Ending the HIV Epidemic Newsletter

By Mike Weir September 24, 2020

NASTAD, with collaboration from 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 community. For questions, comments, or content contributions, please contact Mike Weir.

Administration Updates

Dear Colleague: Shortage of STI Diagnostic Kits and Supplies 

The Centers for Disease Control and Prevention (CDC) Division of STD Prevention issued a Dear Colleague letter offering guidance to prevention programs, including clinics, on approaches to prioritizing chlamydial and gonococcal testing when STI diagnostic test kits are in short supply. “There is a current shortage of STI test kits and laboratory supplies, most notably for chlamydia and gonorrhea nucleic acid amplification tests (CT/GC NAAT). The shortages affect multiple diagnostic companies, public health, and commercial laboratories and impact several components of the specimen collection and testing process.”  

CDC Announces New HIV Treatment Campaign Resources

The CDC has begun rolling out a new suite of HIV Treatment Works (HTW) products and materials as part of its Let’s Stop HIV Together campaign. “The new campaign materials focus on reaching and supporting people living with HIV and encouraging them to get in care, stay on medication, reduce their risks, and live well with HIV throughout their life.

The suite of new HTW products includes posters, print ads, palm cards, web banner ads, short- and long-form videos, and social media assets. Products have been created in English and Spanish and will be released in phases during the summer and fall of 2020. Materials can be accessed on the English and Spanish Let’s Stop HIV Together websites and YouTube channel, and will be promoted through paid and organic outreach across a variety of digital platforms.”

HRSA/HAB Releases New Program Letter on COVID-19 and RWHAP Recipients 

The Health Resources and Services Administration’s (HRSA) HIV/AIDS Bureau (HAB) released a new program letter regarding the COVID-19 public health emergency and its impact on clinical and programmatic operations and workflows and, subsequently, on client services, performance measure data, and health outcomes.  This letter is located on the HAB website under Policy Notices and Program Letters

NOFO PS21-2102: Comprehensive High-Impact HIV Prevention Programs for Community-Based Organizations

The CDC released the Notice of Funding Opportunity (NOFO) PS21-2102: Comprehensive High-Impact HIV Prevention Programs for Community-Based Organizations. Letters of Intent are due September 30, 2020 to CBOFOA@cdc.gov. The application deadline is November 20, 2020, 11:59 PM ET. For additional information, please visit the PS21-2102 website.

Draft Federal STI Action Plan Open for Public Comment

The Department of Health and Human Services (HHS) Office of Infectious Disease and HIV/AIDS Policy (OIDP) released the draft Sexually Transmitted Infections National Strategic Plan 2021-2025 (STI Plan). All comments must be received by 5:00 PM ET on October 1, 2020. NASTAD previously submitted comments on the proposed STI Plan and will submit comments on the draft STI Plan.

Health Department Call for Abstract Submission – Special Journal Issue

The American Journal of Preventive Medicine and CDC are inviting submissions from health departments and their academic partners for a thematic supplement titled “The Evidence Base for Initial Intervention Strategies for Ending the HIV Epidemic in America.” CDC is interested in health department program experience and evidence of best practices for implementing the EHE strategies identified in the PS20-2010 NOFO. Topics may focus on strategies for implementing any of the EHE pillars: Diagnose, Prevent, Treat, or Respond. If you are interested in contributing a paper, please provide a 350-word unstructured abstract summarizing the paper’s topic by October 5, 2020. Please submit abstracts to Dawn Smith at dsmith1@cdc.gov.

Local EHE counties are encouraged to submit abstracts to this special journal issue.

The AHEAD Dashboard

The U.S. Department of Health and Human Services (HHS) launched a new online resource/tool, America’s HIV Epidemic Analysis Dashboard (AHEAD), to measure collective progress in reaching EHE goals. The dashboard is housed on HIV.gov.

The AHEAD dashboard will make HIV data more widely available. It will graphically visualize data for each of the 57 EHE Phase I jurisdictions and track national and jurisdiction progress on six indicators:

  • HIV incidence
  • Knowledge of HIV status
  • HIV diagnoses
  • Linkage to HIV medical care
  • Viral suppression
  • PrEP coverage

On August 4, 2020, HHS hosted an informational webinar on America’s HIV Epidemic Analysis (AHEAD) dashboard for local and state health department officials. The webinar was an opportunity to see how data supports EHE, review the six EHE indicators and available data, walk through the dashboard, and answer questions. Click to watch the recording of the webinar, view the slides, and download the transcript.

HHS HIV/AIDS Treatment Guidelines' Website Change 

HIV.gov, in collaboration with NIH’s Office of AIDS Research (OAR), launched clinicalinfo.HIV.gov, a website providing access to the latest HHS HIV treatment guidelines, HIV drug database, and HIV glossary. The Spanish language versions of these assets are also available on the site. 

The clinicalinfo.HIV.gov website will ensure that health care providers, public health partners, researchers, people affected by HIV, and the general public continue to have access to the latest, federally-approved HIV clinical treatment and prevention guidelines as well as related tools and information about HIV-related research. 

The new site features: 

  • Guidelines: The federally approved medical practice (clinical) guidelines for HIV/AIDS are developed by panels of experts in HIV care. The guidelines are available in multiple formats. Future updates to the guidelines will be released on this site. 
  • Glossary: The HIV glossary provides definitions of a broad range of HIV-related terms and offers an easily searchable interface. 
  • Drug database: This searchable database helps users find information on FDA-approved HIV/AIDS and opportunistic infection drugs as well as investigational drugs for HIV treatment and prevention.

PS19-1906 Deadline Extended to December 31st Notice-of-Funding-Opportunity (NOFO)

The deadline to submit final/updated EHE plans through PS19-1906 Component B has been extended to December 31. CDC extended the deadline to accommodate changes in organizational capacity among health department staff due to the COVID-19 pandemic.

Legislative Updates

COVID-19 Relief and FY2021 Appropriations Updates

Congressional and Administration leaders have reached a deal on a continuing resolution (CR) to avoid a government shutdown – extending government funding through December 11th. The measure passed the House by 359-57, and it is expected to pass in the Senate and be signed by the President before the September 30th deadline. The Coalition for Health Funding sent a letter to Congressional leaders urging them to pass the fiscal year 2021 funding bills as soon as possible, citing examples of the harmful impact CRs have on public health and research programs. 

Congressional and Administration leaders remain in a deadlock over another round of COVID-19 stimulus. Negotiations are expected to continue through October and possibly until after the November election. NASTAD will continue to monitor the appropriations process and stimulus negations and advocate for the highest funding levels on behalf of HIV and hepatitis programs. 

U.S. Senate Democrats Request Response from PhRMA on Recent 340B Actions

Twenty-two Democratic Senators sent a letter to Pharmaceutical Research and Manufacturers of America (PhRMA) “regarding steps being taken by the industry to end denials of 340B pricing for drugs dispensed through contract pharmacies and demands for contract pharmacy claims data.” “Multiple drug manufacturers’ recent refusals “to provide 340B pricing for use in contract pharmacies are likely a violation of the law,” the lawmakers wrote to PhRMA President and CEO Stephen Ubl. Manufacturers’ related demands for 340B covered entities’ claims data, and threats to deny 340B pricing for drugs dispensed through contract pharmacies if entities fail to provide the data, “are also not tied to 340B compliance obligations,” the senators wrote.”

Resources

NASTAD Webinar Series: Effectively Engaging Community in the Ending the HIV Epidemic Process Through Digital Technology

In collaboration with Kaiser Family Foundation (KFF), NASTAD hosted a webinar series titled Effectively Engaging Community in the Ending the HIV Epidemic Process Through Digital Technology. The series, which launched in June 2020, aimed to support health departments and community-based organizations (CBOs) to accelerate jurisdictional efforts toward Ending the HIV Epidemic. Recordings of the webinars are listed below:

EHE Stories from the Field

NACCHO conducted a brief survey to assess local health departments’ (LHDs) HIV self-testing capacity and challenges. The survey highlighted a need for information about the variety of approaches health departments use to implement innovative HIV testing strategies. To fill that need, NACCHO has launched this ‘Stories from the Field’ series on HIV self-testing programs at LHDs.

The first story focuses on Denver Public Health’s HIV self-testing program, in which the health department distributes coupon codes to clients to redeem for oral HIV self-tests on Orasure’s website. Using the coupon code model, Denver maintains a successful self-testing program even with limited staff capacity.

The second story focuses on an innovative partnership between Baltimore City Health Department and Johns Hopkins’ I Want the Kit (IWTK), a public health initiative providing easy and confidential STI testing in Maryland since 2004. In Baltimore, residents can order swabs for HIV, chlamydia, gonorrhea, and trichomonas testing online to self-collect samples in their home or other private location.

The third story focuses on the Thomas Jefferson Health District (TJHD) and their implementation of  HIV self-tests, a self-administered rapid oral swab, to expand access to HIV testing. TJHD serves 150,000 people in urban areas and another 100,000 in highly rural counties. This unique geographic context can make accessing in-person HIV testing difficult, especially amid the COVID-19 pandemic. When it comes to testing for HIV, many factors may prevent someone from knowing their status, such as stigma, scheduling conflicts, or transportation issues. TJHD’s self-testing program, in which individuals can receive a self-test kit at the clinic or through the mail, offers a low-barrier experience for those who are unable or unwilling to test in person. 

The Toolkit for Technology-based Partner Services

“CDC has released the updated Toolkit for Technology-based STD and HIV Partner Services to support health departments, community-based organizations, and others in improving their use of technology to reach persons potentially exposed to STDs, including HIV.”

Kaiser Family Foundation Releases EHE Tracker

The Kaiser Family Foundation (KFF) published two new resources for the federal Ending the HIV Epidemic Initiative (EHE). The first resource is an “EHE explainer” which provides an overview of the federal EHE initiative and explores issues that might mitigate or facilitate its success. The second resource is an EHE funding tracker that provides up-to-date data on federal EHE funding, including an overview of funding mechanisms by year, agency, grant mechanism, and jurisdiction. KFF also released an overview of domestic HIV funding in the FY2021 Budget Request.

PS19-1906 Program Guidance

The CDC, in conjunction with the Health Resources and Services Administration (HRSA), provides program guidance for Component B of PS19-1906: Strategic Partnerships and Planning to Support Ending the HIV Epidemic in the United States. The program guidance “seeks to ensure robust and diverse community involvement in the development of local plans, which will continue to be refined over time, in partnership with local communities. This program guidance provides additional recommendations on the community engagement process, the development of an epidemiologic profile summary, a situational analysis summary, and planning activities and scenarios.”

Self-Testing for HIV and STIs through Local Health Departments: Survey Reveals Barriers, Opportunities

“To better understand the landscape of HIV/STI self-testing at LHDs, NACCHO launched a brief survey to collect information about LHD approaches and challenges to implementing self-testing programs. Survey results demonstrated a large gap in at-home testing capacity in local public health.”

HIV Self-Testing Analysis 

NASTAD is excited to announce a comprehensive, landscape analysis of HIV self-testing programs across the United States through our new state-by-state maps detailing HIV self-testing and TelePrEP services in honor of National HIV Testing Day on June 27. As programs began to experience disruption in HIV testing and PrEP clinical services as a result of COVID-19, the CDC released guidelines to use self-testing via home specimen self-collection kit or an oral swab-based test whenever lab visits are unfeasible. In early June 2020, NASTAD surveyed its members to learn more about how health departments are providing access to at-home HIV, HCV, STI, and PrEP self-testing services. In all, our review demonstrated that twenty-one jurisdictions currently offer HIV self-testing services. This represents 55% of the jurisdictions that responded to NASTAD’s RFI. Most of these self-testing programs are recent additions to expand the availability of HIV testing services, with more than 70% of programs starting in 2019 or 2020. The complete analysis can be viewed here.  

Join NACCHO's Harm Reduction Community of Practice

NACCHO is seeking new members to join its Harm Reduction Community of Practice (HRCoP). As COVID-19 continues to take a toll on local health departments’ harm reduction activities, staff engaged in these services need a venue to meet with peers to discuss successes and challenges for their programs, newly released resources and best practices, and other topics of interest. Group members will participate every other month in one-hour virtual discussion sessions. With harm reduction playing a vital role in EHE activities, it is vital that LHDs have appropriate levels of staff and staff support.

News

Supporting Engagement & Re-engagement in HIV Care to End the HIV Epidemic in Baltimore

“Unapologetically enabling” is the mantra of the Baltimore City Health Department’s Getting to Zero + Initiative, which employs novel approaches to support clients with engagement and re-engagement in HIV care. Dr. Victoria A. Cargill, Assistant Commissioner of the Baltimore City Health Department, discussed the program at the 2020 Ryan White HIV/AIDS Program Clinical Conference. Her August 12 presentation  was part of a panel about the Ending the HIV Epidemic (EHE) initiative which includes a focus on engaging people with HIV in care who have yet to be engaged and re-engaging those who are lost to care.”

How to Visually Track Data From the Plan to End the U.S. HIV Epidemic

“You’ve probably read about “Ending the HIV Epidemic: A Plan for America,” the national initiative President Trump launched last year with the goal of reducing new HIV diagnoses in the country by 75% by 2025 and by 90% by 2030. Now you can actually track the plan’s progress using America’s HIV Epidemic Analysis Dashboard (AHEAD).”

Stigma is keeping LGBTQ+ Hispanic and Latino men from seeking HIV care: report

“Even as women break glass ceilings around them, some men remain trapped by a patriarchal ideal of manhood. "Machismo," in Spanish, is a strong or aggressive masculine pride often associated with a man's role in a traditional, heterosexual family. A new study by ViiV Healthcare and TCC Group finds that for gay and bisexual Latino/Hispanic men with HIV, that machismo can be a threat to their identity and lives.”

Pharmacists Play a Critical Role in Managing Changes to HIV Care During COVID-19

“Overall, cost to the health care system, to insurers, and to society are significant, especially considering the increasing number of people who require lifelong antiretroviral therapy and experience rising drug costs,” Patchett said. “In general, out-of-pocket costs for patients can be a barrier to the initiation and continuation of therapy. Us as pharmacists play such a critical role when it comes to navigating through these potential barriers and cost considerations for patients.”

Researchers explore the acceptability of delivering HIV-positive results by phone

“Stigma, healthcare access issues, and geographic isolation are major barriers to HIV testing and treatment. For a paper published in the journal AIDS and Behavior, a team led by CUNY SPH doctoral student Alexa D'Angelo analyzed interviews from 50 MSM about their experience receiving a positive HIV test result via phone through their participation in a research study that included remote HIV testing.”