Combination Prevention is the integration of behavioral and biomedical strategies to address HIV, especially structural approaches Building on 25 years of knowledge accumulated with efficacious behavioral interventions, structural approaches create access, settings, policies, or community level applications of learned principles to advance prevention, detection, and care^. The CHIPTS Combination Prevention Core (previously, the Intervention Core) has reorganized its mission, partners, and outcome markers to emphasize structural, biomedical, information technology, social media and behavioral innovations. Three major trends demand this realignment. First, HIV prevention, including combination prevention is significantly influenced by the global economic recession. Inadequate resources will force 22 countries to disrupt antiretroviral (ARV) treatments for persons living with HIV. The largest cuts in donor funding have been to the 34 countries carrying 75% of disease burden^ California cut its HIV budget by $82 million in fiscal year 2009-10. Los Angeles County halved its prevention budget, and reduced HIV care by a third. This fiscal environment requires smarter, more cost-effective intervention strategies that can be broadly diffused. Second, domestically, HIV is predominantly a disease of ethnic minority men who have sex with men (MSM). Black MSM are overrepresented among persons living with HIV (PLH) PLH; 18% of LA County cases are African American, while African Americans are only 4.7% of the County's populafion.* Latino (32%) and White, non Latino (47%) MSM are also impacted. Both aging MSM (> 50 years; both HIV+ and HIV-) and younger MSM (< 30 years) have been saturated with HIV prevention messages, yet incidence continues to rise in these groups, highlighting need for innovative delivery modalities and messages. The Core's reorganization responds to these risks among MSM, especially in Los Angeles. Third, HIV services have been vertically integrated in specialty settings; now advocates are lobbying for horizontally integrated systems for comprehensive care delivery. The health priorities that compete with HIV, especially other chronic health conditions, are gaining attention. Domestically, the patient-centered medical home in health care reform will transform HIV care. Our prevention and intervention models must be adapted to respond to these trends. The CHIPTS' Combination Prevention Core will lead innovation in detection, prevention and care in response to these trends. Our interdisciplinary team is a resource for identifying, designing, and implementing structural, combination approaches for HIV prevention systems, be they local, regional, national, or global. The Core has planned a strategic approach to impact HIV burden of disease that includes: adoption of innovations and evidence-based combination interventions by health jurisdictions, networks of providers and communities of HIV care, treatment services, and consumers; implementation of collaborative combination prevention efforts with health departments that can implement and diffuse interventions in large populations; and greater engagement in research among populations identified nationally and globally with the highest need for HIV prevention, care and treatment.
The specific aims for the Combination Prevention Core are: 1. Science: Leading research in combination prevention interventions and strategies that integrate medical, technology, social media and behavioral advancements in HIV prevention and care through individual scientist driven research and participation in research networks. 2. Networking: Providing time and resources to link experts in social media, global information system-technology (GIS), on-line communication, point-of-sale diagnostics and community engagement strategies with agencies and communities at risk. We establish networks for HIV prevention research and programs among those facing highest risks for HIV transmission: communities of color, especially MSM and women at heightened sexual risk. 3. Capacity Building: Advancing the capacity of linked coalitions and networks of scientists, domestic and international health departments and ministries, and engaged non-governmental organizations (NGOs) and CBOs to launch innovative, bold, and creative interventions for impacted populations.
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