Ending the HIV Epidemic Newsletter

By Mike Weir November 15, 2021

November 2021 EHE Newsletter 

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

Hill Happenings 

FY2022 Appropriations 

On Monday, October 18, the Senate Appropriations Committee released the remaining nine Fiscal Year (FY) 2022 Appropriations Bills, including the FY2022 Labor, Health and Human Services, Educations and Related Agencies Appropriations (LHHS) funding bill. The spending bills were not voted on by the full committee, and are instead the Chairman’s Marks, issued by Appropriations Committee Chair Patrick Leahy (D-VT). Senate Democrats proposed the following funding levels: 

  • Health Resources and Services Administration (HRSA) 
    • $131 million increase for the RWHAP Program  
    • $85 million increase for the Ending the HIV Epidemic Plan HRSA component 
  • Centers for Disease Control and Prevention (CDC) 
    • $17 million increase for the Opioids and Infectious Diseases Program 
    • $5 million increase for STD Prevention 
    • $100 million increase for the Ending the HIV Epidemic Plan CDC component 
  • Housing and Urban Development (HUD) 
    • $20 million increase for the Housing Opportunities for Persons With AIDS (HOPWA) Program 

The LHHS spending bill also removes legislative language which prohibited federal funding being used to support sterile injection equipment.   

Democrats must now advance the spending package by December 3, when the current continuing resolution (H.R. 5305) expires and the U.S. is projected to default on its debt. NASTAD will continue to monitor the FY2022 appropriations process to advocate for the highest funding levels on behalf of HIV and hepatitis programs. 

Build Back Better Act and Budget Reconciliation 

Democrats are working to quickly advance the Build Back Better Act (BBB) after months of internal negotiations. The broad-reaching social spending package is being advanced through budget reconciliation, requiring consensus within the Democratic caucus to advance the BBB. On November 3, House Democrats released revised bill text, updating the BBB with provisions that were newly negotiated.  

Notably, the updated House version of the BBB includes a provision to lower the cost of pharmaceutical drugs in Medicare Part D by empowering the Secretary of the Department of Health and Human Services (HHS) to directly negotiate prices with drug manufacturers. The drug price negotiation plan was reintroduced after Democratic leadership negotiated a compromise with centrist holdouts that that were opposed to the original provision. Additionally, the BBB would expand access to affordable coverage by bolstering Marketplace plans. The bill includes provisions that would: 

  • Temporarily close the Medicaid coverage gap until 2025 by subsidizing private coverage for people with low incomes living in states that did not expand their Medicaid programs. Earlier provisions that would have permanently closed the Medicaid coverage gap by launching a federal Medicaid program in 2025 were removed in negotiations. 
  • Extend the ACA premium tax credits that were authorized by the American Rescue Plan Act through 2025, increasing access to coverage and lowering premiums for current enrollees.  
  • $75 million for the Ryan White HIV/AIDS Program. 

It is unclear whether the House version of the BBB will receive enough votes in the Senate to pass. Despite the uncertainty, House Democrats are forging ahead in an effort to end the protracted negotiations and pressure the upper chamber to advance the BBB on the heels of Democrat’s successful bipartisan infrastructure package

House Democrats Reintroduce PrEP Assistance Program Act 

On October 15, Representatives Bonnie Watson Coleman (D-NJ-12), Barbara Lee (D-CA-13), Adam Schiff (D-CA-28) and Mondaire Jones (D-NY-17) reintroduced the PrEP Assistance Program Act. The bill would make PrEP medication more affordable and accessible by providing grants to cover medication costs, clinic and testing fees, physician visits, and community outreach programs. The bill authors highlight the legislation’s potential to improve health equity by mitigating the PrEP access gap for Black and Latinx communities. NASTAD supports the PrEP Assistance Program Act and applauds the Representatives for reintroducing the bill.  

Senate Confirms Dr. Rahul Gupta to lead the Office of National Drug Control Policy 

On October 28, the United States Senate confirmed the nomination of Dr. Rahul Gupta to lead the White House Office of National Drug Control Policy (ONDCP). He will be the first primary care physician to lead ONDCP. In this role, Dr. Gupta will oversee the development of the Biden Administration’s upcoming National Drug Control Strategy and play a significant role in responding to the opioid and overdose crisis. Prior to joining ONDCP, Dr. Gupta was the senior vice president and chief medical and health officer at the March of Dimes and served under two Governors as the Health Commissioner of West Virginia, where he led the state’s opioid crisis response efforts. 

Administration Updates 

AHEAD Releases New SDOH & Stratified Data at State and Local Levels 

HHS recently added social determinants of health (SDOH) to America’s HIV Epidemic Analysis Dashboard (AHEAD). Additionally, AHEAD now allows users to view some EHE indicator data stratified by age, race/ethnicity, sex at birth, and transmission category at the state and county levels.  

AHEAD displays seven SDOH: 

  • HIV stigma among persons living with HIV 
  • Homelessness among persons living with HIV 
  • Poverty 
  • Gini coefficient of income inequality 
  • Educational attainment 
  • Health insurance coverage 
  • Unemployment 

ACIP Issues Recommendation on Adult HBV Vaccination  

On November 3, the CDC Advisory Committee on Immunization Practices (ACIP) convened to vote on the proposal to recommend universal hepatitis b (HBV) vaccination for adults. ACIP unanimously voted to recommend the preventive vaccination for all adults ages 19-59, but maintained the current risk-based guidelines for vaccinating adults aged 60 and older. The ACIP vote will facilitate greater vaccine uptake among adults, helping to prevent disease transmission and outbreaks. Advocates applauded the decision, highlighting that ACIP’s vote will reduce health disparities by increasing affordable or cost-free access to the vaccine and accelerate efforts to eliminate viral hepatitis by 2030. NASTAD supported the universal adult HBV vaccination recommendation and submitted comments in favor of the recommendation.  

USPSTF Releases Draft Research Plan to Update PrEP Recommendation 

On November 4, the United States Preventive Services Task Force (USPSTF) posted a Draft Research Plan on pre-exposure prophylaxis (PrEP) for the prevention of HIV infection. The Draft Research Plan is available for review and public comment from  
November 4, 2021 through December 8, 2021. The draft research plan initiates the process for updating the current USPSTF recommendation for PrEP, which was designated an A grade in 2019.

HHS Releases New Opioid Overdose Prevention Strategy 

On October 27, HHS released the Biden Administration’s Overdose Prevention Strategy. The new strategy takes a polysubstance approach to the overdose crisis and prioritizes four key target areas: primary prevention, harm reduction, evidence-based treatment, and recovery support. Notably, the plan provides coordinated, federal support for harm reduction and seeks to expand sustainable funding strategies for harm reduction services. Additionally, the plan aims to maximize health equity for underserved populations and reduce stigma around drug use.  

CDC Distributes Historic 5-Year Investment for DIS Workforce 

The CDC announced that it distributed funding for the first year of the CDC Disease Intervention Specialists (DIS) Workforce Development Supplement. The DIS funding, afforded by the American Rescue Plan in May 2021, will strengthen the DIS workforce so that the U.S. can respond to COVID-19 and other infectious diseases, and support 21st century disease control and prevention by expanding, training, and sustaining a response-ready DIS workforce over the next five years. The funding supplements CDC’s “Strengthening STD Prevention and Control for Health Departments” (STD PCHD) (RFA-PS19-1901). All 59 current recipients of STD PCHD applied for and received funding for the supplement’s year one $200,000,000 award. 

Biden Administration Releases Title X Final Rule 

On October 7, the HHS Office of Population Affairs (OPA) released a final rule that reverses recent changes to the Title X program, the nation’s only federally-funded family planning program. The final rule largely restores the program to its operating conditions in 2019 prior to the Trump-era changes, which undermined the Title X provider network by forcing abortion providers out of the program. In preparation for the updated program changes which go into effect on November 8, the Administration will soon issue a notice of funding opportunities that will enable the full breadth of family planning providers to re-enter the program.  

HRSA HAB Updates RWHAP Client Eligibility Determination and Recertification Requirements 

On October 19, HRSA’s HIV/AIDS Bureau (HAB) announced the release of HAB Policy Clarification Notice (PCN) 21-02, Determining Client Eligibility and Payor of Last Resort in the Ryan White HIV/AIDS Program (RWHAP), which is immediately in effect. The updated guidance eliminates the six-month client eligibility recertification requirement for RWHAP programs, instead allowing RWHAP recipients and subrecipients to conduct timely eligibility confirmation in accordance with their policies and procedures. The PCN also states affirmatively that immigration status is irrelevant for the purposes of eligibility for RWHAP services. The PCN was issued in response to RWHAP recipient requests to reduce administrative and client burden while enhancing continuity of care to ensure that clients have access to medical and support services in order to achieve viral suppression. 

CDC DHP Expands Guidance on Collection, Use, and Release of HIV Sequence Data 

On October 21, the CDC’s Division of HIV Prevention (DHP) released expanded guidance on the collection, use, and release of HIV sequence data. State and local HIV surveillance programs funded by CDC should collect HIV sequence data only in the form of Sanger sequences or when next generation sequencing (NGS) has been conducted, consensus sequences. The guidance clarifies that analyses of HIV sequence data reported to HIV surveillance programs, whether conducted by health departments or academic partners, should not be interpreted as determining transmission direction or proving direct transmission. Additionally, HIV sequence data reported to CDC-funded HIV surveillance programs should not be released to GenBank or other public repositories by health departments or academic partners without individual consent. 

Resources

Systems Coordination Provider Project  

NASTAD’s Systems Coordination Provider (SCP) staff continues to participate in HRSA Ending the HIV Epidemic Programmatic Site Reviews through February 2022. NASTAD SCP staff attended six reviews in October. The site visits serve as an opportunity for the SCP and CAI, the Technical Assistance Provider (TAP), to provide an overview of the SCP and TAP-in projects and hear directly from jurisdictions about their EHE program and activities.  

NASTAD is convening a Housing Learning Collaborative that launched in October 2021 and runs through February 2022. The learning collaborative is specifically for health department staff in HIV prevention and care programs and aims to support health departments in developing partnerships between HIV and housing programs. NASTAD looks forward to sharing resources from the collaborative with EHE jurisdictions.    

NASTAD SCP is implementing a mentoring program. The EHE mentoring program is a 3-6 month-long intensive strategy for assisting health department staff in EHE jurisdictions focused on transforming leaders and developing emerging talent, improving systems and operations, and ensuring data-driven service outcomes. The mentoring program is a collaborative learning opportunity for new EHE Coordinators and Managers who are interested in strengthening their effectiveness by enhancing their skills to develop as emerging leaders. For additional information, please contact Darion Banister

Guide: Rapid ART: An Essential Strategy for Ending the HIV Epidemic 

TAP-in released, Rapid ART: An Essential Strategy for Ending the HIV Epidemic, a guide on developing a Rapid ART program for EHE jurisdictions, HIV care providers, and other organizations who want to develop or strengthen a rapid ART program. It provides you with concrete “how-to” information on steps to take, protocols to modify and use, and other action needed to put a program in place.   

  • Rapid ART – administering antiretroviral therapy (ART) immediately or as soon as possible after the diagnosis of HIV infection – is the standard of care for people with HIV.  
  • Rapid ART is an essential strategy to meet the Ending the HIV Epidemic in the U.S. initiative's goal (Pillar 2): promptly link all people with HIV to care and treatment to reach sustained viral suppression. 

NASTAD and NNEDV Webinar: Positively Safe - Addressing the Intersection of HIV and Domestic Violence 

Date & Time: Thursday, November 18, 2021, from 3:30 - 5:00 PM ET 

This webinar, presented in partnership with the National Network to End Domestic Violence (NNEDV), will address the intersections of domestic violence (DV) and HIV, specifically in the context of health department service delivery and EHE goals. Participants will receive an overview on DV, trauma, and how perpetrators of violence use HIV status to exert power and control. Attendees will also discuss trauma-informed promising practices to implement when working with individuals that disclose DV, as well as tips and resources to assist in building partnerships with local DV programs. You can register for this webinar here and view additional details.   

CDC MMWR: HIV Infection and HIV-Associated Behaviors Among Persons Who Inject Drugs 

“In 2015, the estimated HIV infection prevalence among persons who inject drugs (PWID) in 20 U.S. metropolitan statistical areas was 7%... In 2018, estimated HIV prevalence among PWID remained unchanged, and although overall syringe service program use did not significantly change, a substantial decrease in their use occurred among Black PWID.” 

CDC NOFO: Enhanced Surveillance of Persons with Early and Late HIV Diagnosis 

The CDC has issued a notice of funding opportunity (NOFO) for supplemental HIV surveillance activities that will improve understanding of barriers and gaps in HIV prevention services that may lead to continued HIV transmission or delayed diagnosis in the era of multiple testing modalities and prevention options such as PrEP. This NOFO will support health departments in conducting enhanced public health surveillance of people diagnosed with HIV during the earliest and latest stages of infection (stages 0 and 3, respectively). It is an effort to understand their recent experiences with HIV prevention and testing services and the system- and individual-level barriers that led to failures in early diagnosis and prevention. 

HRSA NOFO: Ending the HIV Epidemic - Primary Care HIV Prevention 

Application Deadline: Tuesday, December 14 

TA Webinar: Thursday, October 28 at 2 pm ET 

HRSA released the fiscal year (FY) 2022 Ending the HIV Epidemic - Primary Care HIV Prevention (PCHP) Notice of Funding Opportunity (HRSA-22-104). HRSA will invest approximately $50 million in health centers located in the targeted geographic locations where a majority of new HIV infections occur, as identified by the Ending the HIV Epidemic in the U.S. initiative. FY 2022 PCHP will support expanding HIV prevention services that decrease the risk of HIV transmission in underserved communities, focusing on supporting access to and use of pre-exposure prophylaxis (PrEP). Health centers with service delivery sites in the targeted geographic locations that did not receive FY 2020 PCHP or FY 2021 PCHP funding will be eligible to apply. Technical assistance (TA) resources are available on the PCHP TA webpage

CDC NOFO: Comprehensive High-Impact HIV Prevention Programs for Young Men of Color Who Have Sex with Men and Young Transgender Persons of Color 

The purpose of this program is to implement comprehensive high-impact HIV prevention programs to address health disparities among Young Men of Color Who Have Sex with Men (YMSM), Young Transgender Persons of Color (YTG), and their partners with the goal of reducing HIV transmission and HIV-associated morbidity and mortality. Letters of Intent were due October 4, 2021 to CBOFOA@cdc.gov. The application deadline is November 19, 2021, 11:59 p.m. Eastern Standard Time. 

NASTAD Resource: National Harm Reduction Technical Assistance Center (NHRTAC) Training Deck on Harm Reduction and Syringe Access 

The NASTAD Drug User Health Team is pleased to announce the publication of a new resource. The National Harm Reduction Technical Assistance Center (NHRTAC) Training Deck on Harm Reduction and Syringe Access is a customizable PowerPoint slide deck training designed to provide an overview on the foundations of harm reduction philosophy and practice, drug user health issues and trends, and increase cultural competence and humility when working with people who use drugs. 

LetsGetChecked and NCSD Announce Check Yourself 

Check Yourself offers two kit delivery options. Health departments can initiate overnight kit delivery to patients or give kits to patients in person. Patients then collect their samples, return them to the laboratory using a prepaid shipping label, and receive their confidential results within days. Reporting will be integrated with state and local health department surveillance systems, ensuring timely follow-up for treatment. 

NCSD is piloting Check Yourself with five public health departments, offering over 400 free test kits to participating health departments. Check Yourself will increase access to STD testing for all consumers, but especially uninsured and underinsured groups.” 

NCSD Launches New Website to Support Improving State Adolescent Health Policies and Practices 

The National Coalition of STD Directors (NCSD) and Child Trends, in partnership with the National Association of State Boards of Education (NASBE), is excited to announce the launch of a brand-new website dedicated to facilitating interactive virtual trainings and sharing resources for the Leadership Exchange for Adolescent Health Promotion (LEAHP) participants. The website is designed to serve as a hub for LEAHP state teams to immediately access professional development trainings, resources, and events. Participation in the virtual LEAHP trainings creates collaborative and peer-to-peer learning opportunities for state leadership teams to share successes, challenges, innovations, and questions on improving adolescent health policy. 

To learn more about LEAHP and opportunities for getting involved contact info@leahp.org. Explore the new website at leahp.org

Social Determinants of Health (SDH) Monthly Highlight  

NASTAD is pleased to announce a new monthly series that will highlight the intersection of HIV prevention and care with a specific social determinant of health (SDH). November will focus on food insecurity. More information and resource dissemination is forthcoming.  

Call for Abstracts: 2022 CSTE Annual Conference  

The Call for Abstracts for the 2022 Council of State and Territorial Epidemiologists (CSTE) Annual Conference in Louisville, KY is now open. The deadline for abstract submission is Thursday, January 6, 2022 at 11:59 pm EST. To submit an abstract for the 2022 CSTE Annual Conference, please follow the link below for additional information and complete all required fields in the process by the deadline. Information provided in the abstract submission guidelines relate to an in-person event with some virtual components. Presenting authors will be notified of Planning Committee decisions by Friday, March 25, 2022. Click here to review the 2022 Abstract Submission Guidelines. 

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. 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. 

News

Syphilis is resurging in the U.S., a sign of public health's funding crisis 

“In May 2021, President Joe Biden's administration announced it would set aside $7.4 billion over the next five years to hire and train public health workers, including $1.1 billion for more disease intervention specialists... Public health officials are thrilled to have the chance to expand their workforce, but some worry the time horizon may be too short. ‘We've seen this movie before, right?’ Dr. Tom Frieden (former CDC Director) said. ‘Everyone gets concerned when there's an outbreak, and when that outbreak stops, the headlines stop, and an economic downturn happens, the budget gets cut.’” 

Are Health Centers Needlessly Prescribing Pricey Descovy for PrEP Because They Get a Government Kickback? 

“What seems to be happening is that doctors are being encouraged to switch patients to Descovy based on the surface impression that it has a better safety profile,” said Kenyon Farrow, the managing director of Advocacy and Organizing of the group PrEP4All, which advocates for greater expansion of PrEP access, primarily by lowering the drug’s price. “But for most of us, generic Truvada is perfectly safe. The switch to Descovy has more to do with Gilead trying to hold onto its market share of PrEP users in the face of the generics.” 

Overdose deaths hit record high: CDC data 

“Drug overdose deaths hit a record high with almost 97,000 reported fatalities in the 12-month period ending March, according to preliminary data from the Centers for Disease Control and Prevention (CDC). The CDC’s National Center for Health Statistics preliminary data showed that overdose deaths rose 29.6 percent since the year-period ending March 2020. The record fatality count occurred during a time period encompassing the bulk of the pandemic’s first year.”  

Lack of Housing Linked to HIV, HCV Spikes Among People Who Inject Drugs 

“People who inject drugs were 39% more likely to acquire HIV and 64% more likely to acquire hepatitis C virus (HCV) if they were unstably housed or unhoused compared with those who had a safe, stable place to live, according to a meta-analysis published in Lancet Public Health…This may be the first systematic review and meta-analysis specifically looking at the impact of housing on HIV and HCV acquisition rates.”