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Estimating the impact of state budget cuts and redirection of prevention resources on the HIV epidemic in 59 California local health departments.

ABSTRACT: BACKGROUND: In the wake of a national economic downturn, the state of California, in 2009-2010, implemented budget cuts that eliminated state funding of HIV prevention and testing. To mitigate the effect of these cuts remaining federal funds were redirected. This analysis estimates the impact of these budget cuts and reallocation of resources on HIV transmission and associated HIV treatment costs. METHODS AND FINDINGS: We estimated the effect of the budget cuts and reallocation for California county health departments (excluding Los Angeles and San Francisco) on the number of individuals living with or at-risk for HIV who received HIV prevention services. We used a Bernoulli model to estimate the number of new infections that would occur each year as a result of the changes, and assigned lifetime treatment costs to those new infections. We explored the effect of redirecting federal funds to more cost-effective programs, as well as the potential effect of allocating funds proportionately by transmission category. We estimated that cutting HIV prevention resulted in 55 new infections that were associated with $20 million in lifetime treatment costs. The redirection of federal funds to more cost-effective programs averted 15 HIV infections. If HIV prevention funding were allocated proportionately to transmission categories, we estimated that HIV infections could be reduced below the number that occurred annually before the state budget cuts. CONCLUSIONS: Reducing funding for HIV prevention may result in short-term savings at the expense of additional HIV infections and increased HIV treatment costs. Existing HIV prevention funds would likely have a greater impact on the epidemic if they were allocated to the more cost-effective programs and the populations most likely to acquire and transmit the infection.

SUBMITTER: Lin F

PROVIDER: S-EPMC3592871 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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Estimating the impact of state budget cuts and redirection of prevention resources on the HIV epidemic in 59 California local health departments.

Lin Feng F Lasry Arielle A Sansom Stephanie L SL Wolitski Richard J RJ

PloS one 20130308 3

<h4>Background</h4>In the wake of a national economic downturn, the state of California, in 2009-2010, implemented budget cuts that eliminated state funding of HIV prevention and testing. To mitigate the effect of these cuts remaining federal funds were redirected. This analysis estimates the impact of these budget cuts and reallocation of resources on HIV transmission and associated HIV treatment costs.<h4>Methods and findings</h4>We estimated the effect of the budget cuts and reallocation for ...[more]

PMID: 23520447

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Project description:Background COVID-19 forced California Supplemental Nutrition Assistance Program Education (SNAP-Ed) to suddenly shift planned strategies to meet SNAP-eligible population needs. K-12 schools, important SNAP-Ed partners for reaching children and families, were profoundly affected. Most (77%) local health departments (LHDs) reported they were unable to accomplish previously planned activities at school sites in 2020. Objective To understand pandemic-related changes to school-based SNAP-Ed and identify areas of opportunity. Study Design, Settings, Participants We conducted secondary mixed-methods analyses of California LHDs’ school-based SNAP-Ed activity and needs assessment data from fiscal years 2020-2021. Measurable Outcome/Analysis Outcomes include number and type of SNAP-Ed programs that were halted or newly implemented, number of participants reached, policies, systems, and environmental change strategies (PSEs) adopted, new methods of education delivery, and extent to which schools implemented nutrition and physical activity (Nut-PA) best practices. Qualitative analysis examined COVID-19-related barriers and facilitators to SNAP-Ed implementation. Results In 2020, 270 PSE interventions were initiated in schools; 21% were discontinued and 12% were created in response to COVID. New opportunities included using school meal distributions to provide free groceries, home gardening kits, and brief face-to-face nutrition education. Many LHDs transitioned to virtual Nut-PA education, increasing SNAP-Ed participant reach. In Fall 2020, as schools adjusted to alternative learning models, school-level assessments of Nut-PA practices indicated the most common area of opportunity was nutrition education. Over 75% of schools reported that PSE strategies requiring on-site/in-person implementation, such as improving lunchroom facilities, were not feasible. Facilitators of SNAP-Ed implementation included community support and strong partnerships between schools, community-based organizations, and SNAP-Ed implementing agencies; barriers included regulations and staff turnover. Conclusions SNAP-Ed programs nationwide can continue to serve SNAP-eligible children and families during crises like COVID-19 by partnering with schools and other community organizations. These partners identified the nutrition and physical activity needs of a community and the best practices to address them. Funding Supplemental Nutrition Assistance Program - Education

Project description:ObjectiveThe United States Public Health Service released clinical practice guidelines for daily oral preexposure prophylaxis (PrEP) in May 2014. Local health departments (LHDs) are expected to play a critical role in PrEP implementation. We surveyed LHDs to assess awareness of and interest in supporting PrEP implementation, what roles they were taking, or believed they should take, in supporting PrEP, and what resources would be required to do so.MethodsLHDs were surveyed in 2015 to assess their engagement in PrEP implementation (n = 500). The study employed a cross-sectional survey design with a randomly selected stratified sample.ResultsAmong responding LHDs (n = 284), 109 (29%, weighted proportion) reported engagement in PrEP implementation. LHDs serving large jurisdictions (population 500,000+) and located in the West were more likely to be engaged in PrEP implementation. Making referrals for PrEP (74%) and conducting education and outreach to community members (51%) were the activities most frequently reported by LHDs engaged in PrEP implementation; 45% anticipated expanding their level of engagement. Among LHDs not engaged in PrEP implementation, 13% expected to become engaged over the next four years, 46% were undecided, and 41% reported it was unlikely. Information about PrEP for health care providers and information about PrEP for health department staff were the most frequently reported resource needs for LHDs engaged and not engaged in PrEP implementation, respectively.ConclusionsPrEP implementation by LHDs was limited in 2015, three years after Food and Drug Administration approval and one year after the U.S. Public Health Service issued clinical practice guidelines. PrEP is a recently available intervention that is requiring LHDs to adjust existing HIV prevention efforts and service delivery models. Additional resources and implementation research is needed to effectively support PrEP scale-up by LHDs. Efforts must also be undertaken to increase PrEP awareness, knowledge, and implementation capacity among LHDs.

Project description:The commercial asset value of sequestered forest carbon is based on protocols employed globally; however, their scientific basis has not been validated. We review and analyze commercial forest carbon protocols, claimed to have reduced net greenhouse gas emissions, issued by the California Air Resources Board and validated by the Climate Action Reserve (CARB-CAR). CARB-CAR forest carbon offsets, based on forest mensuration and model simulation, are compared to a global database of directly measured forest carbon sequestration, or net ecosystem exchange (NEE) of forest CO2. NEE is a meteorologically based method integrating CO2 fluxes between the atmosphere, forest and soils and is independent of the CARB-CAR methodology. Annual carbon accounting results for CAR681 are compared with NEE for the Ameriflux site, Howland Forest Maine, USA, (Ho-1), the only site where both methods were applied contemporaneously, invalidating CARB-CAR protocol offsets. We then test the null hypothesis that CARB-CAR project population data fall within global NEE population values for natural and managed forests measured in the field; net annual gC m-2yr-1 are compared for both protocols. Irrespective of geography, biome and project type, the CARB-CAR population mean is significantly different from the NEE population mean at the 95% confidence interval, rejecting the null hypothesis. The CARB-CAR population exhibits standard deviation ?5× that of known interannual NEE ranges, is overcrediting biased, incapable of detecting forest transition to net positive CO2 emissions, and exceeds the 5% CARB compliance limit for invalidation. Exclusion of CO2 efflux via soil and ecosystem respiration precludes a valid net carbon accounting result for CARB-CAR and related protocols, consistent with our findings. Protocol invalidation risk extends to vendors and policy platforms such as the United Nations Program on Reducing Emissions from Deforestation and Forest Degradation (REDD+) and the Paris Agreement. We suggest that CARB-CAR and related protocols include NEE methodology for commercial forest carbon offsets to standardize methods, ensure in situ molecular specificity, verify claims of carbon emission reduction and harmonize carbon protocols for voluntary and compliance markets worldwide.

Dataset Information

Estimating the impact of state budget cuts and redirection of prevention resources on the HIV epidemic in 59 California local health departments.

Publications

Estimating the impact of state budget cuts and redirection of prevention resources on the HIV epidemic in 59 California local health departments.

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