DIVISION OF HIV/AIDS

Michigan Office of the
Auditor General
Thomas H. McTavish, C.P.A.
Auditor General

EXECUTIVE DIGEST #3964301
DIVISION OF HIV/AIDS - STD

INTRODUCTION
This report, issued in June 2002, contains the results of our performance audit of the Division of HIV/AIDS - STD, Community Public Health Agency, Department of Community Health (DCH).

AUDIT PURPOSE
This performance audit was conducted as part of the constitutional responsibility of the Office of the Auditor General. Performance audits are conducted on a priority basis related to the potential for improving effectiveness and efficiency.

BACKGROUND
Among the stated goals of the Division is to be the State entity that ensures appropriate human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) and sexually transmitted disease (STD) prevention and care.

Article 5 of Act 368, P.A. 1978, as amended, provides for DCH's efforts to address diseases, including HIV/AIDS and STDs. In 1997, DCH combined its HIV/AIDS and STD entities to form the Division of HIV/AIDS - STD.

The Division focuses its prevention and care efforts on HIV/AIDS, syphilis, gonorrhea, and chlamydia. Organizationally, the Division consists of the HIV/AIDS Prevention and Intervention Section and the Sexually Transmitted Diseases Section.

For fiscal year 2000-01, the Division expended approximately $23.0 million on HIV/AIDS activities and $6.4 million on STD activities for a total of $29.4 million. As of November 2001, the Division had 36 employees and used contractual service providers to assist it in operating its programs.

AUDIT OBJECTIVES, CONCLUSIONS, AND NOTEWORTHY ACCOMPLISHMENTS
Audit Objective: To assess the Division's effectiveness in administering care and prevention activities for persons with, or at risk of acquiring, HIV and AIDS.

Conclusion: We concluded that the Division was generally effective in administering care and prevention activities for persons with, or at risk of acquiring, HIV and AIDS. However, we noted reportable conditions related to its priority for adolescent HIV/AIDS prevention, education, and outreach services; AIDS Drug Assistance Program (ADAP) drug rebate program; ADAP drug and eligibility special request approval process; and quality assurance objective review process (Findings 1 through 4).

Noteworthy Accomplishments: The Division collaborated with the Department of Corrections to help ensure that inmates receive effective HIV/AIDS counseling and testing and continuity of care after their release from incarceration. In February 2001, the Association of State and Territorial Health Officials stated in its report entitled "Behind the Wall - Collaborative Responses in Massachusetts and Michigan to Address HIV/AIDS Among Incarcerated Populations":

          Through their collaborative efforts, the Massachusetts and Michigan programs
          reflect a new model for addressing HIV/AIDS among incarcerated populations. This model
          supercedes traditional barriers and blends together public health and public safety
          approaches, methodologies, cultures, and funding streams.

Audit Objective: To assess the Division's effectiveness in administering care and prevention activities for persons with, or at risk of acquiring, STDs.

Conclusion: We concluded that the Division was generally effective in administering care and prevention activities for persons with, or at risk of acquiring, STDs.

Audit Objective: To assess the effectiveness and efficiency of the administration of selected Divisionwide activities.

Conclusion: We concluded that the Division was generally effective and efficient in its administration of selected Divisionwide activities. However, we noted reportable conditions related to contract monitoring controls, care fiduciary and prevention planning activities, evaluation processes, efficiency of care and prevention activities, policies and procedures, controls over inventories of prescription STD drugs and HIV testing devices, counseling and testing funding, and conflict of interest (Findings 5 through 12).

AUDIT SCOPE AND METHODOLOGY
Our audit scope was to examine the program and other records of the Division of HIV/AIDS - STD. Our audit was conducted in accordance with Government Auditing Standards issued by the Comptroller General of the United States and, accordingly, included such tests of the records and such other auditing procedures as we considered necessary in the circumstances.

Our methodology included examining the Division's records and activities for the period October 1, 1999 through November 30, 2001. To accomplish our first objective, we gained an understanding of how the Division provided HIV/AIDS prevention and direct care services and interacted with regional and local entities. To accomplish our second objective, we gained an understanding of how the Division used the efforts of local health departments to perform STD care and prevention activities. To accomplish our third objective, we considered the extent to which Divisionwide activities were controlled, directed, and coordinated to ensure that DCH's mission and the Division's goals and objectives could be effectively and efficiently accomplished.

AGENCY RESPONSES
Our audit report contains 12 findings and 13 corresponding recommendations. The agency preliminary response indicated that the Division has complied or will comply with all of the recommendations.

Full Audit Report - #3964301 - DIVISION OF HIV/AIDS - STD

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This page was created on June 11, 2002.


INTRODUCTION This report, issued in June 2002, contains the results of our performance audit of the Division of HIV/AIDS - STD, Community Public Health Agency, Department of Community Health (DCH).

AUDIT PURPOSE This performance audit was conducted as part of the constitutional responsibility of the Office of the Auditor General. Performance audits are conducted on a priority basis related to the potential for improving effectiveness and efficiency.

BACKGROUND Among the stated goals of the Division is to be the State entity that ensures appropriate human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) and sexually transmitted disease (STD) prevention and care. Article 5 of Act 368, P.A. 1978, as amended, provides for DCH's efforts to address diseases, including HIV/AIDS and STDs. In 1997, DCH combined its HIV/AIDS and STD entities to form the Division of HIV/AIDS - STD. The Division focuses its prevention and care efforts on HIV/AIDS, syphilis, gonorrhea, and chlamydia. Organizationally, the Division consists of the HIV/AIDS Prevention and Intervention Section and the Sexually Transmitted Diseases Section. For fiscal year 2000-01, the Division expended approximately $23.0 million on HIV/AIDS activities and $6.4 million on STD activities for a total of $29.4 million. As of November 2001, the Division had 36 employees and used contractual service providers to assist it in operating its programs.

AUDIT OBJECTIVES, CONCLUSIONS, AND NOTEWORTHY ACCOMPLISHMENTS Audit Objective: To assess the Division's effectiveness in administering care and prevention activities for persons with, or at risk of acquiring, HIV and AIDS. Conclusion: We concluded that the Division was generally effective in administering care and prevention activities for persons with, or at risk of acquiring, HIV and AIDS. However, we noted reportable conditions related to its priority for adolescent HIV/AIDS prevention, education, and outreach services; AIDS Drug Assistance Program (ADAP) drug rebate program; ADAP drug and eligibility special request approval process; and quality assurance objective review process (Findings 1 through 4). Noteworthy Accomplishments: The Division collaborated with the Department of Corrections to help ensure that inmates receive effective HIV/AIDS counseling and testing and continuity of care after their release from incarceration. In February 2001, the Association of State and Territorial Health Officials stated in its report entitled "Behind the Wall - Collaborative Responses in Massachusetts and Michigan to Address HIV/AIDS Among Incarcerated Populations": Through their collaborative efforts, the Massachusetts and Michigan programs reflect a new model for addressing HIV/AIDS among incarcerated populations. This model supercedes traditional barriers and blends together public health and public safety approaches, methodologies, cultures, and funding streams. Audit Objective: To assess the Division's effectiveness in administering care and prevention activities for persons with, or at risk of acquiring, STDs. Conclusion: We concluded that the Division was generally effective in administering care and prevention activities for persons with, or at risk of acquiring, STDs. Audit Objective: To assess the effectiveness and efficiency of the administration of selected Divisionwide activities. Conclusion: We concluded that the Division was generally effective and efficient in its administration of selected Divisionwide activities. However, we noted reportable conditions related to contract monitoring controls, care fiduciary and prevention planning activities, evaluation processes, efficiency of care and prevention activities, policies and procedures, controls over inventories of prescription STD drugs and HIV testing devices, counseling and testing funding, and conflict of interest (Findings 5 through 12).

AUDIT SCOPE AND METHODOLOGY Our audit scope was to examine the program and other records of the Division of HIV/AIDS - STD. Our audit was conducted in accordance with Government Auditing Standards issued by the Comptroller General of the United States and, accordingly, included such tests of the records and such other auditing procedures as we considered necessary in the circumstances. Our methodology included examining the Division's records and activities for the period October 1, 1999 through November 30, 2001. To accomplish our first objective, we gained an understanding of how the Division provided HIV/AIDS prevention and direct care services and interacted with regional and local entities. To accomplish our second objective, we gained an understanding of how the Division used the efforts of local health departments to perform STD care and prevention activities. To accomplish our third objective, we considered the extent to which Divisionwide activities were controlled, directed, and coordinated to ensure that DCH's mission and the Division's goals and objectives could be effectively and efficiently accomplished.

AGENCY RESPONSES Our audit report contains 12 findings and 13 corresponding recommendations. The agency preliminary response indicated that the Division has complied or will comply with all of the recommendations.