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The Changing Landscape of HIV Prevention in the United States: Health Department Experiences and Local Adaptations in Response to the National HIV/AIDS Strategy and High-Impact Prevention Approach

Fisher, Holly, H., PhD; Essuon, Aba, PhD; Hoyte, Tamika, MPH; Shapatava, Ekaterine, MPH; Shelley, Gene, PhD; Rios, Aisha, PhD; Beane, Stephanie, PhD; Bourgeois, Stacey, BS; Dunbar, Erica, MPH; Sapiano, Tobey, MPH

Journal of Public Health Management and Practice: May/June 2018 - Volume 24 - Issue 3 - p 225–234
doi: 10.1097/PHH.0000000000000575
Research Reports: Research Full Report

Objective: HIV prevention has changed substantially in recent years due to changes in national priorities, biomedical advances, and health care reform. Starting in 2010, motivated by the National HIV/AIDS Strategy (NHAS) and the Centers for Disease Control and Prevention's (CDC's) High-Impact Prevention (HIP), health departments realigned resources so that cost-effective, evidence-based interventions were targeted to groups at risk in areas most affected by HIV. This analysis describes how health departments in diverse settings were affected by NHAS and HIP.

Methods: We conducted interviews and a consultation with health departments from 16 jurisdictions and interviewed CDC project officers who monitored programs in 5 of the jurisdictions. Participants were asked to describe changes since NHAS and HIP and how they adapted. We used inductive qualitative analysis to identify themes of change.

Results: Health departments improved their HIV prevention practices in different ways. They aligned jurisdictional plans with NHAS and HIP goals, increased local data use to monitor program performance, streamlined services, and strengthened partnerships to increase service delivery to persons at highest risk for infection/transmission. They shifted efforts to focus more on the needs of people with diagnosed HIV infection, increased HIV testing and routine HIV screening in clinical settings, raised provider and community awareness about preexposure prophylaxis, and used nontraditional strategies to successfully engage out-of-care people with diagnosed HIV infection. However, staff-, provider-, and data-related barriers that could slow scale-up of priority programs were consistently reported by participants, potentially impeding the ability to meet national goals.

Conclusion: Findings suggest progress toward NHAS and HIP goals has been made in some jurisdictions but highlight the need to monitor prevention programs in different contexts to identify areas for improvement and increase the likelihood of national success. Health departments and federal funders alike can benefit from the routine sharing of successes and challenges associated with local policy implementation, considering effects on the overall portfolio of programs.

Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Fisher, Essuon, and Shelley and Mss Hoyte, Shapatava, Bourgeois, Dunbar, and Sapiano); Karna LLC, Atlanta, Georgia (Dr Rios); and Rollins School of Public Health, Emory University, Atlanta, Georgia (Dr Beane).

Correspondence: Holly H. Fisher, PhD, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop E-59, Atlanta, GA 30333 (

This work was funded by the Centers for Disease Control and Prevention. The authors acknowledge the hard work and commitment of the members of the Changing Landscapes project team: Maria Alvarez, Lisa Belcher, Reginald Carson, Erika Copeland, Samuel Dooley, Odessa Dubose, Frank Ebagua, Renata Ellington, Kimberly Fambro, Benny Ferro, Janet Heitgerd, Angela Hickman, Lisa Kimbrough, Barbara Maciak, Jesse Milan Jr, Antonya Rakestraw, Shuenae Smith, Renee Stein, Dale Stratford, Gary Uhl, and Marlena Wald.

The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

The authors declare no conflicts of interest.

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