HRSA’s HIV Emergency Relief Grants support emergency services to those Eligible Metropolitan Areas (EMAs) that are most severely affected by the HIV/AIDS epidemic. There are 51 EMAs. The program includes approximately 32 HIV-related service categories, such as: outpatient and ambulatory health services, including substance abuse and mental health treatment; other health and social support services for individuals with HIV who live in EMAs. The services are intended primarily for low-income, uninsured, and underinsured people living with HIV/AIDS. HIV Emergency Relief Grants are available to EMAs with populations of at least 500,000 that have had a total of 2,000 cases of AIDS during the most recent 5-year period. Of the 533,000 people in the care system who are infected with HIV, approximately 73 percent, or 365,000, reside in an EMA.

• HRSA’s HIV Emergency Relief Grants provided for 2.67 million visits for health-related care (primary medical, dental, mental health, substance abuse, rehabilitative, and home health) in FY 2001.
• HIV Emergency Relief Grants served people of color and women in proportions that significantly exceed their representation in the overall AIDS epidemic. (See Table 1)

Increase the number of visits for health-related care (primary medical, dental, mental health, sub- stance abuse, rehabilitative, and home health) to a level that approximates inclusion of new clients from 2.71 million visits in FY 2000 to an estimate of 2.92 million visits in FY 2002.

Serve a proportion of women and racial/ethnic minorities in Title I-funded programs that exceeds their representation in National AIDS prevalence data, as reported by CDC, by a minimum five percentage points:

The HIV Care Grants to States provides formula grants to all 50 States, the District of Columbia, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, Guam, and five U.S. Pacific Territories and Associated Jurisdictions (American Samoa, the Commonwealth of the Northern Mariana Islands, the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau). HIV Care Grantees may use their grants to provide:

• Ambulatory health care
• Home-based health care
• Insurance coverage
• Support services
• Medications-AIDS Drug Assistance Program (ADAP)
• Outreach to HIV-positive individuals who know their HIV status
• Early intervention services
• HIV Care Consortia, which assess needs and contracts for services

• HRSA’s HIV Care Grants provided for 1.46 million visits for health-related care (pri- mary medical, dental, mental health, substance abuse, rehabilitative, and home health) in FY 2001.
• HRSA grantees served women and minorities in proportions that exceed their representation in the total U.S. population with AIDS. (See Table 2)

HIV Care Grants include State ADAP that funded 73,784 ADAP clients who received HIV/AIDS medications during at least 1 month of the year in 2001.

HRSA Grants allowed ADAP clients to have access to a broader range of pharmaceuticals to allow for comprehensive therapy. The number of State ADAPs with 26 or more drugs on their formulary increased from 17 in 1997 to 23 in 2001.

In 2001, 50 out of the 54 State ADAPs participated in the drug discount program. Savings from cost-recovery strategies, including participation in this program, increased from $24.4 million in 1997 to $65.5 million in 2001 (a savings increase of 268 percent).

In addition, a policy was developed that allows ADAPs to use ADAP-earmarked funds to purchase health insurance that covers the full range of HIV treatments, comparable to the level of medications the client receives through the State ADAP, and access to comprehensive primary care services as another cost-effective means of providing therapies to eligible clients.

Increase the number of ADAP clients receiving HIV/AIDS medications through State ADAPs during at least 1 month of the year from 73,784 in FY 2001 to an estimated 84,800 clients in FY 2002.

The HIV Early Intervention Services (EIS) Program supports comprehensive primary health care for individuals living with HIV disease. The range of services under HIV early intervention programs include: HIV antibody testing and counseling, medical evaluation, clinical care, antiretroviral therapies, protection against opportunistic infections, oral health, nutritional services, psychosocial support, mental health, case management, and substance abuse counseling. The program also funds planning grants, which help eligible entities to plan for the provision of high quality, comprehensive HIV primary care services in rural and urban areas and communities of color. Additionally, Capacity Building funds are available to eligible entities to strengthen their organizational infrastructure and enhance their capacity to develop, enhance, or expand high quality HIV primary health care services to rural or urban underserved areas and communities of color.

• HAB funded 27 new early-intervention services programs in FY 2002. All of the newly funded EIS programs were previously planning grants. Seventeen were previously funded under the Rural and Underserved Planning Grant Initiative and 13 were previously funded under the Community of Color Planning Grant Initiative. The programs represent a cross section of community-based and public organizations. The organizations include Federally qualified Health Centers; Migrant Health Centers; non-Federally funded community-based health centers; city and county health departments; hospital and university-based medical centers; Health Care for the Homeless sites; family planning grantees; public or private not-for-profit providers of primary care for populations at risk for HIV; faith-based and community-based organizations; and Comprehensive Hemophilia Diagnostic and Treatment Centers.
• HAB’s grantees provided primary medical care services to 157,803 patients in FY 2001. Of those clients, 68.5 percent were minorities. The level of performance reflects increased efforts to target communities of color.
• HAB established planning and capacity building grant programs to assist communities in their effort to develop HIV primary care services. In FY 2002, HAB funded 58 planning grant projects. Forty-two of the planning grants were funded under the Community of Color Initiative and 16 under the Rural and Underserved Initiative.

Increase the number of people receiving primary care services under Early Intervention Services programs from 129,654 clients in FY 2000 to an estimated 138,968 in FY 2002.

Increase the number of racial and ethnic minorities who are receiving primary care services under Early Intervention programs from 87,905 clients in FY 2000 to an estimated 97,277 clients in FY 2002.

These grants support programs for children, youth, women, and families infected or affected by HIV/AIDS. The programs provide coordinated, comprehensive, family-centered systems of care, support services, and access to clinical and other research activities. A special focus of the program is to help identify HIV-positive pregnant women and connect them with care that can improve access to a comprehensive system of health and social services. The youth served consist primarily of historically underserved populations who face significant barriers to accessing care and are confronted with a complex array of medical, economic, and social issues. This population requires intensive case management, child and respite care, and unique models of direct service delivery. Services include: primary and specialty medical care; psychosocial services; logistical support and coordination; and outreach and case management. Project areas include:

• 74 grants for coordinating HIV services and accessing research for children, youth, women, and families
• Sixteen youth initiative grants

• HRSA’s grantees provided comprehensive services to 24,894 enrolled women in 2000, including appropriate services before or during pregnancy to reduce perinatal transmission. Among the women, 3,112 were age 13 to 19, 3,220 were 20 to 24 years old, and 18,558 were 25 years of age and older.
• HRSA’s grantees provided comprehensive prenatal care to 3,307 enrolled women. Eighty-eight percent of clients served by this program were minorities; 63 percent were African American, non Hispanic, 24 percent were Hispanic and one percent was either Asian, American Indian, Alaskan Native, or other Pacific Islanders.
• As a result, the number of newly reported AIDS cases caused by perinatal transmission was reduced from 310 in 1997 to 175 in 2001. This is viewed as a great success.
• In the programs, HIV-positive pregnant women are identified, counseled, and connected with the care that can improve their health and reduce the chances of perinatal transmission. By choosing to take the medications and giving them to their newborns, the numbers of newborns with prenatally acquired HIV continue to decrease significantly.

Decrease by 5 percent annually the number of newly reported AIDS cases in children as a result of perinatal transmission from 177 children reported in FY 2000 to an estimate of 160 children in FY 2002.

The AIDS Education and Training Centers (AETC) program supports a network of 14 regional centers (with more than 75 local performance sites) that conduct targeted, multidisciplinary HIV/AIDS education and training programs for health care providers treating persons with HIV/AIDS. The AETCs serve all 50 States, the District of Columbia, the Virgin Islands, Puerto Rico, and six U.S. Pacific Jurisdictions (Guam, American Samoa, the Commonwealth of the Northern Mariana Islands, the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau). The AETC program increases the number of health care providers who are effectively educated and motivated to counsel, diagnose, treat, and medically manage individuals with HIV infection, and to help prevent high risk behaviors that lead to HIV transmission. Training is preferentially targeted to providers who serve minority populations, the homeless, rural communities, incarcerated persons, and Ryan White CARE Act-funded sites.

Four National, cross-cutting components of the AETC program support and complement the regional training centers. The National Minority AETC (NMAETC) was established with funding from the Congressional Black Caucus Minority AIDS Initiative to benefit minorities who are disproportionately affected by HIV/AIDS. The NMAETC was a National mandate to increase the capacity of minority clinicians providing quality care for HIV-positive individuals. Minority and minority-serving health professionals in communities disproportionately affected by the AIDS epidemic have a greater probability of reaching people affected by or infected with HIV or AIDS. The National HIV/AIDS Clinical Consultation Center provides health care providers with a National resource to obtain timely and appropriate responses to clinical questions related to treatment of persons with HIV infection (“warmline”) and/or possible health care worker exposure to HIV and other blood-borne pathogens (“PEPline”). The AETC National Resource Center disseminates training resources, latest HIV clinical information, changes to treatment guidelines, critical review of available patient education material, and best practices to other AETCs via the Internet and other media. Also, they have a key role in developing and maintaining National AETCs curricula. Additionally, the Evaluation Center is responsible for program evaluation activities, including assessing effectiveness of the AETC’s education, training, and consultation activities.

The overall mission of the AETCs is to increase the competence of health care providers to counsel, diagnose, treat, and manage HIV-infected individuals. The AETCs play a critical role in the dissemination of Federal HIV treatment guidelines. The AETCs target their training to medical providers caring for underserved and marginalized patient populations.

• The resource center is a web-based HIV/AIDS training resource that supports the training needs of the regional AETC’s through coordination of HIV training material, rapid dissemination of late-breaking advances in treatment and changes to treatment guidelines, and critical review of available patient education materials.
• The AETCs have more than 5,000 training events annually and train close to 100,000 participants a year. During FY 2001, 48 percent of persons trained were minority health care and social service providers.
• Since 1997, the national telephone hotline answered more than 17,000 calls.

Increase the proportion of racial/ethnic minority health care providers participating in AETC training intervention programs from 43 percent in FY 2000 to an estimate of 41 percent in FY 2002.

The HRSA Dental Reimbursement Program supports access to oral health care for individuals with HIV infection, by reimbursing dental education programs for non-reimbursed costs incurred in providing such care. Institutions eligible for reimbursement are dental schools, post-doctoral dental education programs such as hospital-based residencies, and dental hygiene education programs that are accredited by the Commission on Dental Accreditation and have documented non-reimbursed cost incurred in providing oral health care to HIV-positive persons. The oral health care provided includes diagnostic, preventive, oral health education and health promotion, restorative, periodontic, prosthodontic, endodontic, oral surgery, and oral medicine services. By offsetting the non-reimbursed HIV care in dental education institutions, the Dental Reimbursement programs address the dual goals of improving access to oral health care and training new generations of dental and dental hygiene students, and dental residents, to manage the oral health care of persons with HIV.

The Community-Based Dental Partnership program funded eligible entities for the first time in FY 2002. Awards were made to twelve institutions with accredited dental education programs to partner with community-based dentists to increase access to oral health care for people with HIV and to train additional providers in the care of patients with HIV in community settings. Grant recipients were awarded funds for a three-year project period, and are geographically and organizationally diverse.

• The Program reimbursed 66 institutions, with dental education programs, 75 percent of the non-reimbursed costs of oral health care they provided to about 29,000 HIV-positive patients reported in 2002.

Increase the number of persons for whom a portion/percentage of their unreimbursed oral health care costs was reimbursed from 29,000 persons in FY 2001 to an estimate of 29,800 person in FY 2002.

The CARE Act authorizes HRSA to use up to $25 million from funds appropriated for Parts A, B, C, and D for Special Projects of National Significance (SPNS). SPNS grants fund innovative models of care and supports the development of effective delivery systems for HIV care. These projects advance knowledge and skills in the delivery of health and support services to underserved populations diagnosed with HIV infection. The SPNS program is considered the research and development arm of the CARE Act. SPNS assesses the effectiveness of models of care, supports innovative program designs, and promotes replication of effective models. Funded projects contain a strong evaluation component and disseminate information necessary for effective replication.

• Evaluating the impact of Information Technology on improving the delivery and quality of care for HIV seropositive individuals
• Supporting the coordination and integration of existing services for Native Americans/ Alaska Natives living with HIV and other-comorbidities
• Prevention with HIV infected persons seen in primary care settings

• Improving quality of HIV care
• Developing methods to estimate unmet needs
• Collaborating with CDC on interventions for HIV-positive substance abusers and continuity of care for incarcerated individuals
• Developing and evaluating end-of-life care and palliation models
• Assessing existing treatment education/adherence efforts
• Establishing and assessing HIV care networks
• Assessing innovations in serving those with chemical dependencies
• Assessing primary prevention strategies for HIV-positive persons

• Since FY 1991, $244 million in CARE Act funds have been set aside for the SPNS Program.

• Demonstration and evaluation models that advance HIV service innovation along the U.S. and Mexico Border
• HIV/AIDS Treatment Adherence Health Outcome and Cost Study
• Services to people with HIV in correctional settings
• Innovative HIV service delivery models for Native American communities

A sample of 4,804 individuals served by SPNS projects found that the program was serving the most underserved populations: only 9 percent had private health insurance, only 17 percent had earned income; 57 percent had not completed high school; and 73 percent were people of color.

In addition to the HIV/AIDS programs that we manage directly, we support several special initiatives and collaborations that improve access for individuals with HIV/AIDS. Listed below are just a few of our activities.

• Public Financing and Delivery of HIV Care – This Institute of Medicine (IOM) study will examine HIV care financing and delivery in light of a changing healthcare system and demographic change in HIV/AIDS cases.
• HIV Cost and Resource Evaluation (HIVCARE Study) – The Agency for Healthcare Research and Quality (AHRQ), HRSA, and others are supporting a pilot study of the HIV Quality Care Network, a network of approximately 600 providers of HIV care, to examine medical service use by over 15,000 people being treated for HIV at 17 sites.
• Impact of Information Technology on Quality of HIV Care – AHRQ and HRSA are funding two grants to study the impact of information technology on health care among medically underserved HIV-infected populations.
• Transition from Counseling to Care – The National Alliance of State and Territorial AIDS Directors (NASTAD) and CDC workgroup on Improving the Transition of HIV+ Individuals from Counseling to Care discusses documenting and improving linkages between prevention and care and treatment programs, with a special focus on referral mechanisms. The HIV/AIDS Bureau will also address this topic through evaluation studies.

• Corrections and Injection Drug Users (IDU) – HAB’s Special Projects of National Significance Program collaborated with CDC to produce a study on “Services to People with HIV in Correctional Settings” and “Intervention for Seropositive IDUs Research and Evaluation”.
• Impact of Part A Funds Study – HRSA and CDC are collaborating on studies in Las Vegas and Norfolk to examine the impact of Part A funds on HIV care outcomes.
• HIV Integrated Services Project – Developmental effort between HRSA, the Centers for Medicare and Medicaid Services (CMS), and CDC looking at blending Federal funding streams to provide more efficient and continuous HIV care.
• HIV Prevention Services Under Medicaid – HRSA, CDC and CMS are involved in a policy study examining the provision of prevention services to people with HIV under Medicaid reimbursement systems. The CDC-funded study is through The George Washington University.
• Minority AIDS Initiative (MAI) – HRSA and CDC participate on various HHS cross-agency initiatives related to the MAI, including work on the Race Disparities Work Group.
• HIV Counseling, Testing, Referral Guidelines – HRSA assisted CDC in revising HIV guidelines to enhance their focus on HIV-infected persons and linking them with HIV services.
• Intervention for SeroPositive IDUs, Research and Evaluation (INSPIRE) – A CDC/HRSA joint effort to develop an integrated behavioral and biomedical intervention focused on prevention, and access/adherence to therapeutic regimens.
• Prevention for HIV-Positive Persons Project – The PHIP Project is a CDC/HRSA collaborative aimed at developing models for comprehensive HIV prevention and referral into care services for HIV-infected persons.
• CARE Act Primary Care Provider Prevention Practices – CDC is participating in a HRSA funded review of prevention practices and policies among CARE Act funded medical providers.
• Early Intervention Services (EIS) – HRSA will develop a “conceptual model” of EIS that will, in part, incorporate CDC counseling, testing, and referral guidelines. Also, in 1991, CDC and HRSA began The Seven Cities Study, cooperative agreements with seven cities to establish HIV early intervention demonstration projects. The two agencies are now assessing the impact of CARE Act funding, changes in health care financing, and demographic changes on CARE services in these cities.
• HHS Departmental Working Group on Routine HIV Testing of Newborns: HRSA and CDC collaborated on the HHS Departmental Working Group’s work on HIV perinatal transmission, including determining the Secretary’s position on routine testing of newborns, which was issued January 2000.

HRSA and HAB are committed to improving care and support services for people living with HIV/AIDS in severely affected regions of the world. The mission of HAB’s Global HIV/AIDS Programs:

• In partnership, we will assist the global community to improve their capacity to increase access to quality care and treatment for people infected and affected with HIV/AIDS and its complications.

• Strengthening of clinical and administrative systems to facilitate sharing of knowledge
• Support of training activities to develop human capacity
• Design of innovative care and support models to remove barriers to care
• Assessment of effectiveness of specific models of care to promote replication of best practices
• Strengthening of capacity of data collection, monitoring patient care, and improving quality of care
• Learning from other countries to improve our technical assistance capacity

• University of Washington and University of California at San Francisco
• Purpose – Share expertise and resources available from the AETC community
• Approach – Provide Technical Assistance (TA) to providers and educational and training organizations at all levels

• Caribbean: Global Fund, distance learning – Caribbean HIV/AIDS Regional Training (CHART) networks
• Ethiopia: Clinical training for providers
• Malawi: Care and support training
• South Africa: Training of Health Care Workers and Anti Retrovirals
• Thailand: Review of training grants
• Uganda: Revise training curricula
• Zimbabwe: Training on care and Anti Retrovirals

• Strengthen the role of nurses in caring for people with AIDS
• Increase the number of nurses trained and prepared to work with HIV/AIDS
• Develop training and education tools adapted to local needs

• Full spectrum of care and support issues related to ART
• Includes instructional information, fact sheets, and tools for trainers to use in nurse training activities
• HRSA will draw from experienced consultant pool for future trainings and collaboration with in-country nurses to adapt the curriculum

• Care and support
• Orphan and vulnerable children
• Prevention of maternal to child transmission

With increased funding for global activities, HRSA/HAB will improve health care infrastructures, train providers, and provide care services in priority countries in collaboration with other Federal partners, non-governmental organizations, international relief organizations, community and faith-based organizations, academic institutions, and host country governments.

Through its Office for the Advancement of Telehealth (OAT), which is organizationally found in the HIV/AIDS Bureau, HRSA is a leading National supporter and developer of telehealth. Telehealth is the use of electronic information and telecommunications technologies for health-related activities. Those include long-distance clinical care, patient and professional education, and health administration.

• Fostering partnerships in our agency and with other Federal agencies, States, and private-sector groups to create telehealth projects
• Administering telehealth grant programs
• Providing technical assistance
• Developing distance learning and training programs
• Assessing technology-investment strategies
• Evaluating the use of telehealth technologies and programs
• Developing telehealth policy initiatives to improve access to high-quality health services
• Promoting knowledge exchange about best telehealth practices

• In FY 2002, administered 100 telehealth or telemedicine grants in 43 States, totaling approximately $38 million.
• Chaired the Joint Working Group on Telemedicine, a Federal interagency forum for coordinating telemedicine activities across Federal agencies.

• Refined Telehealth progress reports to allow grantees to consistently report progress on a series of indicators relevant to health care access.
• Published a comprehensive funding guide on sources of support for Telehealth programs across Federal agencies that is available on the OAT website: http://telehealth.hrsa.gov/

Center for Quality, which is organizationally found in the HIV/AIDS Bureau, was established to strengthen and improve the quality of health care, especially as it relates to HRSA programs and their service populations. The Center operates conjointly with the Office of the Chief Medical Officer.

• Coordinates HRSA quality activities
• Advises on medical and public health policy issues
• Fosters and supports HRSA research activities
• Promotes public health programs
• Supports professional excellence

• Coordinated HRSA participation on the Federal Quality Interagency Coordination Task Force (QuIC), the National Forum for Healthcare Quality Measurement and Reporting, the HRSA Quality Work Group, and other quality related activities.
• Participated in numerous clinical quality assurance and risk management activities.
• Convened several meetings of the HRSA Human Subjects Committee, and coordinated with the Office for Human Research Protections to obtain approval of HRSA’s Federalwide Assurance. Staff oversaw the implementation of the policy for “Protection of Participants in HRSA Research Programs” and issued Certificates of Confidentiality to support efforts of agency and outside researchers.
• The Chief Medical Officer and professional staff participated on Departmental committees, interdepartmental task forces, and work groups addressing diverse public health issues.
• The Center convened the Ricky Ray Hemophilia Relief Fund Program Reconsideration Panel that reviewed more than 65 petitions.
• The Center developed a more comprehensive web site to highlight its program activities.
• Center staff reviewed scores of draft regulations and Federal Register Notices, Reports to Congress, and various correspondence and policy guidance and recommended HRSA responses.

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