Last week, the Department of Health and Human Services’ 12 Cities Project Steering Committee met with several community representatives (PDF 35KB) to discuss the project and explore opportunities to encourage stronger cross-agency collaboration at the local level.

My Federal colleagues—from the Centers for Disease Control and Prevention (CDC), Centers for Medicare & Medicaid Services (CMS), Health Resources and Services Administration (HRSA) HIV/AIDS Bureau, HRSA Bureau of Primary Health Care, Department of Housing and Urban Development (HUD), Indian Health Service (IHS ), National Institutes of Health (NIH), and the Substance Abuse and Mental Health Services Administration (SAMHSA)—and I were heartened to hear ongoing support for and optimism about the potential of the 12 Cities Project to improve HIV/AIDS outcomes. Certainly, the conversation was not without questions and concerns about ongoing challenges and the need for continued discussion and problem solving. A number of important observations were shared during our two-hour discussion, including the following:

• Support efforts in participating jurisdictions to engage diverse partners in more coordinated planning and service delivery. Community representatives recommended that HHS consider multi-agency calls and/or site visits with the participating jurisdictions. Not only would these inform our planning and next steps with first-hand interactions, but such engagement could also support the jurisdictions by helping to facilitate the local convening of various Federally supported programs including HIV prevention, care and treatment, mental health and substance abuse, and others. Related to this, our partners suggested that consideration should be given to how continued education of local stakeholders can be supported by HHS agencies so that community planning groups, planning councils, care providers, state and local health departments, substance abuse and mental health program administrators, prevention grantees, and others can develop a fuller appreciation for the goals and intentions of the project, see how it relates to the broader goals of the National HIV/AIDS Strategy (NHAS), and better understand the important roles that each of them can play in achieving improved HIV/AIDS outcomes. This should include efforts to better train our Federal project officers about how the 12 Cities Project supports the NHAS, so that they can better advocate for the project with their grantees, and be able to explain how success in the 12 Cities can be used to inform comprehensive approaches to HIV/AIDS throughout the U.S.

• Consider quality indicators when assessing metrics. Some participants observed that as we seek opportunities to harmonize and streamline Federal application, reporting, and other grant requirements, HHS should bear in mind that much data reported in current systems may support grant monitoring well, but may not necessarily indicate the quality of care. HHS was urged to consider how better measures of quality of care in HIV testing, linkage to HIV care and treatment, and maintenance in care could be integrated without overburdening grantees.

• Be reasonable in expectations about time to implement the changes called for in the Strategy. We heard cautions about the fact that some of the changes being advanced through the NHAS will take time, perhaps as many as several funding cycles, to take root in communities. This is due, in part, to the time it will take for the changes to “work their way through systems” as well as the time and effort required to engage and educate existing and new partners.

• Share lessons learned in these jurisdictions often and widely. The Steering Committee was reminded that these changes can be supported and advanced by actively sharing models of enhanced HIV prevention planning and approaches to integration of HIV/AIDS prevention, care, and treatment activities from the 12 cities as well as outcomes and lessons learned. This might include technical assistance and/or models of how to use evidence-based approaches to work through the changes called for when a community is assessing and re-balancing its HIV prevention and care activity portfolios to ensure that resources are intensified with populations and locations where HIV is concentrated and that they are utilizing the combination of interventions most likely to have impacts in reducing new infections, linking people to care and promoting health equity.

These thoughtful recommendations and perspectives provided the Steering Committee with much to consider as we continue to work with governmental and non-governmental partners to operationalize the NHAS in these 12 jurisdictions, and throughout the United States.