Address correspondence to: Holly H. Fisher, PhD, Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, 1600 Clifton Rd. NE, MS E-59, Atlanta, GA 30333, Phone: 404-639-1940, Fax: 404-639-0929, vog.cdc@rehsifh.
Copyright © 2016 Association of Schools and Programs of Public HealthThe Enhanced Comprehensive HIV Prevention Planning (ECHPP) project was a demonstration project implemented by 12 U.S. health departments (2010–2013) to enhance HIV program planning in cities with high AIDS prevalence, in support of National HIV/AIDS Strategy goals. Grantees were required to improve their planning and implementation of HIV prevention and care programs to increase their impact on local HIV epidemics. A multilevel evaluation using multiple data sources, spanning multiple years (2008–2015), will be conducted to assess the effect of ECHPP on client outcomes (e.g., HIV risk behaviors) and impact indicators (e.g., new HIV diagnoses).
We designed an evaluation approach that includes a broad assessment of program planning and implementation, a detailed examination of HIV prevention and care activities across funding sources, and an analysis of environmental and contextual factors that may affect services. A data triangulation approach was incorporated to integrate findings across all indicators and data sources to determine the extent to which ECHPP contributed to trends in indicators.
To date, data have been collected for 2008–2009 (pre-ECHPP implementation) and 2010–2013 (ECHPP period). Initial analysis of process data indicate the ECHPP grantees increased their provision of HIV testing, condom distribution, and partner services programs and expanded their delivery of prevention programs for people diagnosed with HIV.
The ECHPP evaluation (2008–2015) will assess whether ECHPP programmatic activities in 12 areas with high AIDS prevalence contributed to changes in client outcomes, and whether these changes were associated with changes in longer-term, community-level impact.
In 2010, the White House released the National HIV/AIDS Strategy (NHAS), a five-year plan that detailed principles, priorities, and actions to guide the national response to the human immunodeficiency virus (HIV) epidemic. 1 NHAS included four main goals: reduce new HIV infections, increase access to care and optimal health outcomes for people living with HIV infection (PLWH), reduce HIV-related health disparities, and achieve a more coordinated response to the HIV/AIDS epidemic. In support of this national strategy, the Centers for Disease Control and Prevention (CDC) conducted the Enhanced Comprehensive HIV Prevention Planning (ECHPP) project from September 30, 2010, to September 29, 2013. 2 , 3 Through ECHPP, health departments in the 12 U.S. metropolitan statistical areas with the highest prevalence of acquired immunodeficiency syndrome (AIDS) were required to conduct a situational analysis of all their HIV prevention and care activities (across all sources of HIV funding). Based on this analysis, the health departments were required to develop a set of goals and strategies that would increase the impact of their HIV programs on the local epidemic and increase the likelihood they would meet NHAS goals.
The ECHPP project was unique in that it required CDC's Division of HIV/AIDS Prevention to evaluate the collective implementation of numerous HIV prevention and care interventions across multiple sites. Typically, a program evaluation focuses on an assessment of a single intervention or program and whether or not intended client outcomes were achieved, comparing outcomes of the intervention arm with the outcomes of a planned control or comparison arm, in which a similar population did not receive the intervention. Funded with non-research (i.e., program) funds, the ECHPP project did not have a research design that used random assignment or planned comparison groups. Instead, the ECHPP project used a new programmatic approach that charged health departments with making local programmatic changes to maximize the impact of their HIV programs, considering all sources of HIV funding (CDC and other federal, state, local, and private funding streams). Additionally, the ECHPP evaluation was designed to use data from existing data sources only, avoiding the need to conduct new, costly, and time-consuming data collection activities. Taking these factors into consideration, to assess the overall success of the ECHPP project, the Division of HIV/AIDS Prevention developed an evaluation approach that would accommodate 12 unique program models implemented in 12 unique geographic areas with 12 unique local epidemics. This article describes the overall evaluation approach and specific evaluation activities; some have been completed, and others are in progress.
The overall ECHPP evaluation goals are ultimately to assess whether or not ECHPP programmatic activities in 12 areas with a high prevalence of AIDS contributed to changes in client outcomes (e.g., client-reported HIV risk behaviors and access to service) and whether or not the changes in client outcomes were associated with changes in longer-term measures of impact (e.g., community-level trends in HIV diagnoses and prevalence). Once completed, this evaluation will provide a better understanding of HIV-related activities supported by health departments in high-prevalence areas and how health departments leveraged local prevention and care resources to increase local impact. Additionally, the evaluation will provide an opportunity for federal agencies to identify strategies that increase the coordination, collaboration, and integration of HIV-related services and the standardization and streamlining of data collection both within and across agencies. 4 – 6
Each health department was required to develop an enhanced comprehensive HIV program plan to describe how it would improve its HIV prevention and care services using a combination of interventions, intervention targets, and intervention scales to optimize impact on NHAS goals. 3 Program plans focused on priority populations (black/African American, Hispanic/Latino, injecting drug users, high-risk heterosexuals, men who have sex with men, and PLWH) consistent with the needs of the local epidemic. CDC provided a list of 24 required or recommended interventions ( Table 1 ), many of which were already being implemented at some level in these sites. Innovative local initiatives, if approved by CDC, could also be included in a health department's plan.
Required and recommended interventions, by category—Enhanced Comprehensive HIV Prevention Planning (ECHPP) project sites, a 2010–2013
a The 12 ECHPP sites were Atlanta, Georgia; Baltimore, Maryland; Chicago, Illinois; Dallas, Texas; Houston, Texas; Los Angeles, California; Miami, Florida; New York, New York; Philadelphia, Pennsylvania; San Francisco, California; San Juan, Puerto Rico; and Washington, D.C.
b Required intervention
c Recommended intervention
