Application for Public Health Detailing Institute
Thank you for your interest in the Public Health Detailing Institute for High-Impact Prevention taking place February 14-16 in San Francisco, California. Because capacity is limited, we ask that you complete a BRIEF application describing the need and existing or projected resources for a public health detailing program focused on biomedical HIV prevention and care. Your responses will also help inform the content and planning of the Institute sessions.

Participation is limited to individuals affiliated with local or state health departments; those planning to implement detailing programs in higher-burden jurisdictions will be prioritized.

Registration for the Institute is free, but attendees are responsible for costs associated with travel, accommodation, and meals outside of the Institute schedule.

Please submit one application per institution by responding to each question below.

You can save your progress and return to a partially-completed application at a later time by clicking the "Submit" button below the questions. The page will then give you an "Edit this form" link that you will need to save so that you can come back later and finish the application.

The deadline to apply is DECEMBER 15, 2017. Applicants will be notified of their selection beginning January 3, 2018, and are encouraged to participate in a pre-Institute interactive webinar on January 11th, 2018.

Please contact Gary Najarian-Riese (415) 437-6226,
Organization *
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Address *
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Prospective participant : Name *
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Prospective participant 1: Role / Title *
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Prospective participant 1: Email Address *
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Prospective participant 1: Phone Number *
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Prospective participant 2 : Name
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Prospective participant 2 : Role / Title
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Prospective participant 2 : Email Address
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Prospective participant 2 : Phone Number
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1. In one paragraph, please summarize the HIV burden/prevention and/or care cascade in your jurisdiction (to the extent these data are available).
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2. What are your current provider education efforts?
3. How would detailing fit into your other ongoing HIV prevention/care activities? [including but not limited to other provider education initiatives]
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4. What is your experience with academic/public health detailing to date?
5. On what topic(s) are you interested in conducting academic/public health detailing?
6. How would you staff an academic/public health detailing initiative?
7. When do you anticipate launching your detailing program?
8. Which types of support do you have from departmental leadership to begin an academic/public health detailing program? (select all that apply)
9. What do you see as potential barriers to implementing a detailing program?
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