Ending the HIV Epidemic Newsletter

By Mike Weir February 1, 2021

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 the community. For questions, comments, or content contributions, please contact Mike Weir.

Administration Updates

HHS Releases HIV National Strategic Plan

The U.S. Department of Health and Human Services (HHS) released the HIV National Strategic Plan for the United States: A Roadmap to End the Epidemic 2021-2025 (HIV Plan). The National HIV/AIDS Strategy was first released in 2010 and updated in 2015. The 2021 update includes the original vision, mission, and four goals and incorporates changes that have occurred since the previous two releases, including the EHE initiative. The HIV Plan establishes eight core indicators to measure progress, with quantitative targets for each indicator and designates priority populations and key areas of focus. NASTAD submitted comments on the draft plan in December in 2020.

The HIV Plan and the EHE initiative are closely aligned and complementary, with the EHE initiative serving as a leading component of the work by HHS, in collaboration with local, state, and federal partners, to achieve both the Plan’s and the initiative’s goal of reducing new HIV infections by 90% by 2030. 

NASTAD will be carefully reviewing the updates to the HIV Plan and encourage our members to do the same. For more information on the HIV Plan release, please visit HIV.gov

HIV Criminalization Laws and Ending the HIV Epidemic in the United States

Recently, The Lancet HIV published a commentary by authors from the Centers for Disease Control and Prevention (CDC) titled “HIV Criminalization Laws and Ending the HIV Epidemic in the United States.” The article emphasizes the need to align HIV-specific criminal exposure laws with science and consider reforming, rescinding, and revising the application of relevant laws for the sake of people with HIV and for the public’s health.

New Mail Order Option for Ready, Set, PrEP Program 
HHS’s Ready, Set, PrEP program, which provides free HIV PrEP medication for people without prescription drug coverage, is offering a new mail order option for participants.

By visiting GetYourPrEP.com or calling 855-447-8410, participants can choose to have their PrEP medication mailed to their preferred address or to their health care provider (in participating states). The hope is that a new, direct mail order through Ready, Set, PrEP will add convenience for patients, especially during the COVID-19 public health emergency and for those in rural areas, thereby increasing access and adherence to PrEP. For enrollment, visit GetYourPrEP.com; to learn more about PrEP and Ready, Set, PrEP, visit HIV.gov/PrEP.

Biden Nominates Dr. Rachel Levine to serve as the Assistant Secretary of Health

Dr. Rachel Levine, President of the Association of State and Territorial Health Officials (ASTHO), has been nominated by President Biden to the role of Assistant Secretary of Health at HHS. The Office of Infectious Disease and HIV/AIDS Policy (OIDP) is within the Office of the Assistant Secretary. Dr. Levine is an accomplished pediatrician who currently serves as the Secretary of Health for the Commonwealth of Pennsylvania, professor of Pediatrics and Psychiatry at the Penn State College of Medicine, and as president of ASTHO. In her various roles, she has led Pennsylvania’s public health response to the COVID-19 pandemic; spearheaded efforts to end the opioid epidemic; and advocated on behalf of the LGBTQ community. With this nomination, Dr. Levine would become the first openly transgender federal official to be confirmed by the U.S. Senate. Click here to read NASTAD’s press release congratulating Dr. Levine.

HHS Releases the Viral Hepatitis National Strategic Plan

On Thursday, January 7, 2021 HHS/OIDP released The Viral Hepatitis National Strategic Plan for the United States: A Roadmap to Elimination (2021–2025) (“Strategic Plan”). The 64-page plan outlines a vision, goals, objectives, and strategies to eliminate hepatitis A, B, and C as public health threats in the U.S. NASTAD applauds HHS on the release of a comprehensive domestic plan for elimination of viral hepatitis through strategic coordination with internal and external hepatitis stakeholders. However, we note that a number of key recommendations from NASTAD’s comments were not integrated into the final plan and should be considered at the jurisdictional level in the development and implementation of state and local viral hepatitis elimination plans.

Over the next several months, NASTAD staff will work with our members, organizational partners, and federal colleagues to support the release of the corresponding implementation plan by HHS. Additionally, NASTAD will continue to engage in advocacy and policy efforts to increase federal funding for viral hepatitis and implementation of the national hepatitis strategic plan. 

HRSA’s Bureau of Primary Health Care FY2021 EHE Funding Opportunity 

The Health Resources and Services Administration’s (HRSA) Bureau of Primary Health Care (BPHC) released the FY2021 Ending the HIV Epidemic - Primary Care HIV Prevention (PCHP) Notice of Funding Opportunity (HRSA-21-092). HRSA estimates approximately $83 million to be available annually to fund 300 recipients located in EHE Phase 1 Jurisdictions, with the goal of increasing the number of health centers in the geographic locations that are focused on HIV prevention. PCHP applications are due in Grants.gov on Tuesday, February 2, 2021 by 11:59 PM ET.

CDC Funding Opportunity Announcement: Partnering and Communicating Together

The CDC published the Notice of Funding Opportunity (NOFO) PS21-2104: Partnering and Communicating Together. The NOFO seeks to engage strategic partners from across a variety of sectors to support the dissemination of messages and resources from the Let’s Stop HIV Together campaign to the populations and communities most impacted by HIV. The funding opportunity is part of CDC’s efforts to increase HIV awareness, testing, prevention, and treatment under the EHE initiative. A total of $11 million is available for the five-year period of performance to support up to 12 awards. Letters of Intent are due on February 17, 2021, and applications are due April 5, 2021. Additional resources are available online at the funding opportunity announcement page. Additionally, CDC will host two information webinars on February 17 and February 23 at 1:00 PM ET.

National Black HIV/AIDS Awareness Day Toolkit

February 7 marks National Black HIV/AIDS Awareness Day (NBHAAD), a yearly event hosted by the Let’s Stop HIV Together campaign. The CDC released its 2021 National Black HIV/AIDS Awareness Day Toolkit, featuring digital assets to help partners raise awareness on the impact of HIV in Black communities, promote messaging around reducing HIV stigma, and engage audiences to get tested, take action to prevent HIV, or get care and treatment. 

Legislative Updates

Congressional Leadership in the 117th Congress

On January 20, newly elected Senators Raphael Warnock (D-GA) and Jon Ossoff (D-GA) were sworn into the 117th Congress by Vice President Kamala Harris. The addition of the two Georgia Democrats to the Senate cements the Democratic party’s narrow majority, with Vice President Kamala Harris casting the tie-breaking vote in the evenly split chamber (50-50). Additionally, Harris swore in Alex Padilla (D-CA) to replace her former seat as junior senator for the state of California. With Senator Chuck Schumer (D-NY) now Senate Majority Leader, Democrats seek to quickly confirm President Biden’s Cabinet appointees, conduct the Senate Impeachment trial of former President Donald Trump, and pass a new round of financial relief amid the ongoing pandemic. 

Senate Majority Leader Chuck Schumer (D-NY) and Minority Leader Mitch McConnell (R-KY) are currently negotiating a power-sharing agreement for presiding over the evenly split Senate. The negotiations will have deep implications for Democrats’ ability to pass progressive policy proposals in the Senate over the next two years. In the House, the new Energy & Commerce (E&C) Committee Republican Leader Cathy McMorris Rodgers (R-WA-05) announced changes to the Republican subcommittee leaders and subcommittee rosters for the 117th Congress, including naming Representative Brett Guthrie (R-KY-02) as the ranking GOP member on the E&C Subcommittee on Health, replacing Representative Michael Burgess (R-TX-26).

NASTAD will continue to monitor stimulus negotiations in the 117th Congress and the appropriations process under a Biden Administration to advocate for the highest funding levels on behalf of HIV and hepatitis programs.

Resources

Jurisdictional Map of Phase 1 EHE Final Plans  

All final Phase 1 EHE plans were submitted to CDC by Dec. 31, 2020. EHE jurisdictions are required to share their EHE plan on a public-facing website. NASTAD is creating an interactive jurisdictional map to allow access to EHE websites and EHE plans. The map will be released in early February. As a reminder, though the planning period has ended, all jurisdictions are expected to evaluate their plans on an ongoing fashion and adapt accordingly. 

Self-Testing Webinar Series Update     

NASTAD held the third webinar in a four-part webinar series entitled, Self-Testing Strategies for HIV Testing and PrEP Access on January 13. The webinar focused on various models currently in place within organizations by highlighting the overall model, outreach efforts, order fulfillment and resources available to promote within communities. The recording, presentation slides, and questions posed during the webinar can be accessed via NASTAD's website and EHE Microsite. Information regarding the final webinar in the series is forthcoming.

NASTAD Webinar: Condom Distribution as a Structural Intervention

Dates: February 8 – 9, 2021

Registration is now open for the NASTAD workshop, “Condom Distribution as a Structural Intervention,” being held through our Capacity Building Assistance (CBA) program. The workshop will be hosted through two interactive virtual sessions on February 8-9, 2021. This workshop is designed for HD HIV prevention program staff and CBO staff. Moreover, the workshop is open ONLY to participants from CDC directly-funded HDs and CBOs in the Southern CBA region of the U.S. Registration will be open through February 1, 2021.

Fact Sheet: Preparing for Long-Acting Antiretroviral Treatment

Following a December 2019 U.S. Food and Drug Administration (FDA) approval delay due to Chemistry Manufacturing and Controls issues, the first long-acting antiretroviral product for HIV treatment is expected to be available in the U.S. in the first quarter of 2021. Cabenuva will be a co-packaged product containing cabotegravir and rilpivirine and is manufactured by ViiV Healthcare. Cabenuva will be delivered via monthly intramuscular injections that generally will need to be administered in a clinical setting. This novel maintenance therapy option may help to improve adherence and reduce stigma for some patients but will require pharmacy and/or clinical delivery system and administrative adjustments for clinics and providers. 

In collaboration with the HIV Medicine Association (HIVMA) and the American Academy of HIV Medicine (AAHIVM), NASTAD developed a fact sheet highlighting delivery system, staffing, and administrative issues for clinics and clinicians to consider in preparing to provide patients access to this novel treatment modality. 

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.”

HOPWA Resource Tool Helps Jurisdictions Plan for and Evaluate Housing Needs

A new tool is available to assist EHE Phase 1 jurisdictions and stakeholders in evaluating and planning for housing needs for people with HIV. The development of the Housing Opportunities for Persons With AIDS (HOPWA) Resource Tool was a collaborative effort between the Department of Housing and Urban Development’s Office of HIV/AIDS Housing, which administers the HOPWA program, and HHS’ OIDP.

Jurisdictional Townhalls   

Jurisdictional townhalls conducted in November 2020 were released in December. Recordings of the four virtual sessions can be viewed by clicking this link or by visiting NASTAD's Ending the HIV Epidemic (EHE) website.   

The town halls, held in November 2020, educated, encouraged, and empowered local community on the engagement and planning process for the Ending the HIV Epidemic (EHE) initiative. Health department staff and community members were present from all (32) jurisdictions funded through PS19-1906 Component B. CDC thanks all participants, CBA providers and NASTAD for their participation and contribution.

NASTAD Resource: PrEP Generics Entering the U.S. Market: FAQs

NASTAD is pleased to announce the release of a new resource created to address the many changes to the PrEP drug landscape, including the introduction of generics for PrEP in the United States. As new drugs are approved for PrEP and generic options become available, more questions have come up about what these changes mean for the PrEP access. Titled, PrEP Generics Entering the US. Market: Frequently Asked Questions (FAQs), this FAQ provides current information on the introduction of PrEP generics, potential coverage changes related to the changing PrEP drug market, and the impact on PrEP access.

TelePrEP Learning Collaborative  

NASTAD is pleased to announce the opening of the application cycle for cohort two of the TelePrEP Learning Collaborative. The TelePrEP Learning Collaborative is a virtual learning community for select Phase One Ending the HIV Epidemic (EHE) jurisdictions interested in implementing a telePrEP program and aims to provide ongoing technical assistance (TA) from peers and subject matter experts to increase the uptake of telePrEP programs. NASTAD will support the learning collaborative with funding from CDC PS19-1906 Component A.  

NASTAD will select up to eight jurisdictions to participate in the second cohort of the collaborative. If selected, jurisdictions will be expected to select one representative to participate throughout the six-month cohort (April 2021 - October 2021). The representative may be a health department staff member or a leader of a partnering community-based organization or Federally Qualified Health Center (FQHC) that the jurisdiction has identified. PS20-2010 Component A health departments and partnering community-based organizations are encouraged to apply. The application for cohort two of the TelePrEP Learning Collaborative can be accessed here.   

The estimated timeline for the application process is as follows:  

  • Applications open: January 14, 2021   
  • Applications due: February 12, 2021   
  • Selected jurisdictions notified: March 5, 2021  
  • Introductory calls with jurisdictions: March 2021 (based on availability)  
  • Beginning of cohort two: April 13, 2021  

For questions about this application or the TelePrEP Learning Collaborative, please contact Nicole Elinoff.  

Apply to Be a Host Site for CDC’s Public Health Associate Program
The Public Health Associates Program (PHAP) is accepting applications from prospective host sites until February 16. PHAP is a two-year training program for early-career public health professionals, providing frontline public health experience, guidance, training, and supervision from host sites nationwide. State, tribal, local, and territorial public health departments, nongovernmental organizations, public health institutes and associations, and academic institutions are encouraged to apply. Learn more about PHAP, the benefits of being a host site, and how to apply

Planning Toolkit for Using CDC's "Recommendations for Providing Quality Sexually Transmitted Diseases Clinical Services, 2020”
NACCHO recently created a STD Quality Clinical Services (QCS) Planning Toolkit, which includes a user guide and assessment tools to help healthcare settings translate recent CDC recommendations for optimal STD care into practical application. This toolkit may be of particular interest for jurisdictions awarded through Component C of PS20-2010 and any jurisdiction seeking resources to support the integration of HIV prevention into existing STI clinical services. Read more on NACCHO’s website here.

Health Career Connection Partnership with NACCHO: Internship Placements at Health Departments

NACCHO has partnered with Health Career Connection to support health departments to recruit and manage talented, diverse undergraduate students from local communities and nationally for 10-week, paid internships in public health. Email info@healthcarecareers.com to learn more about hosting interns virtually and in-person. Commitment to host is due February 15, 2021.

Join NACCHO’s Harm Reduction Listserv for Funding and Technical Assistance

To support our growing harm reduction portfolio, NACCHO is launching a new listserv where we’ll share harm reduction opportunities, resources, news, information, and evidence-based science on an ad-hoc basis. Sign up to be the first to know about NACCHO’s forthcoming funding and technical and capacity building assistance opportunities. 

Ending the HIV Epidemic Jurisdictional Directory

NASTAD maintains an Ending the HIV Epidemic (EHE) Jurisdictional Directory. The directory provides a list of local and state points of contact for EHE-related community engagement activities. Aiming to increase community participation, the directory also includes EHE websites, EHE jurisdictional plans, and social media accounts if available. NASTAD coordinates the directory as the HRSA-20-089 Systems Coordination Provider and CDC PS19-1906 National Partner. The directory is available through NASTAD’s EHE website and it is used to populate additional national contact lists. Health department staff members are encouraged to update their jurisdiction’s information using this brief form.  

Systems Coordination Provider Project

NASTAD’s Systems Coordination Provider (SCP) staff is finalizing introductory calls with jurisdictions and will complete calls with the first eight EHE jurisdictions by the end of January. NASTAD continues to work closely with CAI, the Technical Assistance Provider (TAP) and participated in the following webinars/calls with CAI:

  • HRSA EHE Site Visit with Hillsborough County of Tampa, FL- NASTAD/CAI provided and overview of the SCP and TAP projects.
  • Responding to HIV Clusters or Outbreaks Webinar- NASTAD, CAI, MidAtlantic AETC, and HRSA
  • Call with AETC Directors, HRSA, and CAI to discuss SCP/TAP project and share areas/themes of work NASTAD and CAI is anticipating.   
  • NASTAD SCP staff used each of these opportunities to provide an overview of SCP and TA available and to learn about areas to greater coordinate EHE efforts.   
  • SCP EHE Virtual Collaboration Meetings will begin in February 2021.   

NASTAD’s Engagement Advisory Council continues to meet to provide feedback to the NASTAD SCP and CDC EHE teams through monthly calls and ongoing communication.

News

COVID-19 Stymies Plan To End HIV in America

“In adjusting to the pandemic, “almost every health department has had staff detailed away from their normal activities, to respond to COVID-19,” including 75% of HIV prevention program staff, and 57% of Ryan White HIV/AIDS Program staff, according to the National Alliance of State and Territorial AIDS Directors.”

Many Primary Care Providers Still Don’t Understand PrEP

“Eight years into the pre-exposure prophylaxis (PrEP) era and two years into the federal government’s plan to end the HIV epidemic in the United States by 2030, about half of the primary care providers in one hard-hit Texas community still lack a basic understanding of PrEP eligibility, side effects, and adherence. And that deficiency was associated with a significantly decreased likelihood of prescribing the Truvada (tenofovir disoproxil fumarate/emtricitabine) or Descovy (tenofovir alafenamide/emtricitabine) prevention pills to their patients. The good news is that 35% of those providers had prescribed PrEP in the previous year.”

A new clash over needle exchange program

“Officials shut down the Kanawha-Charleston Health Department’s needle exchange program in 2018. A state Department of Health and Human Resources investigation criticized the program for, among other things, ineffective patient tracking, the lack of a detailed plan to prevent needle litter, and the failure to offer and provide substance use treatment before dispensing needles. Since then, HIV and hepatitis cases in Charleston have risen. Testing has decreased this year with resources being directed to the coronavirus pandemic, but HIV and hepatitis rates have continued increasing. Overdoses also have increased, according to state Office of Drug Control Policy data.”