Committee merger heralds integration of approaches
Committee merger heralds integration of approaches
This merger puts the best of both worlds together’
After more than 15 years of meeting separately, the two committees that advise the U.S. Department of Health and Human Services (HHS) on HIV prevention and care have merged into a single committee, HHS Secretary Tommy Thompson announced recently.
"This merger puts the best of both worlds — prevention and treatment — together for the benefit of all who are affected by this illness," he said.
The Centers for Disease Control and Prevention’s Advisory Committee for HIV and STD Prevention (ACHSP) has met in Atlanta since the late 1980s. During the past two years, it has held several joint meeting with the Health Resources and Services Administration’s (HRSA) AIDS Advisory Committee to increase efforts at integrating prevention and care.
The announcement that the committees would merge and meet alternately in Atlanta and Washington took committee members by surprise. However, most of them supported the move, seeing it as a significant and long-overdue step toward filling the gap in the care-to-prevention continuum.
The merger is part of a national effort to improve both HIV and STD prevention in persons already infected with HIV. The CDC and HRSA are already working with the Infectious Diseases Society of America to develop prevention guidelines for providers who care for HIV-positive patients. A set of practical recommendations for integrating risk assessment, STD screening, and brief HIV prevention messages will be published this spring.
Divisions grew out of historical differences
The separation between the two committees reflects the historical differences that have partitioned HIV treatment and prevention. While the merger has been positioned as a win-win effort to integrate prevention and care, advisors from both committees voiced concern that the combined committee would diminish the role of the advisors.
ACHSP members were particularly concerned that prevention issues would get short shrift, considering that the budget for HIV care is many times larger than that for prevention.
"I hope that combining the two committees will not prevent us from having the kind of interaction and deep detailed knowledge of the programs of these two agencies that we need," says Jessie Milan, chair of the HRSA committee.
"I would like to think there is an increasing commitment to continue the merging of cultures that has already started," responds David Fleming, the CDC’s deputy director for science. "This is just one more good reason to make it happen in fact."
HRSA administrator Elizabeth Duke, PhD, agrees, saying the merger will provide a richer staff collaboration. "Organizational culture is something that is valuable and something we encourage," she explains. "But by working together, we have an opportunity to do a lot more together than by alone. Having a natural marriage of interests and commitment is a positive thing for all of us."
Another concern is that the combined committee will be larger and also will only meet twice a year, whereas each committee had met three to four times a year separately.
"The full domain of the scope of the existing committees will be in this single unified committee," Fleming says. "So we are not eliminating individuals or the domain. We really are seeking instead to create an atmosphere that allows for a more integrated approach. I’m excited because being able to incorporate STDs into that mix of treatment and prevention, such as current activities with syphilis, will be a major step forward for our agency and for our ability to collaborate with HRSA."
"It will allow us all to be much more efficient and much more innovative," adds Duke.
There needs to be some thought of how to ensure that prevention is not overlooked, says Cornelius Baker, MD, executive director of the Whitman Walker Clinic in Washington, DC. "I want to make sure prevention doesn’t get the shorter stick if the sticks aren’t equal. It’s easier and less politically volatile to talk about a lot of the care issues; the prevention issues have been difficult over the last year."
"This is a work in progress, and we will continue to evaluate and modify and learn from it," Fleming says.
Another downside of the merger is that prevention may become too focused on HIV-positives, says ACHSP member Neil Schram, MD. "I think it will be very difficult in this setting to focus on broad and narrow strategies for people who are HIV-negative," he says.
"There is uniform agreement in the department, both from HRSA and CDC, that we make sure we address the eclectic prevention messages to those who are at risk for HIV," Fleming responds.
After more than 15 years of meeting separately, the two committees that advise the U.S. Department of Health and Human Services (HHS) on HIV prevention and care have merged into a single committee, HHS Secretary Tommy Thompson announced recently.Subscribe Now for Access
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