management declined over the period, while spending on ADAP increased significantly, from 46 percent to 68 percent in response to the growing demand for antiretroviral therapy.
Title I funding is determined by a formula based on the estimated number of people living with AIDS in the EMA over the most recent 10-year period. Supplemental grants are awarded competitively by the U.S. Department of Health and Human Services (DHHS) on the basis of demonstrated severity of need and other criteria. Title II grants are also determined by a formula based on the estimated number of living AIDS cases in a state.9 The allocation of CARE Act Title I funds is guided by local planning councils. Councils have responsibility for assessing an EMA’s HIV/AIDS service needs, establishing priorities for the allocation of funds, developing a comprehensive plan for the organization and delivery of HIV services that is compatible with existing state and local plans, addressing the efficiency of the administering agency in rapidly allocating funds to areas of greatest need, and establishing operations to make planning tasks function smoothly (HRSA, 2003c). Planning council membership is determined by law and is intended to reflect the demographics of the population of individuals with HIV disease in the eligible area involved, with particular consideration given to disproportionately affected and historically underserved groups and subpopulations (HRSA, 2003c). It is required that 15 membership categories (see Box 3-2) be represented in the planning council.
CARE Act Title II funds are awarded to a state agency for administration. States use funds to provide services directly as well as through consortia. The Act defines consortia as “an association of one or more public, and one or more nonprofit private health care and support service providers and community based organizations operating within areas determined by the state to be most affected by HIV disease” (HRSA, 2003d). Consortia are responsible for assessing needs and contracting and coordinating a comprehensive continuum of outpatient health and related support services (HRSA, 2001). Furthermore, consortia are expected to promote the coordination and integration of available community resources, use case management to ensure continuity of services, and evaluate their effectiveness at meeting service needs. Consortia membership includes agencies with expe-