Ending the HIV Epidemic Newsletter

By Mike Weir March 30, 2021

March 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.

Administration Updates

EHE Quarterly Stakeholder Webinar Presentation & Recording

The Department of Health and Human Services’ (HHS) Office of Infectious Disease and HIV/AIDS Policy (OIDP) will hold its quarterly EHE stakeholder webinar on Thursday, April 8 from 2:00 PM - 4:00 PM ET. Please click here to register for the webinar. Registration is required for the webinar. This event is open to everyone, but please note capacity is limited. The webinar will be audio-recorded and slides will be publicly available for those unable to attend.

CDC Funding Opportunity Announcement: Partnering and Communicating Together

The Centers for Disease Control and Prevention (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 were due on February 17, 2021, and applications are due April 5, 2021. Additional resources are available online at the funding opportunity announcement page.

HRSA Data Show Key Role of Health Centers in the EHE Initiative

In February 2020, as part of the EHE iniaitive, 195 health centers were awarded a total of $54 million in supplemental resources under the Primary Care HIV Prevention funding opportunity. This funding supports health centers to expand outreach, partnerships, and their workforce to increase HIV testing, increase access to and use of PrEP, and link individuals who test positive for HIV to treatment.

Data from the Health Resources and Services Administration’s (HRSA) Bureau of Primary Health Care indicate that within the first eight months of award (March-November 2020):

  • 93% of the health centers hired dedicated staff for a total of 389 full-time equivalent employees working on HIV outreach, testing, linkage to care and treatment, and PrEP services
  • Over 573,000 individuals were tested for HIV
  • 2,260 individuals tested positive for HIV and received follow-up within 30 days
  • Nearly 50,000 individuals at health centers were prescribed PrEP

HRSA Awards $99 Million to End the HIV Epidemic in the United States

HRSA has awarded $99 million in FY 2021 Ending the HIV Epidemic (EHE) funding to Ryan White HIV/AIDS Program Part A and B jurisdictions. This fiscal year’s funding will be used “to continue to link people who are either newly diagnosed with HIV, or diagnosed but currently not in care, to essential HIV care, treatment, and support services, helping them reach viral suppression and reduce HIV transmission.” Jurisdictions receiving year two EHE awards can be found here.

The awards include:

  • More than $87 million to 39 metropolitan areas and eight states, which are Ryan White HIV/AIDS Program Parts A and B jurisdictions
  • $3 million was awarded to 12 Ryan White HIV/AIDS Program Part F AIDS Education and Training Centers Program
  • $8 million was awarded to two organizations to provide technical assistance and systems coordination services

Integrated HIV Prevention and Care Plan Guidance Update

The HRSA HIV/AIDS Bureau (HAB) and the CDC Division of HIV/AIDS Prevention (DHAP) announced the release of updated guidance for the Ryan White HIV/AIDS Program (RWHAP) Integrated HIV Prevention and Care Plan. The release of the updated Integrated HIV Prevention and Care Plan guidance and plan submission for the calendar years 2022 – 2027 was postponed due COVID-19 pandemic. HAB and DHAP plan to issue the updated guidance in June of 2021, with submission of the plans targeted for December of 2022.

PACHA Virtual Meeting 

The Presidential Advisory Council on HIV/AIDS (PACHA) held its 70th full Council meeting virtually on Monday, March 8 and Tuesday, March 9, 2021. The meeting agenda and materials can be found here.

Legislative Updates

Senate Confirms HHS Secretary and Assistant Secretary of Health Nominees

On March 18, the Senate voted 50-49 to confirm Xavier Becerra as the next Secretary of the Department of Health and Human Services (HHS). Becerra, the former California Attorney General known for his vigorous defense of the Affordable Care Act (ACA) under the Trump Administration, will become the first Latino to head the agency. NASTAD joined a coalition of over 100 public health advocacy organizations and sent a letter to the Senate in support of Becerra’s nomination.

Additionally, the Senate voted 52-48 to confirm Dr. Rachel Levine as the next HHS Assistant Secretary for Health. With Dr. Levine’s confirmation, she becomes the first openly transgender federal official to be confirmed by the U.S. Senate. NASTAD supported the nomination of Dr. Levine.

COVID-19 Relief

Congressional Democrats leveraged the budget reconciliation process to pass President Biden’s $1.9 trillion American Rescue Plan, a broad-ranging economic stimulus and COVID-19 relief package, without a single Republican vote. On March 10, the House voted to approve the Senate-amended relief package that cleared the upper chamber on March 6, finalizing the legislative requirements needed to pass the bill. President Biden signed the landmark legislation on March 11, authorizing the delivery of economic relief and healthcare aid to communities.

The final American Rescue Plan includes a number of provisions that provide economic relief for individuals and bolster the nation’s pandemic response, including direct payments to individuals, extended unemployment benefits, and $55.5 billion in funding to the CDC for COVID-19 testing, workforce capacity, and vaccination. Additionally, the relief package allocates $30,000,000 in community-based funding for local substance use disorder services, like syringe service programs and other harm reduction interventions. Notably, this dedicated funding for syringe service programs marks the first time that federal legislators allocated funding specifically to harm reduction providers and organizations. Additional funded areas include:

  • $362.05 billion in financial aid to state and local governments;
  • $47.8 billion for testing and tracing activities;
  • $8.5 billion for vaccine activities at the CDC, including funding for vaccine confidence activities;
  • $7.66 billion to expand the public health workforce;
  • $1.75 billion for genomic sequencing and surveillance;
  • $500 million for CDC data modernization and disease forecasting;
  • $3 billion for SAMSHA block grant programs;
  • $6 billion for the Indian Health Service

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

FY2022 Appropriations

The Congressional HIV Caucus sent a letter to the Biden Administration requesting a significant increase in funding for domestic HIV programs in the FY2022 Presidential Budget request. The Caucus calls for increased funding to the Ending the HIV Epidemic Initiative and discretionary domestic programs, including an additional $238 million for the HRSA Ryan White HIV/AIDS Program, $67.1 million for the CDC/DHAP, and $107 million for the CDC Opioid Related Infectious Diseases program. Additionally, the caucus calls on Congress to remove funding restrictions for harm reduction programs like syringe service providers in order to address the skyrocketing HIV and viral hepatitis infection incidence among injection drug users.

Resources

Jurisdictional Map of Phase 1 EHE Final Plans

All final Phase 1 EHE plans were submitted to CDC by December 31, 2020. EHE jurisdictions are required to share their EHE plan on a public-facing website. NASTAD created a jurisdictional map to showcase all public-facing EHE plans. The map is currently under CDC review. As a reminder, though the planning period has ended, all jurisdictions are expected to evaluate their plans on an ongoing basis and adapt accordingly based upon community feedback. 

For questions about the jurisdictional map please contact Krupa Mehta

TelePrEP Learning Collaborative

The first cohort of the TelePrEP Learning Collaborative (TLC) was completed on March 30, 2021. Cohort 2 will begin on April 13, 2021 hosting 14 jurisdictions across the United States. 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 supports the learning collaborative with funding from CDC PS19-1906 Component A. 

For questions about the TelePrEP Learning Collaborative, please contact Nicole Elinoff

TakeMeHome Program Expands to Offer STD Test Kits 

NASTAD continues to partner with Building Healthy Online Communities (BHOC) on a free HIV and STD test kit home delivery program, TakeMeHome. The program has already distributed more than 5,000 HIV test kits in eight states around the U.S. and is now expanding to include test kits for syphilis, gonorrhea, and chlamydia. BHOC and NASTAD worked over two years to create a seamless process to handle payment from health jurisdictions, which will be promoted by Grindr to users who live in city or states included in the program. 

For more information about the program, contact Natalie Cramer or Kendrell Taylor.

Infographic: Verifying PrEP is Covered as a Preventive Service

The Patient Protection and Affordable Care Act (ACA) now requires qualified health plans to cover PrEP as a preventive service at no cost to the patient. 

The new NASTAD infographic, “Verifying PrEP is Covered as a Preventive Service,” summarizes the steps to verify that a given plan is offering PrEP at no cost to the patient. The brief tool aims to support enrollment assisters and PrEP navigators to maximize the current Special Enrollment Period (SEP).

NASTAD Release: HIV Data Protection Landscape for EHE Jurisdictions

NASTAD released a new resource assessing HIV Data Protection Landscape for EHE Jurisdictions. This interactive map summarizes state-level legal authorities and protections related to health department HIV surveillance data release in response to requests from courts, prosecutors, and law enforcement agencies. The tool helps health department HIV program staff and legal counsel assess data privacy laws in their state and supports health departments in responding appropriately to requests for HIV data in connection with legal and law enforcement matters. NASTAD has also released a Research Protocol explaining the project scope and methodology. 

Specifically, this map identifies: 

  • Whether your state has a law criminalizing exposure to or transmission of HIV. 
  • Whether your state’s laws permit release of health department HIV data for law enforcement and/or prosecution purposes, and under what circumstances. 
  • The types of health department data that can be released for law enforcement and/or prosecution purposes. 

This map is funded through CDC PS19-1906 Component A, and as such, currently reflects laws in priority states included in Phase I of the EHE initiative.

Contact Dori Molozanov with questions.

Community of Practice

On April 1, 2021, NASTAD and the National Association of County and City Health Officials (NACCHO) will launch a new “Community of Practice” on NASTAD’s online technical assistance platform (OnTAP) to support peer-to-peer learning and mentorship during the implementation of jurisdictional Ending the HIV Epidemic (EHE) plans. The EHE Community of Practice is a virtual space for those leading their jurisdictions' EHE efforts at local and state health departments, to share resources and news, discuss challenges and successes and request technical assistance from NASTAD and NACCHO. For any questions or to be added to the Community of Practice, please contact Krupa Mehta at NASTAD or Julia Zigman at NACCHO.

Self-Testing Webinar Series Update  

The fourth and final webinar in the series Self-Testing Strategies for HIV Testing and PrEP Access will be held on April 6, from 3:00 PM – 4:30 PM ET. This webinar, Self-Testing: A Strategy to Improve Access to HIV, Viral Hepatitis, and STI Testing, will highlight a toolkit NASTAD, in collaboration with the Association for Public Health Laboratories (APHL), has developed to support health departments implementing self-testing strategies. This webinar will feature policy and technologic aspects and operational issues that health departments should consider in evaluating self-testing strategies in the context of their prevention and linkage programs.

The webinar will include a preview/overview of the toolkit as well as examples of how different jurisdictions have implemented self-testing strategies to advance public health priorities, such as implementation of PrEP, integration of services, addressing health equity, and addressing gaps in services during the COVID-19 pandemic. Please click here to register for this webinar. For additional questions about the series, please contact Kendrell Taylor.

The recording, presentation slides, and questions posed during the previous three webinars can be accessed via NASTAD's website and EHE Microsite.

2021 CSTE HIV Subcommittee SAS e-learning Application

The CSTE HIV Subcommittee is offering a limited number of self-paced, e-learning trainings from the SAS Institute to those working in HIV surveillance programs. We hope to offer a variety of courses including SAS Programming 2, SAS Programming 3, SAS SQL Essentials 1, and SAS Macro Language 1. The CSTE SAS e-learning application can be completed here https://cste.co1.qualtrics.com/jfe/form/SV_e9WjJnDqNJ01o8u and will close on March 31st, 2021 at 11:59pm ET. Selected applicants will be notified on April 16th, 2021. New HIV Surveillance Coordinators, Data Managers, and those from low-morbidity jurisdictions are encouraged to apply!

Please note: If you are selected to participate in SAS e-learning, you will have a maximum of 180 days (6 months) from the date of course code receipt to complete this course. Failure to complete to this course and submit the certificate to CSTE may result in your jurisdiction’s ability to be considered for CSTE SAS e-learning in the future.

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.”

Issue Brief: Big Ideas: Improving the Health of People Who Use Drugs and People in Recovery Is Essential for Ending the HIV Epidemic

“HIV and drug use are inextricably intertwined. Today, one in ten new HIV diagnoses in the U.S. are attributed to people who inject drugs, with other forms of drug use contributing to additional transmissions. New HIV cases among people who use drugs increased 9% from 2014 to 2018. Success at achieving the goals of the Ending the HIV Epidemic (EHE) Initiative in the United States depends on improving the health of people who use drugs. The following policy actions are recommended: (1) Develop tailored plans with the meaningful participation of people who use drugs to respond to the unique challenges in each jurisdiction; (2) Deploy effective interventions at greater scale; and (3) Decriminalize substance use and re-orient drug use policy to enhance prevention, harm reduction, and treatment of addiction.”

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.

EHE Systems Coordination Provider Project 

  • March 1, 2021, marked the official start of year 2 of the NASTAD Systems Coordination Provider (SCP) project! 
  • NASTAD SCP staff completed all introductory EHE Calls with the initial set of high-priority jurisdictions. Calls included NASTAD SCP staff, HRSA EHE project officers, and critical EHE staff. These conversations will inform the development of TA Plans for each jurisdiction. NASTAD SCP staff is working closely with jurisdictions to review SCP EHE TA priority areas and schedule ongoing calls with EHE staff. 
  • NASTAD continues to work closely with CAI, NASTAD SCP partners (NACCHO, SAC, JSI, and ASTHO), and regularly meets HRSA EHE project officer and EHE staff. 
  • As a result of the initial introductory calls, NASTAD staff coordinated an EHE Collaboration Planning Call with high-priority jurisdictions to identify opportunities to increase coordination around EHE activities between city and county health departments. NASTAD compares activities in EHE jurisdictional plans and HRSA EHE work plans to identify crucial opportunities for collaboration. 
  • NASTAD SCP staff is participating in HRSA Ending the HIV Epidemic Programmatic Site visit reviews through February 2022. The site visit will serve as an opportunity for NASTAD/CAI, the Technical Assistance Provider (TAP), to provide an overview of the SCP and TAP projects and hear from the jurisdiction about their EHE program, activities and work plan, data system(s), partnerships, and community engagement. 
  • 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. NASTAD updated the meetings' format to prioritize small group discussions in year 2.
  • Current SCP activities:
    • Peer-to-peer learning
      • Group and individual calls
      • Mentorship program for new HD staff
      • Promising practice summaries
      • Peer document repository
    • Learning collaboratives focused on collaboration
      • Housing – bring together health departments and housing stakeholders
    • Expert Consultations
    • State-specific policy analysis 
    • Jurisdiction-wide stakeholder meeting planning and facilitation with high-priority jurisdictions

STD Quality Clinical Services Planning Toolkit Now Available
NACCHO recently created a STD Quality Clinical Services (QCS) Planning Toolkit, which includes a user guide and assessment tools to help healthcare settings critically assess existing STD care service offerings in their facilities and identify opportunities to build, maintain, or enhance the delivery of those services. 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. Access the toolkit and assessment here.

News

Call to action: how can the US Ending the HIV Epidemic initiative succeed?

“With more than 1.2 million people living with HIV in the USA, a complex epidemic across the large and diverse country, and a fragmented health-care system marked by widening health disparities, the US HIV epidemic requires sustained scientific and public health attention. The epidemic has been stubbornly persistent; high incidence densities have been sustained over decades and the epidemic is increasingly concentrated among racial, ethnic, and sexual and gender minority communities. This fact remains true despite extraordinary scientific advances in prevention, treatment, and care—advances that have been led, to a substantial degree, by US-supported science and researchers. In this watershed year of 2021 and in the face of the COVID-19 pandemic, it is clear that the USA will not meet the stated goals of the National HIV/AIDS Strategy, particularly those goals relating to reductions in new infections, decreases in morbidity, and reductions in HIV stigma.” 

CSTE Public Health Law Subcommittee: At-home testing – HIV Prevention and Surveillance Panelists Needed

CSTE’s Public Health Law Subcommittee is planning for a series to begin in March addressing current legal issues. This series will consist of 3 parts with 2 topics currently selected. The first webinar will cover mandating vaccination using state & local governments and EUAs; the second will be on data. Specifically, the second webinar will address data sharing and mandating results from at-home tests. The Public Health Law Subcommittee is seeking panelists/speakers for this webinar to inform this guidance and have been advised to look to HIV at-home testing as a model. CSTE would like to hear from those who are knowledgeable about HIV at-home testing and reporting requirements in their jurisdiction, particularly those working in prevention. If you are interested in participating, please reach out to Sunbal Virk at svirk@cste.org.

Join the Ryan White Part A Community of Practice!
NACCHO and the CAEAR Coalition are launching a Ryan White Part A Community of Practice (CoP) for local health department staff in Part A jurisdictions to have a space to share best practices, discuss program and policy strategies, and determine current barriers to implementing effective HIV interventions. The CoP will meet every other month beginning in 2021 for one-hour discussion sessions, which will be held via a Zoom conference line. Please access the sign-up here or forward to your care-facing colleagues.

Request for Applications (RFA): Leaving Retail Health Clinics and Pharmacies for STI Services and Care
NACCHO, with support from the CDC Division of STD Prevention (DSTDP), will fund 2-4 projects up to $75,000 (per site) to develop, design, and implement a collaborative partnership between local health departments and retail health clinics or pharmacies to expand STI services and care. This project will offer essential information about the development of expanded STI patient care provided in retail health or pharmacy settings. Findings will be shared broadly with STD programs across the country. Full RFA can be found here. The deadline to apply is April 30, 2021.

An informational webinar will be hosted for potential applicants on March 30, 2021 at 1-2PM ET. Please note that advanced registration is not required, simply click here at the time of the webinar. Questions may be submitted in advance to rhorowitz@naccho.org and will be accepted until 11:59PM Pacific Daylight Time (PDT) on March 29, 2021.

Featured Event! Sexually Transmitted Infections: Adopting a Sexual Health Paradigm Report
One in five people in the United States will have a sexually transmitted infection in a given year, which, untreated, can lead to severe health consequences. In light of this, the CDC, through NACCHO, commissioned the National Academies of Sciences, Engineering, and Medicine to convene a committee to examine the prevention and control of sexually transmitted infections in the United States and provide recommendations for action. Members of the committee who wrote the report gave an overview of key issues, conclusions, and recommendations.