Webinar Q&A: Questions and Answers about the Integrated HIV Prevention and Care Plan and Planning Process

Webinar Q&A: Questions and Answers about the Integrated HIV Prevention and Care Plan and Planning Process

September 2016
IHAP TA Center
IHAP TA Center

JSI Research & Training Institute, Inc. (JSI), together with its partners, is collaborating with the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB) and the Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention (DHAP) to implement the Integrated HIV/AIDS Planning Technical Assistance Center (IHAP TAC). The IHAP TAC will support integrated jurisdictional HIV planning efforts across prevention, care, and treatment service delivery systems and effectively meet the needs of people living with HIV (PLWH) and those at risk for HIV infection. Click to learn more about IHAP TAC.

The IHAP TAC hosted a one-hour introductory webinar on September 12, 2016. The webinar was attended by over 240 participants representing staff from Ryan White HIV/AIDS Program (RWHAP) recipients, HIV prevention programs, and associated planning bodies. Following an overview of the IHAP TAC, representatives from HRSA/HAB, CDC/DHAP, IHAP TAC and its partners, HealthHIV, NASTAD, and UCHAPS, responded to questions related to the Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need CY 2017-2021, due on September 30, 2016. Questions for this webinar were received through the registration process or from the panelists based on frequently received questions.

The purpose of this document is to provide an overview of the questions and answers received related to the Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need and integrated planning processes.

The questions and answers are organized by the following eight categories:

  1. Submitting the Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need
  2. Next Steps After the Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need, is Submitted
  3. Monitoring and Improvement of the Integrated HIV Prevention and Care Plan
  4. CDC/HRSA Use of the Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need
  5. Coordination of the Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need and Planning with Other Initiatives
  6. Part A-Related Planning
  7. Community Engagement
  8. Integrated Prevention and Care Planning Bodies

Category 1: Submitting the Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need

Q1.1 Does the letter of concurrence need to be one single letter, or can it be several separate letters? For example, how does a jurisdiction submit a letter of concurrence when three different planning bodies have voted with two different outcomes?

A1.1 There should be one letter of concurrence per Integrated HIV Prevention and Care Plan. RWHAP Part A and Part B recipients should not submit two separate letters for the same Plan. If there is non-concurrence, the letter that is submitted should include both the concurrence and non-concurrence.

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Q1.2 How should the letter of concurrence be presented in the Integrated HIV Prevention and Care Plan?

A1.2 A draft letter of concurrence is provided in the Integrated HIV Prevention and Care Plan Guidance, including the Statewide Coordinated Statement of Need, CY 2017-2021 (see page 19).

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Q1.3 Are all of the signatories for the Concurrence/Concurrence with Reservations Letter necessary for the Integrated HIV Prevention and Care Plan?

A1.3 Yes, all of the signatories for the Concurrence/Concurrence with Reservations Letter for the Integrated HIV Prevention and Care Plan are necessary. Recipients should provide a letter of concurrence to the goals and objectives of the Integrated HIV Prevention and Care Plan from the co-chairs of the planning body and the representatives of funded entities. The letter should be jointly signed by both community and health department representation. The letter of concurrence is for the Integrated HIV Prevention and Care Plan and not for the specific funded entity’s CDC or HRSA-funded budget.

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Q1.4 Will extensions be granted for the Integrated HIV Prevention and Care Plans, including the Statewide Coordinated Statements of Need?

A1.4 The deadline for submitting the Integrated HIV Prevention and Care Plan is September 30, 2016. There are no extensions. However, in the unlikely event of an extraneous circumstance, extensions may be considered on a case by case basis. Extensions should be requested through the jurisdiction’s Project Officer, who will then consult with their leadership regarding the request.

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Q1.5 Is the Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need being submitted through the HRSA Electronic Handbooks (EHB)? If so, how?

A1.5 Both RWHAP Part A and Part B recipients are required to submit an Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need to their respective programs. Submission will be through EHB as follows:

  • For RWHAP Part A recipients, submit the Integrated HIV Prevention and Care Plan through the Prior Approval Portal in EHB.
  • For RWHAP Part B recipients, submit the Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need through the Reporting Requirements Other Submissions Portal for the Integrated HIV Prevention and Care Plan/Statewide Coordinated Statement of Need, CY 2017-2021 in EHB.

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Q1.6 What should a jurisdiction do if the Epidemiologic Overview in the Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need was developed using data from five counties, when the EMA has only four counties.

A1.6 Jurisdictions will need to provide jurisdictional level data for the Epidemiologic Overview using the data elements required in the Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need.

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Category 2: Next Steps After the Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need, is Submitted 

Q2.1 Now that the Integrated HIV Prevention and Care Plans, including the Statewide Coordinated Statements of Need is finished, what are the next steps for marketing and distribution of the Plan and Epidemiologic Profile?

A2.1 Distribution of the Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need, which includes the Epidemiologic Profile, is an important part of supporting planning activities going forward. Here are a few suggestions regarding with whom and how to market or distribute the Integrated HIV Prevention and Care Plan:

  • Among existing planning body members: Be sure that planning body members have received either a hard copy of the Integrated HIV Prevention and Care Plan or a link to an online version. Posting the Integrated HIV Prevention and Care Plan online is a great way to improve its visibility and access by a wide variety of stakeholders.
  • Among people living with HIV or at risk for HIV infection: Assign someone closely involved in the Integrated HIV Prevention and Care Plan development to attend meetings or other activities of people living with HIV or at risk for/affected by HIV. If there is not a shorter summary or executive summary of the Integrated HIV Prevention and Care Plan that highlights key aspects of it, consider creating one.
  • Among policy makers: Likewise, a shorter version of the Integrated HIV Prevention and Care Plan, ranging from a one page “fact sheet” to a multi-page executive summary, can be useful when explaining to policymakers the current status of the epidemic in the jurisdiction and the plan to address the epidemic.

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Q2.2 What will happen after the Integrated HIV Prevention and Care Plans, including the Statewide Coordinated Statements of Need are submitted?

A2.2 After the Integrated HIV Prevention and Care Plans, including the Statewide Coordinated Statements of Need are received by CDC/HRSA on September 30, 2016, recipients will receive an email acknowledging receipt, including next steps. CDC/HRSA will conduct a joint review of the Integrated HIV Prevention and Care Plans and recipients will receive joint feedback from CDC/HRSA, including strengths and areas for improvement. Please note that the Integrated HIV Prevention and Care Plans are not being approved or scored by CDC/HRSA.

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Category 3: Monitoring and Improvement of the Integrated HIV Prevention and Care Plan

Q3.1 How should jurisdictions monitor and evaluate their Integrated HIV Prevention and Care Plan once it is in place?

A3.1 There are several ways jurisdictions can monitor and evaluate their Integrated HIV Prevention and Care Plan once they are in place:

  • Put the Integrated HIV Prevention and Care Plan on the planning body’s agenda at routine intervals. This can be monthly, bi-monthly, quarterly, or on another schedule.
  • Identify whether the Integrated HIV Prevention and Care Plan’s objectives, strategies, and activities are being implemented according to the timeline. Why or why not? There may be specific reasons (e.g., a decision to do something different, a change in resources or staffing) for why some activities have not occurred.
  • Use a quality improvement approach. Improve the Integrated HIV Prevention and Care Plan as needed on an ongoing basis. This is what is meant when people talk about the Integrated HIV Prevention and Care Plan as a “living document.” Think about crossing disease areas as well, such as hepatitis or STDs, and evaluating the need for expanding the focus of the Integrated HIV Prevention and Care Plan moving forward.
  • Document and share findings, modifications, and updates to the Integrated HIV Prevention and Care Plan to key stakeholders within your jurisdiction on a regular basis.

For example, in San Francisco, the workgroup that developed the Integrated HIV Prevention and Care Plan will become the ongoing committee that will focus on monitoring and improvement of the Integrated HIV Prevention and Care Plan. This will ensure that Integrated HIV Prevention and Care Plan monitoring will be reported on at all full planning council meetings during regular committee updates, and it will also serve to mobilize needed resources for monitoring and improvement that would not otherwise be identified.

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Q3.2 What are the expectations for monitoring the Integrated HIV Prevention and Care Plans, including the Statewide Coordinated Statements of Need?

A3.2 HRSA will have its Funding Opportunity Announcements (FOAs), reporting requirements, and monitoring more closely linked with the Integrated HIV Prevention and Care Plans, including the Statewide Coordinated Statements of Need. The HRSA HAB Division of Metropolitan HIV/AIDS Programs has already included the integration of the Integrated HIV Prevention and Care Plan into several sections of its FY 2017 Part A FOA applications due October 18, 2016, such as the sections on the Epidemiology Overview, the HIV Care Continuum section, and the Early Identification of Individuals with HIV/AIDS (EIIHA).

Additionally, in its monitoring, HRSA will be looking for consistency across a jurisdiction’s Integrated HIV Prevention and Care Plan and other program planning and reporting requirements. See page 16 of the Integrated HIV Prevention and Care Plan Guidance, Including the Statewide Coordinated Statement of Need, CY 2017-2021, which includes guidance on monitoring and improvement.

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Category 4: CDC/HRSA Use of the Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need

Q4.1 How will the government use the Integrated HIV Prevention and Care Plans, including the Statewide Coordinated Statements of Need? 

A4.1 HRSA will have its Funding Opportunity Announcements (FOAs), reporting requirements, and monitoring more closely linked with the Integrated HIV Prevention and Care Plans, including the Statewide Coordinated Statements of Need. The HRSA HAB Division of Metropolitan HIV/AIDS Programs has already included the integration of the Integrated HIV Prevention and Care Plan into several sections of its FY 2017 Part A FOA applications due October 18, 2016, such as the sections on the Epidemiology Overview, the HIV Care Continuum section, and the Early Identification of Individuals with HIV/AIDS (EIIHA).

Additionally, in its monitoring, HRSA will be looking for consistency across a jurisdiction’s Integrated HIV Prevention and Care Plan and other program planning and reporting requirements.

The Integrated HIV Prevention and Care Plans, including the Statement Coordinated Statements of Need will not be scored. They will be reviewed using a tool that will assess whether or not the submitted Integrated HIV Prevention and Care Plans, including the Statewide Coordinated Statements of Need were responsive to the elements in the CDC/HRSA guidance. Feedback will be provided to CDC/HRSA recipients on the Integrated HIV Prevention and Care Plans, including the Statewide Coordinated Statements of Need in the areas of strengths, best practices, and areas for improvement.

CDC/DHAP and HRSA/HAB Project Officers will be using the Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need as a monitoring tool.

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Q4.2 Will the Integrated HIV Prevention and Care Plans, including the Statewide Coordinated Statements of Need impact future funding considerations?

A4.2 For HRSA, the Integrated HIV Prevention and Care Plans, including the Statewide Coordinated Statements of Need will not directly impact funding. RWHAP Part A and B funding is determined through a formula process. The RWHAP legislation outlines the determination of recipient eligibility and the calculation of award amounts. HRSA/HAB is responsible for calculating the RWHAP Part A and B awards as instructed in the legislation. However, in evaluating responses to HRSA’s Funding Opportunity Announcements (FOAs), the extent to which the Integrated HIV Prevention and Care Plans, including the Statewide Coordinated Statements of Need align with other program elements such as unmet need estimates, epidemiological overviews, and other data may have an impact on the evaluation of FOA responses, and therefore may indirectly impact funding. 

For CDC, please refer to the following language regarding letters of concurrence which may impact future funding consideration:

When CDC does not receive a HIV/AIDS Planning Group (HPG) letter of concurrence, the project officer may initiate the following:

  • Obtain more input or information from the HPG and health department (HD) regarding the situation;
  • Meet with the HPG co-chairs and HD staff;
  • Negotiate with the HD concerning any issues raised by the HPG;
  • Recommend local mediation between the HPG and HD; 
  • Request that the HD provide a detailed corrective action plan to address areas of concerns expressed by the HPG and specify a timeframe for completion;
  • Conduct an onsite, comprehensive program assessment to identify and propose action steps to the HD to resolve areas of concern;
  • Conduct an onsite HPG assessment focused on specific area(s) of concerns;
  • Develop a detailed technical assistance plan for the jurisdiction to systematically address the concerns and request technical assistance from CDC’s Division of HIV/AIDS Prevention capacity building assistance (CBA) program;
  • Place conditions or restrictions on the HD funding awards; and/or
  • Overrule any HPG objection(s) if the HD can provide fact-based evidence, specifically the collaborative input, development, and review of the jurisdictional plan by the HPG.

Category 5: Coordination of the Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need and Planning with Other Initiatives

Q5.1 How will the Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need, coordinate with the CDC 2018 HIV Prevention Funding Opportunity Announcement (FOA)?

A5.1 The Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need, will be a part of the FOA. Jurisdictions can contact their CDC Project Officer for additional information regarding CDC’s FOAs.

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Q5.2 How does planning interact with other initiatives, such as the Ending the Epidemic initiative?

A5.2 Some jurisdictions are bringing the planning in-house, and the planning groups are working on one Integrated HIV Prevention and Care Plan that is going to serve as their Ending the Epidemic plan. HRSA has also seen separate groups, such as in Massachusetts, for example, where there is a separate initiative. They are communicating and collaborating to make sure that the scope of the Ending the Epidemic plan is broader and includes different partners and stakeholders than those that may traditionally be involved in the planning group. This allows the jurisdiction to fill in some of the gaps that they may not have resources to address through their federal partners.

Communication and thinking about the Ending the Epidemic plan is a chance to bring in different people who may not be coming regularly to the planning group or who may not be able to participate in a regularly scheduled meeting. This is an opportunity to hear their voices in an effort to think about an Integrated HIV Prevention and Care Plan that will bring together different resources within the jurisdiction.

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Category 6: Part A-Related Planning

Q6.1 How do jurisdictions reconcile the Part A grant guidance and the guidance for Integrated HIV Prevention and Care Plans, including the Statewide Coordinated Statements of Need since they are not 100 percent the same. How do jurisdictions use the Statewide Integrated Planning information when the Part A service area is not the whole state?

A6.1 There are many variations on what could occur between a jurisdiction at the city/county level and the state/territory level. HRSA attempted to decrease burden and align much of what is being done under the Integrated HIV Prevention and Care Plans, including the Statewide Coordinated Statements of Need with the Funding Opportunity Announcements (FOAs) FY 2017 RWHAP Part A FOA, such as the Epidemiology Overview, the HIV Care Continuum, and the Early Identification of Individuals with HIV/AIDS (EIIHA) section.

However, there is not 100 percent concurrence on other sections. For example, under the Unmet Need section, jurisdictions may wish to use more updated information than what was included in the Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need.

If the RWHAP Part A and Part B recipients have submitted a joint Integrated HIV Prevention and Care Plan, including the Statewide Coordinated of Need, and if that Integrated HIV and Prevention and Care Plan adequately described the RWHAP Part A jurisdiction(s), then that information can be reused for the application to HRSA. If the data does not describe statewide data and the RWHAP Part A jurisdictional data is not separate, then it will be the responsibility of the RWHAP Part A jurisdiction(s) to separate out their data.

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Q6.2 What is the guidance for navigating integration of planning across Part A and Part B programs?

A6.2 CDC/HRSA have allowed flexibility on how jurisdictions complete the Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need and what planning groups look like as long as they are responsive to CDC/HRSA guidance and legislative requirements. There are a variety of approaches from the state supporting development of the Epidemiologic Overview, and the cities/counties having their own chapters within the Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need, to the state taking the lead on drafting the Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need and bringing the RWHAP Part A planning bodies into the fold.

It may be beneficial to have co-occurring meetings. For example, the RWHAP Part A meeting could be a day and a half, and then the next day and a half would be the statewide meeting to bring those together as two co-occurring groups.

There have also been some jurisdictions that have been able to form one group to represent all of the RWHAP Part A recipients as well as prevention and care across the state. CDC/HRSA has also seen having chapters within the Integrated HIV Prevention and Care Plan, so that states can work with their Part A recipients, but the Part A planning councils can still retain their ongoing planning structure.

Jurisdictions have used different models. For example, the Atlanta Eligible Metropolitan Area (EMA) developed a local Ending the Epidemic plan, which was then used to inform the state Integrated HIV Prevention and Care Plan. The Integrated HIV Prevention and Care Plan is a combination of the local plan, plus they brought in the state for the prevention part of the Integrated HIV Prevention and Care Plan. In Philadelphia, the planning bodies will be integrating to move forward in their work.

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Category 7: Community Engagement

Q7.1 How should the community be involved when it comes to evaluating the work of the Integrated HIV Prevention and Care Plan?

A7.1 Ideally, the Integrated HIV Prevention and Care Plan will be monitored and evaluated by a planning body or committee of a planning body that includes community stakeholders.

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Q7.2 What are some strategies to enhance recruiting, retaining, and engaging Persons living with HIV (PLWH) and persons affected by HIV in the planning process?

A7.2 Here are some general suggestions based on what has worked across many jurisdictions:

  1. Utilize personal relationships with PLWH and people who are at risk and affected by HIV to engage and invite them to participate in planning bodies.
  2. Explain clearly what they are being invited to participate in (e.g., close- vs. open-ended participation in a group; if close-ended, how many meetings, how long, and where meetings happen, etc.).
  3. Identify what, if any, resources are available to support participation such as meals at meeting, transportation reimbursement, ride pooling, or child care.
  4. Ensure that meetings are welcoming to newcomers by avoiding use of acronyms without explanation of what they stand for, making sure to identify precisely what is being discussed and what the potential decision making and/or action items may be for participants, and explaining how their input will make a difference (e.g., if they get to “vote” on something).

HRSA/HAB has recommitted to supporting technical assistance (TA) activities that will train and develop leadership among PLWH to participate in all levels of the RWHAP, which could enhance the involvement of PLWH in the planning process. The National Minority AIDS Council (NMAC) was recently funded to support this national TA effort through the HRSA/HAB Leadership Training for People Living With HIV project.

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Category 8: Integrated Prevention and Care Planning Bodies

Q8.1 What are some examples of jurisdictions that have successfully integrated treatment and prevention, including successes and challenges from different types of cities (such as those that are well resourced/under resourced, well supported/not well supported).

A8.1 Some existing resources related to integrated HIV care, treatment, and prevention planning include:

  1. Integrated HIV Prevention-Care Planning Activities: This document describes six types and levels of cooperation and collaboration on HIV prevention-care planning. It is intended to provide illustrative examples of integrated HIV planning activities that involve RWHAP Part A, Part B, and CDC HIV Prevention Planning Bodies and Recipients. The chart is non-exhaustive.
  2. Developing a Unified HIV Prevention and Care Planning Body: Lessons from the Los Angeles EMA. This summary is designed to help RWHAP Part A programs and CDC-funded HIV prevention programs develop unified planning bodies by sharing the initial process and experience of Los Angeles County.

Providing technical assistance (TA) resources that support HIV planning efforts to increase the integration of prevention and care services are at the core of the IHAP TA Center's mission. Additional information on TA resources to support these efforts will be forthcoming.

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Q8.2 How can planning processes address differences in planning body membership representation, parity, and inclusion across HRSA and CDC guidance?

A8.2 HRSA is flexible in terms of how this shapes up within the jurisdiction between cities, counties, and states/territories. However, CDC/HRSA would like diverse representation across the board. The RWHAP Part A Program does have some very specific legislative requirements, which we cannot waive for that planning body. For more information about membership requirements for RWHAP Part A Planning Councils, see Section X. Planning Council Operations. Chapter 4. Planning Council Membership of the RWHAP Part A Manual: http://hab.hrsa.gov/manageyourgrant/files/happartamanual2013.pdf.

Planning body membership comes down to different categories of stakeholder representation, i.e., having the entire membership being reflective of the epidemic, as well as meeting the legal requirement that a third of the body be made up of unaligned consumers, people living with HIV (PLWH), who are also reflective of the epidemic.

Jurisdictions should start to think more broadly about the definition of a consumer-- including PLWH who are using RWHAP-funded services, and also individuals who are at risk for HIV infection, and who might be utilizing HIV prevention services such as pre-exposure prophylaxis (PrEP).

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Q8.3 How does the CDC and HRSA plan to address high risk populations as consumers on planning councils?

A8.3 The Planning Council shall reflect in its composition the demographics of the population of individuals living with HIV. Section 2602(b)(1) of Title XXVI of the Public Health Service (PHS) Act requires a Ryan White Part A planning council to “reflect in its composition the demographics of the population of individuals with HIV/AIDS in the eligible area involved, with particular consideration given to disproportionately affected and historically underserved groups and subpopulations.” Section 2602(b)(2) of the PHS Act lists specific membership categories that must be represented on the planning council. There are 13 different categories of representation that are required, including “affected communities, including people with HIV/AIDS, members of a Federally recognized Indian tribe as represented in the population, individuals co-infected with hepatitis B or C, and historically underserved groups and subpopulations,” and overall across those categories, the membership has to be reflective of the epidemic, so by definition that would likely include many high-risk populations that have been identified by a jurisdiction.

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Q8.4 How is priority setting and allocations conducted at the same time with the two pots (CDC/HRSA) of funding?

A8.4 A consolidated approach to priority setting and resource allocation may be utilized, especially by integrated HIV planning bodies. At the same time, the resulting resource allocation must respect the allowable uses for HRSA and CDC funds.

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