The agency responsible for curtailing the exploding number of new HIV infections in Atlanta has been returning sometimes as much of or more of the money it receives from the CDC due to failure to spend it.

WABE has the scoop, reporting that since 2012, the CDC has awarded grants to the Fulton County Health Department totaling nearly $20 million to fund HIV prevention efforts. In the first two years, the county spent about half of the money and in 2014 they spent more than half, in the process leaving $8.7 million on the table that should have gone to the fight against HIV.

The reason? Take it away, Dr. Patrice Harris, director of health services for Fulton County and who, as principal investigator of the grant, is responsible for executing the county’s HIV prevention strategy.

Harris said there many reasons, including the grant’s funding cycle, the amount of time needed to hire and train personnel, turnover and county bureaucracy. Plus, because the CDC requires Fulton County to contract with various community-based non-profits, ensuring their compliance can slow things down, she said.

“It’s certainly money that’s not spent going to work toward HIV prevention, and we need every dollar we can get,” said Harris. She noted the county is eligible to apply to get some of the unspent money back, a process called “carry-over.”

But that amount doesn’t begin to cover the county’s loss, and some close to the process said on background the money only replaces new funds the CDC would otherwise grant.

Dr. Harris, meanwhile, remained firm that her department is committed to fixing its spending issues. In April, she convened what she called a “turn-around” meeting, where various stakeholders offered their ideas on how to mend the problem.

She also said she’s certain the county will spend all of its grant money this year, barring what she called “unforeseen personnel problems.”

This isn’t the first time an agency in Georgia has had trouble allocating funds for HIV prevention. Local HIV/AIDS activists complained in 2011 about the Georgia Department of Public Health’s HIV Unit, whose responsibility it is to distribute CDC funds to state health departments and HIV/AIDS agencies. At that time, a CDC spokesperson told the Georgia Voice millions in HIV prevention funds were being returned.

“From fiscal year 2007 through fiscal year 2009, the Georgia Department of Public Health averaged an annual award of approximately $7.93 million and requested to carryover funds an average of 8 percent [or about $634,000] per year,” CDC spokesperson Scott Bryan told the Georgia Voice in 2011.

“Essentially, if a health department has unspent funds at the end of the year, that money is returned to CDC. The state health department can request those unspent funds be carried over and added to the following year’s budget (funds),” Bryan told the Georgia Voice three years ago.

Fulton’s current problems are a common one as health departments across the country have been adjusting to the CDC’s decision in 2012 to change policy by shifting hundreds of millions of dollars in prevention funds away from the states and moving the money directly to the local level.

Because of Atlanta’s high prevalence of HIV, the Fulton County Health Department suddenly found itself with millions of new dollars and a mountain of new responsibility. It not only had to spend a huge influx of new money, but it had to put into action a federal plan that represented a major shift in HIV policy.

Others, like Fulton County, quickly had to ramp up brand new programs.

“Fulton County had both this brand new resources with new reporting requirements, brand new scopes of activities, and not the historical infrastructure for HIV prevention,” Cramer said.

Given the demands of starting the program from scratch, it makes sense there would be growing pains. But Fulton County is heading into year four of the five-year grant, and the health department continues to struggle in some ways like it was day one. It still gives back to the CDC millions of dollars it hasn’t been able to spend.

The health department falls under the oversight of the Fulton County Board of Commissioners, whose chair John Eaves tells WABE that he just learned of the spending problems days ago, calling them “inexcusable.” But spending wasn’t the only issue, as WABE reports that compliance documents show the health department failed to meet several benchmarks tied to the grant money.

For example, it didn’t link enough newly-diagnosed HIV patients to medical care. It also failed to identify enough new HIV-positive people in non-health care settings. Recording and reporting data also posed a challenge, according to CDC records.

Fulton Commission Chair John Eaves said he was not aware of the compliance issues, but said he would direct the county manager to investigate “to make sure someone is held accountable and that going forward, this type of thing never happen[s] again.”

Fulton County is about to enter the final year of the CDC grant. Soon, the health department will apply for the next round of HIV prevention money.

The CDC is apparently staying mum on how Fulton’s spending issues will affect the status of any future funding for HIV prevention.

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