Ending the HIV Epidemic Newsletter

By Mike Weir April 30, 2021

April 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

Biden Administration Releases FY2022 Discretionary Funding Request 

On April 9, the Biden Administration released its Executive Budget Proposal, a non-binding document that typically serves as a starting point for appropriations negotiations on the hill. The Administration’s “skinny budget” provides only top-line funding levels for federal agencies and a framework detailing the Administration’s spending and policy priorities. A detailed fiscal budget proposal is expected in late May. 

The Department of Health and Human Services’ (HHS) overall funding request was $131.7 billion, an increase of $25 billion or 24%. The Department of Housing and Urban Development, where Housing Opportunities for Persons with AIDS (HOPWA) sits, received a 15% increase. The budget request notes that the President wishes to invest $670 million in funding for the Ending the HIV Epidemic (EHE) Initiative, which is an increase of $267 million over the current level. While the breakdown of funding by programmatic area is not available, the skinny budget notes that investments will be made in the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), and the National Institutes of Health (NIH) to “reduce new HIV cases aggressively while increasing access to treatment, expanding use of pre-exposure prophylaxis (also known as PrEP), and ensuring equitable access to services and supports.”  

Additionally, the budget request notes that the President would like to invest $10.7 billion dollars into combatting the opioid crisis across the government. NASTAD will be working to ensure that some of this funding goes to harm reduction services. The overall funding amount for the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) has not yet been released. However, an increase of 22% overall was requested for CDC. The overall funding amount for HRSA is not available at this time.  

NASTAD will continue to advocate with Congress to secure the highest funding amounts possible for HIV, hepatitis, and other infectious disease and drug user health programs. NASTAD will continue to provide updates throughout the process. 

CDC Announces that Federal Funds Can Be Used to Buy Fentanyl Test Strips 

On April 7, the CDC and the Substance Abuse and Mental Health Services Administration (SAMHSA) announced that federal funding may now be used to purchase rapid fentanyl test strips (FTS). The policy change will allow overdose response programs funded through the CDC and SAMHSA to purchase FTS to support harm reduction services. FTS enable drug users to determine whether drugs have been mixed or cut with illicitly manufactured fentanyl, a key driver of rising drug overdose deaths, and reduce the possibility of drug overdose. 

CDC Declares Racism a Public Health Threat 

On April 8, CDC Director Rochelle Walensky declared racism a serious public health threat. In the statement, Walensky pointed to the life-long negative effects perpetuated by structural inequities and racial discrimination on the mental and physical health for people of color. Walensky committed the agency to studying the impact of race and social determinants on health outcomes, announced new investments in the health of racial and ethnic minority communities, and launched a new web portal on “Racism and Health.” 

CDC Report Shows STDs Reach All-Time High for 6th Consecutive Year 

On April 14, the CDC’s NCHHSTP released the 2019 STD Surveillance Report, an annual report that documents the incidence of chlamydia, gonorrhea, and syphilis in the US. CDC found that reported cases of chlamydia, gonorrhea, and syphilis increased for the sixth consecutive year—reaching a new, all-time high. CDC calls for targeted efforts to reduce STI health disparities for populations facing social inequities, particularly racial and ethnic minority populations, and adolescent and young adults, have limited access to these services. 

Biden Administration Announces Nominee for Assistant Secretary for Mental Health and Substance Use and SAMHSA Administrator 

On April 23, the Biden Administration announced the nomination of Dr. Miriam Delphin-Rittmon to serve as the Assistant Secretary for Mental Health and Substance Use and the HHS SAMHSA Administrator. Dr. Miriam Delphin-Rittmon is currently the Commissioner of the Connecticut State Department of Mental Health and Addiction Services and completed a two-year White House appointment working as a Senior Advisor to the SAMHSA Administrator in 2014. The Administration highlighted Dr. Delphin-Rittmon’s extensive experience in the design, evaluation and administration of mental health, substance use and prevention services, programs, and policy.

CDC HIV Surveillance Report: HIV Infection, Risk, Prevention, and Testing Behaviors Among Transgender Women 

“This report summarizes findings from the first NHBS [National HIV Behavioral Surveillance] -Trans data collection cycle, which was conducted in 2019–2020. Transgender women, especially transgender women of color, are disproportionately affected by HIV. This report provides descriptive, unweighted data that can be used to describe HIV infection among transgender women and the percentages of transgender women reporting specific behaviors, HIV testing, access to care, participation in prevention programs, gender-affirming medical treatment, experiences of abuse and harassment, and suicidality.” 

Legislative Updates

FY2022 Appropriations 

On April 15, Department of Health and Human Services (HHS) Secretary Xavier Becerra testified before the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies on the Administration’s FY 2022 Budget Request for HHS. Becerra defended the increased funding proposed for HHS and the Centers for Disease Control and Prevention (CDC) in the President’s Budget request, pointing to the need for improved public health systems, increased medical research funding, and greater focus on mental and maternal health.  

Resources

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.   

NASTAD Resource: Jurisdictional Map of Phase 1 EHE Final Plans    

NASTAD released a resource that provides access to Phase 1 EHE websites and plans. Please note that though all funded Phase 1 jurisdictions successfully submitted final EHE plans to CDC in December 2020, NASTAD is in the process of gaining access to each plan and will update the table on an ongoing basis. Though the EHE planning period is complete, all jurisdictions welcome community feedback and are committed to continuous evaluation, and subsequent EHE plan adaptation. Please email Krupa Mehta additional Phase 1 EHE plans for inclusion in this resource as well as any changes to existing plans. 

NASTAD Webinar: U=U is a Public Health Imperative! 

Date: Wednesday, May 5 from 3:00 – 4:30 pm ET  

NASTAD and Prevention Access Campaign are co-hosting a webinar for state, county, and city health department staff focusing on integrating U=U (Undetectable = Untransmittable) into their responses to the HIV/AIDS epidemic. The webinar will include presentations focusing on U=U as a public health strategy, the latest scientific evidence supporting U=U, and a panel of representatives from four health departments that have been leading the way in endorsing and implementing U=U in their HIV testing, surveillance, prevention, and care programs.Anyone interested in learning about integrating U=U into publicly funded HIV prevention and care programs is welcome to attend. Please register for the webinar here.  

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 created 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

Gilead Announces Payment Model Changes for HIV and HBV Medications in Patient Assistance Programs 

On April 8, Gilead Sciences announced changes to payment models used in the Advancing Access® Patient Assistance/Medication Assistance Program (PAP/MAP), which would result in significant reductions in reimbursement rates for AIDS Drug Assistance Programs (ADAP) and community-based providers that are 340B covered entities. Advocates warn that the changes to the retail pharmacy model will drastically reduce 340B revenue for HIV prevention and care programs serving low-income and uninsured people living with and vulnerable to HIV, threatening the sustainability of the programs, especially in the South. The effective date for the change was delayed from October 1, 2021 to January 1, 2022, after advocates urged Gilead to reconsider the payment model changes.  

NASTAD Resource: COVID-19’s Impact on PrEP/PEP and Sexual Health Services 

NASTAD, in collaboration with NCSD, is pleased to announce the release of a resource that further explores the impact COVID-19 has had on the provision of sexual health and HIV prevention services over the last year. This reflection piece details the many challenges, and opportunities, COVID-19 has brought to the HIV/STD prevention field, particularly in the southern United States, and showcases the innovative approaches sexual health providers implemented to further prevent service disruption. 

NASTAD FactsheetCOVID-19 Vaccine Guidance for Syringe Service Programs, Health Departments, and People Who Use Drugs 

Health departments across the country are working to make COVID-19 vaccines available to populations at higher risk of experiencing serious complications or illness. Partnering with syringe services programs (SSPs) for vaccine distribution is one way to increase access to COVID-19 vaccines among people who use drugs and others underserved by traditional healthcare systems. This fact sheet contains recommendations that are based on experiences from SSPs in the United States and includes strategies for involving SSPs and health departments in vaccine distribution, increasing vaccine access among SSP staff and participants, and supporting people who use drugs throughout the vaccination process. 

Self-Testing Webinar Series Update   

NASTAD is pleased to announce the release of a new toolkit entitled “Self-Testing: A Strategy to Improve Access to HIV, Viral Hepatitis, and STI Testing”. NASTAD, in partnership with the Association of Public Health Laboratories (APHL), developed this toolkit to help health departments, public health laboratories, and their community partners decide whether and how to incorporate self-testing for HIV, viral hepatitis, and STIs. The toolkit is designed to support health departments in their efforts to strengthen HIV, viral hepatitis, and STI testing and linkage programs.  

The toolkit provides an overview of self-testing models; the roles of HIV, viral hepatitis, and STI programs, and public health laboratories in supporting self-testing; and a discussion of the benefits and drawbacks of self-testing. Also included are tools that health departments can use to evaluate self-testing as a public health strategy, a summary of currently available commercial self-testing services, and detailed recommendations and “tips” from health departments that have implemented self-testing.   

The toolkit includes case studies of selected health department-supported self-testing programs. The case studies provide detail about the self-testing models employed by health departments, including recruitment and operational details, along with lessons learned that other health departments might find helpful.   

The toolkit was previewed in the final webinar of the Self-Testing Series held on April 6, 2021. The recording of the final webinar, slides presented and previous webinars in the series can be accessed on NASTAD’s EHE Microsite. NASTAD and APHL encourage you to share these resources widely with other health department staff, testing and linkage providers, laboratories, and others. For additional questions about the toolkit, please contact Kendrell Taylor (NASTAD), Liisa Randall (NASTAD Consultant) or Anne Gaynor (APHL).

STI Express Initiative 

With funding from the CDC’s Division of STD Prevention (DSTDP), NACCHO leads the STI Express Initiative, which is designed to increase the evidence base for express STI clinical visits and support clinics in quality improvement efforts to strengthen, scale-up, and evaluate STI express models. Resources on the homepage provide access to reports, case studies and tools for clinics implementing express STI services.  

Funding Opportunity: Harm Reduction Monitoring & Evaluation  
With support from CDC and in partnership with the University of Washington, NACCHO will provide funding (up to $98,750) and technical assistance to local health department (LHD) and community-based syringe services programs (SSPs) to strengthen monitoring and evaluation and support the use of data for SSP program involvement. Applications are due May 21, 2021 at 11:59 PM PT. 

News

Fighting the Syphilis and HIV Epidemics: Voices from the Field 

The National Coalition of STD Directors, in partnership with Chembio, is excited to present an informational webinar featuring different presenters from across the nation who will share their experiences using the DPP® HIV-Syphilis Tests in the ongoing HIV and syphilis epidemics. The webinar will be held May 27, 2021 from 2:30 - 3:45 pm ET. Click here to register for the webinar  

Call for Abstracts: NCST STD Engage 2021 

The National Coalition of STD Directors invites members and partners to submit presentation and electronic poster proposals for STD Engage 2021, being held virtually October 12-15, 2021. Click here to learn more.  

EHE Systems Coordination Provider (SCP) Project  

NASTAD SCP staff are working closely with jurisdictions by facilitating calls/meetings to plan, coordinate, and discuss SCP TA activities with EHE staff. NASTAD continues to work closely with CAI, NASTAD SCP partners (NACCHO, SAC, JSI, and ASTHO) and regularly engages with HRSA EHE project officer and EHE staff. 

NASTAD SCP staff conducted a review of HRSA EHE work plans to highlight TA themes and strategies and compare activities in EHE jurisdictional plans to identify areas for collaboration. NASTAD SCP staff continues to participate in HRSA Ending the HIV Epidemic Programmatic Site visit reviews through February 2022. The site visit serves 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 bi-monthly using a small, topic-focused group format to provide feedback to the NASTAD SCP and CDC EHE teams through calls and ongoing communication.