Local Health Department (LHD) HIV/STI Program Preparations for Health Reform

Background: The Health Reform law, signed in March 2010, has important implications for HIV/STD prevention and care programs. Although much of the planning for implementation has focused at the national and state level, LHDs must also plan for how to adjust to changes in their service delivery structure.

Objectives: This query sought to assess the extent to which LHDs are planning for Health Reform implementation and to gauge how they anticipate that Health Reform will change the roles of LHDs providing of HIV/STD prevention services.

Methods: The NACCHO HIV/STD Prevention Sentinel Network was developed to gather feedback via electronic query about CDC policies and recommendations and to understand LHD HIV/STD prevention programs. The Sentinel Network is composed of 74 LHD HIV/STD program managers, public health nurses, and outreach workers representing a snapshot of LHDs in the US.

Results: 28/37 LHD respondents reported that they have begun to prepare for Health Reform. For example, 12 LHDs are developing LHD capacity to bill third-party payers (public or private) for services; 13 are training staff to perform new roles and 13 are partnering with community health centers and other partners to provide HIV/STD services.  LHDs indicated that they are facing uncertainty planning for future of Ryan White funding; receiving limited guidance from their state health departments and are facing challenges ensuring LHD staff capacity to meet future service needs.

Conclusions: Health Reform is likely to lead to major changes in how LHDs deliver HIV/STD services.   These data suggest some of the challenges for LHDs.

Implications for Programs, Policy, and Research: These data represent formative research into anticipated Health Reform challenges for LHDs and point to the need for further attention to how service delivery at the local level will be impacted.