The 2017-2021 Iowa Comprehensive HIV Plan serves as a statewide guide to responsive, effective, and efficient HIV service delivery in Iowa. Goals and strategies included in this strategic plan are designed to meet the specific needs of Iowans who are at high-risk for HIV infection, who are members of populations disproportionately impacted by HIV, and/or who are living with HIV/AIDS.
Purpose of HIV Plan
In accordance with direction from the Iowa Department of Public Health’s (IDPH) primary federal funding agencies for HIV-related programs, the U.S. Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA), this comprehensive plan has been developed to improve the effectiveness of the state’s HIV prevention and care programs by strengthening the scientific basis, relevance, and focus of prevention and care strategies.
Developments in Health Care for PLWH
Iowa is at a critical juncture in addressing HIV. Significant changes to the health care environment, combined with recent studies that demonstrate the utility of treatment as prevention, have significantly altered the way in which state and local programs deliver prevention, care, and treatment services. Some of these developments include:
- Further scientific evidence demonstrating that HIV antiretroviral treatment (ART) not only provides tremendous clinical benefit to an HIV-infected person, but it can also significantly reduce the risk of HIV transmission to partners;
- The full implementation of the Affordable Care Act (ACA), which has increased access to preventive health and health care services for thousands of Iowans, including people with HIV;
- Approval of pre-exposure prophylaxis and single-dose drug regimens for HIV, and effective oral-only therapies for viral hepatitis; and
- An increase in Ryan White funding through the Part B Supplemental Program. These funds will significantly increase the state’s capacity to address the stages of the HIV Continuum of Care to assist more people to ultimately attain viral suppression.
GOAL 1: Reducing new HIV infections
OBJECTIVE A: By December 31, 2021, decrease the proportion of people who are infected yet unaware of their statuses from 20% in 2014 to 10%.
OBJECTIVE B: By December 31, 2021, reduce the number of new HIV diagnoses by 25% (reduce to 93 from baseline of 124 in 2015).
GOAL 2: Increasing access to care and improving health outcomes for PLWH
OBJECTIVE A: By December 31, 2021, link 95% of people living with HIV to care services within one month of diagnosis (baseline of 88% in 2015).
OBJECTIVE B: By December 31, 2021, reduce the proportion of Iowans diagnosed with HIV who are out-of-care to 10% or less (baseline of 17% in 2015).
OBJECTIVE C: By December 31, 2021, increase the retention in care of people living with HIV to 90% (baseline of 83% in 2015).
OBJECTIVE D: By December 31, 2021, promote adherence to treatment guidelines to increase the number of PLWH who have attained viral suppression to 90% (baseline of 76% in 2015).
GOAL 3: Reducing HIV-related disparities and health inequities
OBJECTIVE A: By December 31, 2021, reduce the diagnosis disparity rate among African Americans/Blacks and MSM by 15%.
OBJECTIVE B: By December 31, 2021, ensure a 90% viral suppression rate among African Americans/Blacks (67% in 2015) and among Latinxs (64% in 2015).
OBJECTIVE C: By the end of 2021, certify at least 5 IDPH-contracted sites as “Health Equity Providers of Excellence”.
OBJECTIVE D: By December 31, 2021, measure a 10% decrease in HIV-related stigma as reported by people living with HIV on the Consumer Needs Assessment.
Iowa’s HIV service providers, public health experts, and advocates are in a to address the HIV epidemic by capitalizing on Iowa’s resources and programs. This is the role and responsibility of the Plan Development Group that was formed to develop this plan as well as that of the HIV and Hepatitis Community Planning Group (CPG) that will be involved in the implementation and monitoring of this plan.
The plan is divided into three sections:
Section 1 - Statewide Coordinated Statement of Need
Section one contains information that answers the question, “what is the state of HIV prevention and care in Iowa?” This section presents an epidemiological summary of the state’s current HIV epidemic which is designed to provide an overview of HIV among the state’s populations in terms of sociodemographic, geographic, behavioral, and clinical characteristics. A thorough understanding of the epidemic, including trends and future forecasting, is necessary for determining how best to reduce the impact of HIV in the state. The current HIV Continuum of Care is presented along with results from the most recent Consumer Needs Assessment (CNA) and HIV Prevention Provider Services Survey.
Section 2 - HIV Prevention & Care Plan
Section two explores the contrast between the current state of Iowa’s HIV/AIDS epidemic and the preferred future in which the impact of HIV is reduced by improved prevention and care efforts. A strategy is presented in this section that both responds to the needs identified in Section I of the Statewide Coordinated Statement of Need (SCSN) and that aligns with the three National HIV/AIDS Strategy (NHAS) goals: (1) reducing new HIV infections; (2) increasing access to care and improving health outcomes for people living with HIV (PLWH); and (3) reducing HIV related disparities and health inequities.
Section 3 - Monitoring and Improvement
This final section describes the process for monitoring and evaluating implementation of the goals and objectives from Section II. A description of how surveillance and program data will be used to improve health outcomes along the HIV Continuum of Care is included. Additionally, the process for regularly updating planning bodies and stakeholders on the progress of plan implementation, soliciting feedback, and using the feedback from stakeholders for plan improvements is included in this section.
The Nation’s first comprehensive National HIV/AIDS Strategy for the United States (Strategy) was released in 2010, and in the subsequent five years, people and organizations have joined together around its vision and goals. The Strategy has changed the way the American people talk about HIV, prioritize and organize prevention and care services locally, and deliver clinical and non-clinical services that support people living with HIV to remain engaged in care, and has helped achieve the following:
- Implementation of the Affordable Care Act
- Groundbreaking work by the National Institutes of Health (NIH)
- The introduction of PrEP (pre-exposure prophylaxis)
- Vital work by the Centers for Disease Control and Prevention (CDC), including key guidance for the adoption of new testing technologies
- Critical funding increases for the AIDS Drug Assistance Program (ADAP) of the Health Resources and Services Administration (HRSA)
- Major strides in collaboration across the Federal government
- A Federal interagency workgroup was established to investigate the intersection of HIV and violence against women and it resulted in more than 15 new initiatives within two years.
- The Department of Justice (DOJ) collaborated with CDC to publish a comprehensive examination of HIV-specific criminal laws.
- Demonstration projects funded through the Secretary’s Minority AIDS Initiative Fund (SMAIF)
Stop HIV Iowa is one of the several agencies nationwide supporting this plan and implementing projects appropriate for Iowans.