In September 2010, CDC launched the Enhanced Comprehensive HIV Prevention Planning (ECHPP) project to shift HIV-related activities to meet goals of the 2010 National HIV/AIDS Strategy (NHAS). Twelve health departments in cities with high AIDS burden participated. These 12 grantees submitted plans detailing jurisdiction-level goals, strategies, and objectives for HIV prevention and care activities. We reviewed plans to identify themes in the planning process and initial implementation. Planning themes included data integration, broad engagement of partners, and resource allocation modeling. Implementation themes included organizational change, building partnerships, enhancing data use, developing protocols and policies, and providing training and technical assistance for new and expanded activities. Pilot programs also allowed grantees to assess the feasibility of large-scale implementation. These findings indicate that health departments in areas hardest hit by HIV are shifting their HIV prevention and care programs to increase local impact. Examples from ECHPP will be of interest to other health departments as they work toward meeting the NHAS goals.

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The HIV/AIDS epidemic in the United States continues despite several recent noteworthy advances in HIV prevention. Contemporary approaches to HIV prevention involve implementing combinations of biomedical, behavioral, and structural interventions in novel ways to achieve high levels of impact on the epidemic. Methods are needed to develop optimal combinations of approaches for improving efficiency, effectiveness, and scalability. This article argues that operational research offers promise as a valuable tool for addressing these issues. We define operational research relative to domestic HIV prevention, identify and illustrate how operational research can improve HIV prevention, and pose a series of questions to guide future operational research. Operational research can help achieve national HIV prevention goals of reducing new infections, improving access to care and optimization of health outcomes of people living with HIV, and reducing HIV-related health disparities.

In December 1999 the Centers for Disease Control and Prevention's (CDC's) Division of HIV/AIDS Prevention initiated a standardized evaluation system for CDC-funded health department HIV prevention programs. This health department evaluation guidance asks health departments to develop comprehensive evaluation plans and to submit aggregated data on such activities as intervention planning, process monitoring, and outcome evaluation. During the first year of this system, of 65 health departments, 62 submitted evaluation plans, 37 submitted intervention plan data, and 20 submitted process monitoring data. Major issues affecting implementation of a national evaluation system include varying levels of evaluation capacity among health departments, differences between the CDC's taxonomy for national data collection and local definitions, and limitations regarding use of 1st-year data. The CDC has learned that implementation of a standardized evaluation system takes considerable time and that stakeholder involvement and technical assistance and capacity building support are essential.