GWU Support of ECHPP Initiative

Amanda D. Castel, MD, MPH

September 1, 2011

The District of Columbia has a severe and generalized HIV/AIDS epidemic with 3.2 percent of adults and adolescents living with HIV/AIDS as of December 31, 2008. The District of Columbia Department of Health’s HIV/AIDS, Hepatitis, STD, TB Administration (HAHSTA) has been proactive in establishing data driven responses to the epidemic, including the implementation of a routine testing initiative in 2006, development of programs to ensure linkage of and engagement in care of newly diagnosed individuals, as well as re-engagement of HIV-positive persons who are out of care. HAHSTA has also developed one of the few free city-wide condom distribution programs in the country, promoted couples counseling and testing, instituted social marketing campaigns, and partnered extensively with the community and clinical providers. To date, surveillance and testing data have shown substantial increases in the numbers of persons tested, earlier diagnosis with improved clinical outcomes, and increased linkages to care.

The District’s aggressive response is consistent with the priorities of the National HIV/AIDS Strategy (NHAS). The DC DOH has identified several areas in which the expertise of researchers at the DC Developmental Center for AIDS Research (DC D-CFAR) can complement and support the activities of DC DOH HAHSTA. Therefore, this proposal aims to evaluate the DC DOH linkage to care portfolio, evaluate clinical and non-clinical routine HIV testing implementation strategies and assess the feasibility and cost-effectiveness of non-occupational exposure prophylaxis (NPEP) and pre-exposure prophylaxis (PrEP). Each of these goals will be addressed through a combination of epidemiologic analyses, ethnographic studies, and costing and cost-effectiveness activities.