U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
IHS HIV/AIDS Program

The IHS Minority AIDS Inititative (MAI)

IHS MAI Introduction and Focus

Monument valley at duskThe Minority AIDS Initiative provides critical funding that can be coordinated and utilized to advance HIV/AIDS prevention and mitigation efforts in the American Indian/Alaska Native (AI/AN) population. As you are aware, the Indian Health Service does not have a base budget assignment of Minority Health funds, thus no allocated amount comes directly to the agency. It is only through MAI proposals and dollars that these special programs can be initiated and/or continued. We continue to utilize these funds to build capacity within and collaborate with other HHS agencies on providing training, expanding services, increasing surveillance, infusing behavioral health initiatives, integrating traditional health service linkages, advancing information and technological enhancements and developing outreach to communities.

As mentioned in the introduction to the IHS HIV/AIDS Program, strategic planning is essential to effective and efficient response to HIV/AIDS. Currently, a National IHS HIV/AIDS Work Plan is under development and will integrate the components/initiatives of these MIA proposals. Integration of this strategic planning into these MAI funded projects is critical for outcome success. These coordinated MAI proposals demonstrate early efforts to incorporate strategic planning into ongoing and new MAI initiatives. It is once again important to identify that all components of this developing plan (i.e. capacity building, treatment, prevention, policy, advocacy, monitoring, evaluation and research) are being addressed – even within the limited number of funded proposals. Although our IHS budget allocation (outside of MAI) is focused on service delivery and primary-care, there is also a critical and substantial need for enhanced prevention program efforts. This is where MAI funding is critical.

FY08 Minority AIDS Initiative Projects:

Over the past year, a National IHS HIV/AIDS Administrative Work Plan was developed with input from many stakeholders internal and external to the agency. This included a new MOU with HRSA, SAMHSA, a draft with NIH and also one with a community-based Capacity Building Assistance Network of three AI/AN organizations. We have worked diligently toward program transparency and integration. The HIV Program has also facilitated an expanded collaborative and integrative environment with native health and native HIV organizations as well as the Office of Urban Indian Health and some of the Tribal HIV infrastructure. Integration of activities (including all the MAI funded projects) is a key factor to success as information sharing, capacity building, resource mobilization and data collection are challenging in a ‘trifurcated’ healthcare delivery system. Through collaborative efforts and implementation of initiatives through MAI funded projects, we believe our strategic plan is having success. Additionally, with ongoing efforts from MAI funding to build infrastructure, we are moving toward more capacity to produce tangible outcomes. These outcomes (stated in our IHS HIV/AIDS Goals and Objectives) are now more aligned with the Office of Management and Budget requested measures.

Currently, eight MAI projects were approved for FY08.

  1. Chronic Care Initiative - HIV Center of Excellence, Phoenix Indian Medical Center
  2. HIV Testing Initiative - Office of Urban Indian Health
  3. Continuity of Care Project - Gallup Indian Medical Center
  4. Enhanced Prenatal and Universal Screening – IHS Division of Epidemiology
  5. HIV Behavioral Health Trainings – IHS Division of Behavioral Health
  6. Quality of Care Initiative - IHS Office of Information Technology
  7. Community Health Representative Training and Youth Camps - CHR Program
  8. National Knowledge/Attitude/Behavior (KAB) Survey - IHS Division of Epidemiology

The overall IHS objectives through these 8 MAI funded projects are to:

  1. Implement a new clinical quality reporting measure to improve the rates of HIV screening among patients with known STDs.
  2. Continue the widespread improvement of quality health through use of innovative software deployed at I/T/U facilities – HIV Management System – to track CD4 and Viral Load.
  3. Provide an innovative HIV training with a behavioral health and culturally fluent focus to I/T/U providers.
  4. Implement a chronic care model and network to build capacity for quality treatment and care and technical assistance (TA) for IHS providers. Also, expand ongoing telemedicine network.
  5. Improve overall IHS GPRA prenatal screening rates IHS-wide and implement pilot site universal screening.
  6. Execute Tribal Advocacy and Youth STD/HIV Educational Camps from IHS para-professionals (CHRs) by bridging the gap between community and health system
  7. Implement rapid and/or traditional HIV testing into Urban facilities.
  8. Through a pilot project, improve continuity of care within a critical sub-population of seropositive substance users.

MAI Funding Cycle

Proposals for the funds come through the IHS HIV/AIDS program office from various Divisions or entities within the IHS in consultation with the Principal Consultant. They are integrated into strategic planning and coordinated for reporting requirements to include appropriate objectives, posturing within the President’s HIV/AIDS Initiative and enumeration of measurable outcomes data. This will happen early in the fiscal year. Proposals are collated at headquarters and sent to MAI Office in Washington D.C. in November. Once graded for criteria, relevance, etc, the MAI office will notify the IHS HIV/AIDS Principal Consultant of the number and amount of funds to be distributed. This timeline can vary, but should happen late in the 2nd quarter of FY06. Progress reporting is due bi-annually from receipt of funding and outcome and evaluation reporting is due annually.

Picture credit: Ms. Velonia Hardy

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