27628 Federal Register / Vol. 63, No. 96 /Tuesday, May 19, 1998 / Notices

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.

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 communitylevel 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 communitybased 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:

• Develop a comprehensive HIV

Prevention Plan for their jurisdictions
Federal Register / Vol. 63, No. 96 /Tuesday, May 19, 1998 / Notices 27629

through a participatory process as

described in the Guidance on HIV

Prevention Community Planning

(included in application kit).

• 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, communityvalidated 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:

• 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:

• Routinely offer, on a voluntary basis

with informed consent, confidential

client-centered HIV prevention

counseling and HIV laboratory testing

services.

• Provide, unless prohibited by law

or regulation, anonymous opportunities

for persons to receive client-centered

HIV prevention counseling and HIV

laboratory testing.

• 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.

• 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.

• 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. Clientcentered 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:

• Culturally competent;

• Sensitive to issues of sexual

identity;

• Developmentally appropriate; and

• 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:

• 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.

• 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 HIVinfected at any CTRPN service site

should receive:

• A CD4+ cell test, an initial viral

load staging, or the current

recommended test to determine stage of

illness; and appropriate medical

management;

• An assessment of medical eligibility

for treatment;

• 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;

• Prevention case management;

• Referral for substance abuse

treatment, if indicated;

• Referrals for all indicated services;

• 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.
27630 Federal Register / Vol. 63, No. 96 /Tuesday, May 19, 1998 / Notices

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:

• Establish standards, implement,

and maintain procedures for

confidential voluntary notification of

sex and needle-sharing partners of HIVinfected persons, consistent with the

CDC Partner Notification Guidance, to

be published.

• Maintain their good faith effort to

notify spouses of infected persons as

required by law and as certified to CDC.

• Develop, implement, and maintain

a mechanism to determine that

notification and appropriate follow up

of partners has been completed.

• 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 clientcentered 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 needlesharing 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:

• 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;

• Plan, refine, and target program

intervention strategies;

• Analyze and refine resource

allocation;

• Provide population-specific

feedback to health departments,

community-based organization staff,

community planning groups, and other

community prevention partners; and

• 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:

• 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.

• Ensure interventions are culturally

competent, developmentally

appropriate, linguistically specific, and

sensitive to sexual identity.

• 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 highrisk 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
Federal Register / Vol. 63, No. 96 /Tuesday, May 19, 1998 / Notices 27631

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:

• 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;

• Persuading community members

who are at risk of acquiring or

transmitting HIV infection to accept and

use HIV prevention measures; and

• 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 riskreduction 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:

• 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.

• 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.

• 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.

• 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.

• Develop and implement a

mechanism to determine that

notification and follow up of partners

has been completed. Review data and

improve process as necessary.

• Develop and implement a

mechanism to assure HE/RR activities
27632 Federal Register / Vol. 63, No. 96 /Tuesday, May 19, 1998 / Notices

are culturally competent,

developmentally appropriate,

linguistically specific, and sensitive to

sexual identity.

• 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:

• 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.

• 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 nongovernmental 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:

• 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.

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

• Ongoing data collection and

monitoring regarding the

implementation of health department

and health department-funded program

activities.

• Assessment of the congruency

between the intended and actual

implementation of health department

and health department-funded program

activities.

• 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 nongovernmental) 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 81⁄2′′ 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
27634 Federal Register / Vol. 63, No. 96 /Tuesday, May 19, 1998 / Notices

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:
Federal Register / Vol. 63, No. 96 /Tuesday, May 19, 1998 / Notices 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 nongovernmental 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 nonconcurrence. 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
27636 Federal Register / Vol. 63, No. 96 /Tuesday, May 19, 1998 / Notices

(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., theorypredicted 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

KGM1@CDC.GOV; See also the CDC

home page on the Internet: http://

www.cdc.gov.

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 JCG3@CDC.GOV.
Federal Register / Vol. 63, No. 96 /Tuesday, May 19, 1998 / Notices 27637

* 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 decisionmaking process.

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 communitylevel 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 communitybased 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;

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
27638 Federal Register / Vol. 63, No. 96 /Tuesday, May 19, 1998 / Notices

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 nongovernmental 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 nongovernmental 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
Federal Register / Vol. 63, No. 96 /Tuesday, May 19, 1998 / Notices 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
27640 Federal Register / Vol. 63, No. 96 /Tuesday, May 19, 1998 / Notices

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.
Federal Register / Vol. 63, No. 96 /Tuesday, May 19, 1998 / Notices 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 caseby-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
27642 Federal Register / Vol. 63, No. 96 /Tuesday, May 19, 1998 / Notices

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 costeffectiveness, 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 reexamining:

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

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