan; and
    4. Community planning groups will review the entire application for 
their jurisdiction, including the budget, prior to writing letters of 
concurrence and nonconcurrence.
    CDC will continue to conduct external reviews of health department 
HIV prevention cooperative agreement applications and comprehensive HIV 
prevention plans to monitor the progress health departments and 
community planning groups are making in meeting these expectations. 
These reviews will focus on whether or not:
    1. A jurisdiction's planning process is in compliance with this 
guidance and the five core objectives;
    2. Priority populations and recommended interventions identified in 
the comprehensive HIV prevention plan are consistent with the 
epidemiologic profile, needs assessment, and behavioral/social science 
data presented in the plan;
    3. Proposed prevention program objectives, activities, and budget 
in the application are consistent with the comprehensive HIV prevention 
plan; and
    4. Any discrepancies noted are adequately justified.
    CDC will review the recommendations provided by the External 
Reviewers and consider them when making decisions concerning issues 
such as funding restrictions and conditions, as well as detailed plans 
of technical assistance.

[FR Doc. 98-13307 Filed 5-18-98; 8:45 am]
BILLING CODE 4163-18-P


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