Ending the HIV Epidemic Newsletter
NASTAD, in collaboration with the National Association of County and City Health Officials (NACCHO), the Council of State and Territorial Epidemiologists (CSTE), and the National Coalition of STD Directors (NCSD), distributes a monthly newsletter to Phase 1 Ending the HIV Epidemic: A Plan for America (EHE) jurisdictions. The newsletter informs recipients of EHE-related policy updates, communications from federal partners, success stories, and other related EHE information. As the CDC PS19-1906 National Partner and HRSA-20-089 Systems Coordinator Provider recipients, NASTAD also launched an EHE website to house programmatic updates, share strategies and outcomes from Phase 1 jurisdictions, and connect health departments with the community. For questions, comments, or content contributions, please contact Mike Weir.
Hill Happenings
FY2024 Appropriations
On January 27, Senate Appropriations Chair Patty Murray (D-WA) and House Appropriations Chair Kay Granger (R-TX-12) reached an agreement on topline spending totals for the 12 Fiscal Year 2024 (FY2024) appropriations subcommittee bills. Appropriators are now working to draft bill text ahead of spending deadlines set by a January 19 continuing resolution (CR) (H.R. 2872). The new CR establishes an updated “laddered” deadline for federal spending bills, with some federal agencies and programs facing a March 1 deadline. Larger agencies, including those funded through the Labor, Health and Human Services, Education, and Related Agencies (LHHS) bill, now face a March 8 deadline, granting lawmakers a few more weeks to finalize FY2024 spending levels.
NASTAD will continue to monitor the congressional appropriations process and advocate for the highest possible funding for HIV, hepatitis, and drug user health programs.
Administration Activities
Dr. Robyn Neblett Fanfair to Lead CDC Division of HIV Prevention
On February 12, the Director of the Centers for Disease Control and Prevention (CDC) National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) announced that Robyn Neblett Fanfair, MD, MPH (CAPT, USPHS), will lead the NCHHSTP Division of HIV Prevention (DHP) in a permanent capacity after serving as Acting Division Director since 2022. As Director, Dr. Fanfair will continue to provide her scientific leadership and expertise to manage, direct, and coordinate the work of the Division to reduce new HIV infections, advance health equity, and improve the health of people with HIV. Since first joining NCHHSTP in 2012, Dr. Fanfair has led research activities to enhance engagement and retention in HIV care, increase viral suppression, and improve equity in health and life for persons with HIV. NASTAD congratulates Dr. Fanfair on her new role as permanent Director of DHP.
New CDC NOFO PS24-0047: High-Impact HIV Prevention and Surveillance Programs for Health Departments
On February 9, the CDC published PS24-0047: High-Impact HIV Prevention and Surveillance Programs for Health Departments on Grants.gov. This notice of funding opportunity (NOFO) will provide HIV prevention and surveillance funding to 60 health departments previously supported by PS18-1802. An additional 32 awards are available for eligible health departments previously funded under PS20-2010 as part of EHE. CDC shared funding tables that lists anticipated funding ranges for budget period one and subsequent budget periods for PS24-0047 and for Ending EHE activities for eligible jurisdictions. Applications are due by Monday, April 29, 2024, no later than 11:59 PM ET.
Updated HIV Cluster Detection and Response Guidance for Health Departments
The CDC has updated their guidance for HIV Cluster Detection and Response (CDR) for health department. The guidance provides actions that health departments can take to develop capacity, engage key partners, and successfully implement CDR activities.
CDC STI Surveillance Report Shows Dramatic Increase in National Syphilis Rates in 2022
On January 30, the CDC released the Sexually Transmitted Infections Surveillance, 2022 report, which reveals a dramatic increase in national syphilis rates during calendar year 2022. While gonorrhea rates decreased by 8.7% between 2021 and 2022, national rates of syphilis increased by 17% in the same times-pan, contributing to an overall 78% increase in syphilis rates since 2018. A significant burden of the increased syphilis incidence occurred in the congenital syphilis cohort, which saw a 30.6% increase between 2021 and 2022 and an overall 183.4% increase since 2018. The report authors call for a redoubling of prevention efforts and treatment approaches as the public health system rebounds from the COVID-19 pandemic and mpox outbreak, which strained the STI workforce.
CDC, FDA Work to Address Syphilis Epidemic and Treatment Shortages
On February 8, CDC published an MMWR, CDC Laboratory Recommendations for Syphilis Testing, United States, 2024, which updates laboratory recommendations for syphilis testing. The updates are meant to facilitate greater testing and reporting of syphilis at laboratories as the nation grapples with a growing epidemic. The recommendations highlight the significant health disparities associated with syphilis infections, particularly among sexual and gender minority populations, intersections with the HIV and substance use epidemics, and increased morbidity and mortality attributable to congenital syphilis infections. The STI surveillance report and updated laboratory recommendations follow a January 16 notice that the FDA is temporarily approving importation of Extencilline, an antibiotic approved for use among populations with perinatally acquired syphilis in some countries outside of the US, to fill manufacturing shortages of Bicillin L-A® in the US.
DOJ, HHS Push State Medicaid Administrators to Comply with Federal Laws Protecting Access to HCV Treatment for People with SUD
On January 24, the Department of Justice (DOJ) and the Department of Health and Human Services (HHS) issued a joint letter to state Medicaid administrators uplifting their obligation under federal law to ensure that state programs do not impose unlawful barriers to antiviral treatment for people who have HCV and substance use disorder (SUD). The letter reminds states that the Americans with Disabilities Act prohibits non-medically indicated sobriety restrictions for HCV treatment and communicates the DOJ’s willingness to act against any violations. The letter highlights a 2022 settlement agreement between the DOJ and the Alabama state Medicaid program which removed sobriety restrictions for HCV treatment that violated ADA protections.
HHS Issues Final Rule to Permanently Extend Remote Prescribing of Buprenorphine
On February 2, HHS and the Substance Abuse and Mental Health Services Administration (SAMHSA) finalized rulemaking that will permanently extend telehealth flexibilities for Opioid Treatment Programs (OTPs) that were first introduced during the COVID-19 public health emergency. The final rule authorizes remote prescribing of buprenorphine without an in-person visit or restrictions against audio-only telehealth appointments. Additionally, the rule updates federal opioid use disorder (OUD) treatment standards to include harm reduction education and services when clinically necessary or otherwise appropriate. The rule will go into effect on April 2, 2024.
HHS Finalizes Regulation Protecting Patient Confidentiality for People Living with SUD
On February 8, HHS finalized rulemaking that will facilitate greater care coordination for patients with living with SUD. The final rule strengthens confidentiality protections and aims to integrate behavioral health information with other medical records to facilitate interoperability between health systems while reducing provider stigma for patients who seek medical care. Notably, the regulation provides HHS with the enforcement authority to address privacy violations. The rule was spurred by the bipartisan Coronavirus Aid, Relief, and Economic Security Act (CARES Act), which required HHS to update existing SUD treatment records privacy regulations into closer alignment with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy, Breach Notification, and Enforcement Rules.
Resources
CDC MMWR:
- National HIV Behavioral Surveillance Among Transgender Women — Seven Urban Areas, United States, 2019–2020
- Overview and Methodology of the National HIV Behavioral Surveillance Among Transgender Women — Seven Urban Areas, United States, 2019–2020
- Characteristics Associated with Pre-Exposure Prophylaxis Discussion and Use Among Transgender Women Without HIV Infection — National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019–2020
- Structural and Psychosocial Syndemic Conditions and Condomless Anal Intercourse Among Transgender Women — National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019–2020
- Nonprescription Hormone Use Among Transgender Women — National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019–2020
- Transgender Women Experiencing Homelessness — National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019–2020
- Prevalence of Discrimination and the Association Between Employment Discrimination and Health Care Access and Use — National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019–2020
- Social Support and the Association Between Certain Forms of Violence and Harassment and Suicidal Ideation Among Transgender Women — National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019–2020
- CDC Laboratory Recommendations for Syphilis Testing, United States, 2024
- Comparison of Administration of 8-Milligram and 4-Milligram Intranasal Naloxone by Law Enforcement During Response to Suspected Opioid Overdose — New York, March 2022–August 2023
- Selection of Antibiotics as Prophylaxis for Close Contacts of Patients with Meningococcal Disease in Areas with Ciprofloxacin Resistance
NASTAD: Southern Region Cluster Detection and Response (CDR) Video Series
“This animated video series breaks down multiple foundational components of HIV cluster detection and response (CDR) work. The series discusses complexities surrounding this public health strategy in a digestible, basic manner and aims to educate staff members at health departments and community-based organizations (CBOs) new to CDR concepts. Health departments and CBOs can also utilize these videos as an engagement and education tool for their community members and stakeholder groups.”
“The US government has established a national goal of hepatitis C virus (HCV) elimination by 2030. To date, most HCV elimination planning and activity have been at the state level. Fifteen states presently have publicly available HCV elimination plans. In 2019, Louisiana and Washington were the first states to initiate 5-year funded HCV elimination programs…Louisiana's and Washington's comprehensive plans, funding approaches, and programs provide a useful framework that can move states and the nation toward HCV elimination.”
Advocates for Youth: Recruiting National Youth HIV & AIDS Day Ambassadors
“Every year, Advocates for Youth pays young people (ages 13-24) to work in their own community or campus to share factual sexual health information, organize actions to address the impact of HIV & AIDS on youth, and create community spaces for healing and reflection. This year, we are selecting 50 young people (ages 13-24, of any gender) for the program. Ambassadors will be trained in HIV policy and community engagement in order to promote a message of prevention, treatment, care and youth empowerment. They will be given a $150 stipend for their work.”
TAP-in Webinar: Ending the HIV Epidemic (EHE) by Addressing Methamphetamine Use Among Black Gay, Bi-sexual, Same-Gender-Loving (GBSGL) Men with HIV
On February 22, 2024, TAP-in delivered the national webinar, Ending the HIV Epidemic (EHE) by Addressing Methamphetamine Use Among Black Gay, Bi-sexual, Same-Gender-Loving (GBSGL) Men with HIV. This webinar discussed how Methamphetamine (Meth) is a key driver of the HIV epidemic for GBSGL men and aims to engage, educate, and empower communities to be one step closer to Ending the HIV Epidemic. If you missed it, the webinar recording, and slide deck are available on TargetHIV.
NACCHO Webinar: Sexual Health Services in Jails Webinar: Part 3
Join NACCHO on Wednesday, March 13th at 2:00 PM ET for part three of our Sexual Health Services in Jails series. This session will feature impactful jail projects from the San Francisco Department of Public Health and Orange County, FL. We will be discussing the stakeholders involved in these projects, how the projects were implemented, and what was learned along the way. Register here.
NCSD: National Network of Disease Intervention Training Centers (NNDITC)
NNDITC is now offering interactive training courses for 2024 on topics of STI/HIV interviewing, self-care for DI professionals, cultural humility, and much more! Register for an upcoming session at NNDITC.org.
NCSD: STI Engage: Shaping the Nation's Health
STI Engage 2024 is known as the place for STI professionals to hear from national leaders – government officials, researchers, clinicians – as well as their own peers, as always, with top-notch production, game-changing content, and a lot of fun. Building on the momentum of STD Engage 2023, when more than 1,200 STI professionals joined us in New Orleans, we’re bringing the STI sector’s signature conference to the nation's capital. Register & Book Your Hotel
NCSD: DIS Scholarships Available for STI Engage
NACCHO and NCSD are pleased to offer scholarships for disease intervention specialists (DIS) who work in local and state health departments to attend NCSD’s annual meeting, STI Engage! Scholarships will cover conference registration, lodging, travel, and per diem expenses. Apply Here
NCSD: DIS Funding Support Job Aid
While NCSD continues our national advocacy work to increase funding for DIS, our policy team created a job aid that provides strategies for funding and sustaining the DIS workforce. It includes ideas for alternative funding sources, data on the importance of DIS, and messaging about how DI professionals reduce STI transmission. Check It Out
University of Pennsylvania Survey: PrEP Use Across EHE Jurisdictions
The Social Action Lab at the University of Pennsylvania is inviting health departments across the EHE jurisdictions to participate in a research study. The purpose of the study is to explore strategies to improve PrEP use across EHE jurisdictions. Through a survey link, the research team is looking to collect data on structural determinants of PrEP use and policy implementation factors in your EHE state/county. Participants will be invited to a PrEP promotion conference fully sponsored by the team at the University of Pennsylvania and to participate in research publications resulting from the project.
If you are interested in participating, please contact Bita Fayaz Farkhad at bitaf@upenn.edu to learn more and to receive the link to the survey. We hope you will consider participating.
Please contact Natalie Cramer or Kristina Santana with questions.
NASTAD and RAISE Webinar Series
The Research Alliance in Implementation Science to End HIV (RAISE) Hub aims to advance the implementation of EHE initiatives through evidence-based interventions. NASTAD is proud to collaborate with The University of Washington/Fred Hutch Center for AIDS Research on the RAISE Hub on this initiative which includes a monthly webinar series. To learn more about RAISE and view previous webinars, click here.
HIV Cluster Detection and Response Learning Collaborative: Apply Now
CAI’s Technical Assistance Provider – innovation network (TAP-in), together with the New York State AIDS Institute’s Center for Quality Improvement and Innovation (CQII), is launching an HIV Cluster Detection and Response Learning Collaborative. This Collaborative aims to improve HIV cluster detection and response efforts to reduce the number of new HIV diagnoses and better link people newly diagnosed with HIV to care. Join other EHE jurisdictions funded by HRSA to participate in a 15-month learning collaborative that will build community partnerships, share lessons learned from other jurisdictions, discover the latest evidence-based practices, and provide strategies for updating HIV cluster and detection plans. For more information and to apply.
CSTE Infectious Disease Peer-to-Peer TA Consultancy Form - HIV
The CSTE Infectious Disease Program is pleased to offer coordination of peer-to-peer technical assistance. CSTE's HIV peer-to-peer technical assistance will be conducted virtually at this time. To give or receive peer-to-peer technical assistance, please complete the CSTE Infectious Disease Peer-to-Peer TA Consultancy Form. If you have any questions regarding HIV peer-to-peer technical assistance, please reach out to Symone Richardson at srichardson@cste.org. If you have any questions about completing the consultancy form, please reach out to Akila Simmons at asimmons@cste.org.
EHE Community of Practice (CoP) on NASTAD’s Online Technical Assistance Platform (OnTAP)
NASTAD and NACCHO manage a virtual Community of Practice (CoP) to support peer-to-peer learning and mentorship for EHE jurisdictions. The EHE CoP is housed on NASTAD’s online technical assistance platform (OnTAP) for those leading their jurisdictions' EHE efforts at local and state health departments to share resources and news, discuss challenges and successes, access notes from monthly EHE Office Hours calls, and request technical assistance (TA). If you need access to OnTAP, please contact Krupa Mehta.
Ending the HIV Epidemic Jurisdictional Directory
NASTAD maintains an Ending the HIV Epidemic (EHE) Jurisdictional Directory. NASTAD has recently updated the EHE Jurisdictional Directory, which lists local and state points of contact for all EHE Phase 1 jurisdictional activities. This directory is used to communicate with EHE Phase 1 jurisdictions, disseminate resources, and gather information. Health department staff members are encouraged to update their jurisdiction’s information using this brief form.
Jurisdictional Map of Phase 1 EHE Final Plans
NASTAD released a resource that provides access to Phase 1 EHE websites and plans. Please email Krupa Mehta additional Phase 1 EHE plans for inclusion in this resource, as well as any changes to existing plans.
Job Postings
KFF: Senior Program Manager, Health Departments & Community Partnerships
KFF is looking for a Senior Program Manager to work “with state and local health departments on localized iterations of our campaigns designed to address local priorities and extend the reach of limited public resources. We also have a large-scale ongoing partnership with Walgreens to bring health department and community partners into stores on National HIV Testing Day (June 27) to provide free testing and the latest information about prevention and treatment.”
News Bulletin
Is Housing Health Care? State Medicaid Programs Increasingly Say ‘Yes’
“States are plowing billions of dollars into a high-stakes health care experiment that’s exploding around the country: using scarce public health insurance money to provide housing for the poorest and sickest Americans…At least 19 states are directing money from Medicaid — the state-federal health insurance program for low-income people — into housing aid and addressing the nation’s growing homelessness epidemic, according to the Centers for Medicare & Medicaid Services.” – KFF News
H.I.V. Groups Warn of Privacy Risks in How C.D.C. Tracks Virus Samples
“The new policy did not allow waivers for opting out of molecular surveillance in places where such data could be used in criminal proceedings, a change that had been recommended by the National Alliance of State and Territorial AIDS Directors, a nonprofit representing public health officers.” – New York Times
Can Vending Machines Help Curb STDs?
“Vending machines offering tests for sexually transmitted infections hold promise as a way to reach people with sexual health services, according to a study that comes on the heels of recent increases in STIs in both the U.S. and England…Researchers said increased access to testing among men who have sex with men, people from Black communities and younger people 16 to 25 years old “was a priority” in the two regions the machines were placed, “as these groups have high risk of infection and do not regularly engage in HIV and STI testing,” according to the study.” – US News
Syphilis cases spike as budget cuts threaten efforts to contain outbreaks
“Syphilis rates jumped more than 17 percent over last year’s record-setting rate to reach the highest level since the 1950s — a dangerous trend that could worsen if Congress allows scheduled budget cuts to disease trackers to take effect this year. New data from the Centers for Disease Control and Prevention released Tuesday shows a steep escalation of a years-long national increase in syphilis and other sexually transmitted infections as local health departments work to recover from their battle against Covid-19 and Mpox.” – Politico
Surge in syphilis cases drives some doctors to ration penicillin
“But this already difficult situation was complicated last spring by a shortage of a specific penicillin injection that is the go-to treatment for syphilis. The ongoing shortage is so severe that public health agencies have recommended that providers ration the drug — prioritizing pregnant patients, since it is the only syphilis treatment considered safe for them. Congenital syphilis, which happens when the mom spreads the disease to the fetus, can cause birth defects, miscarriages, and stillbirths.” – NPR