Policy Updates: Hill Happenings and Administration Activities

By Mike Weir July 2, 2018

Hill Happenings

PrEP Resolution

Congresswoman Bonnie Watson Coleman (D-NJ-12) introduced a resolution calling for “additional research and public education efforts on the usage of pre-exposure prophylaxis (PrEP)” for communities disproportionality impacted by HIV. The resolution “calls on the Secretary of Health and Human Services (HHS) to conduct a departmentwide review on the outreach efforts of all HIV prevention programs in agencies such as the Health Resources and Service Administration (HRSA), the Centers for Disease Control and Prevention (CDC), the Substance Abuse and Mental Health Services Administration (SAMHSA), and others to ensure that they are conducting effective outreach, especially to communities of color, gay and bisexual men, and transgender people” The resolution also calls on the HHS Secretary to “conduct a study on the solutions to the barriers individuals face in accessing PrEP medication and its associated services, such as HIV and other STI screening, especially among communities of color, gay and bisexual men, and transgender people.”

FY2019 Budget and Appropriations 

The House Appropriations Committee’s markup of the FY2019 Labor, Health and Human Services, Educations and Related Agencies Appropriations (LHHS) funding bill has been postponed until after the July 4threcess. Prior to the postponement, the Appropriations Committee released their report language detailing the funding levels in the bill. The bill flat funds the Divisions of HIV Prevention, Viral Hepatitis, STD Prevention, and Tuberculosis. Included in the bill is $20 million for the Infectious Disease Elimination Initiative proposed in the President’s Budget. According to the report language, “This new initiative will support efforts to eliminate new infections such as HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), STDs, and TB in high-risk States and jurisdictions, including those with high rates of opioid-related transmission.” The bill flat funds all parts of the Ryan White Program and the Secretary’s Minority AIDS Initiative Fund. It also includes language banning federal funding for safe consumption sites. NASTAD will send a detailed update after the mark up. 

The Senate Appropriations Committee passed the FY2019 LHHS funding bill out of full Committee on June 28. In addition, the Committee released their report, which details their intentions for the funding.The bill includes $5 million for the Infectious Disease Elimination Initiative, while flat funding the other divisions within the Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculous Prevention. It also flat funds the Secretary’s Minority AIDS Initiative Fund and all parts of the Ryan White Program. 

The Senate intends to bring the bill to a vote on the floor, where there will be a possibility of amendments. The House will mark up their bill in full Committee and intends to bring the bill to the floor. While in past fiscal years, the House and Senate have not been able to pass individual bills, both chambers are further in the process to do so than in years past. NASTAD will continue to monitor the appropriations process and advocate for the highest funding level on behalf of HIV and hepatitis programs.

NASTAD has provided this analysis of the FY2019 appropriations bills. 

The Hepatitis Appropriations Partnership (HAP) sent a letter to appropriators requesting increased FY2019 funding for the Division of Viral Hepatitis. The Global AIDS Policy Partnership sent a letter to Senators Graham (R-SC) and Leahy (D-VT) to express appreciation for their efforts on the FY2019 State, Foreign Operations, and Related Programs bill. NASTAD signed onto both of these letters. 

Budget Process Reform

House Speaker Paul Ryan (R-WI-1) and Democratic Leader Nancy Pelosi (D-CA-12) recently testified before the Joint Select Committee on Budget and Appropriations Process Reform. Both lawmakers backed plans for operating on two-year budget resolutions rather than single-year budgets.

340B Oversight

The Government Accountability Office (GAO) released a new report, requested by House Energy and Commerce leaders, that “found weaknesses in HRSA’s oversight that impede its ability to ensure compliance with 340B Program requirements at contract pharmacies.”

Administration Activities 

National HIV Testing Day

The White House released a statement highlighting National HIV Testing Day. In the statement, President Trump says, “As we observe National HIV Testing Day, we celebrate the advancements we have made in medical science, and I encourage all Americans to invest in their health and be aware of their HIV status. Through greater awareness and education, we can all do our part to lead healthier and longer lives.”

HIV, STD & Hepatitis Policy Partnership Met with CDC Director

Last week, the Executive Directors of the National HIV, STD & Hepatitis Policy Partnership (AIDS United, NASTAD, NCSD, NMAC, The AIDS Institute) met with CDC Director Robert Redfield, M.D. During the very encouraging meeting, the Partnership advanced a series of requests and had a productive discussion about ending the HIV epidemic and the intersecting epidemics of STDs, viral hepatitis and opioid misuse. Dr. Redfield committed to an ongoing collaboration and a process that would seek broad community input around any newly developed strategies to end these epidemics. NASTAD and the Partnership look forward to working with Dr. Redfield and his team, as well as other relevant federal agencies and the community in realizing these goals.

CDC Opioid Grants

The CDC announced a funding opportunity for approximately “$345 million to provide new funding over a one-year period across all 50 states, Washington, D.C., and eight territories. These funds will assist states in improving the timeliness and quality of surveillance data, as well as supporting public health response activities necessary to prevent further opioid-related overdoses, deaths, and other harms. Given the urgency of this epidemic, CDC is aiming for states to receive additional funding in early September 2018.” Applications are due by July 30.

Federal Office of Rural Health Policy Opioid Response and Planning Grants

The HRSA Federal Office of Rural Health Policy (FORHP) recently released the Rural Community Opioids Response (RCORP) Planning Grant Notice of Funding Opportunity announcement. The RCORP grant announcement specifically notes, “The opioid epidemic has also led to an increase in people who inject drugs (PWID), which in turn has increased the risk of transmission of viruses such as human immunodeficiency virus (HIV) and hepatitis B and C viruses (HBV and HCV) through shared equipment. Rural communities are particularly vulnerable to outbreaks of HIV and HCV among uninfected PWID.” FORHP has encouraged the National Organization of State Offices of Rural Health (NOSORH) to engage with State HIV Programs and stakeholders and to make the link to enhance their broad, cross-sector partnership for this funding opportunity. Applications are due by July 30.

Medicaid Waiver Decision

The Trump administration has rejected a proposal from Massachusetts that would have allowed the state to limit what prescription drugs would be covered in its Medicaid program. The HIV Health Care Access Working Group sent a letter to CMS urging CMS to oppose the MassHealth Request.

2018 National STD Prevention Conference

The 2018 STD Prevention Conference will be held August 27-30, 2018 in Washington, DC. Registration for the conference is now open.

2018 National Ryan White Conference on HIV Care & Treatment

The 2018 Ryan White Conference on HIV Care & Treatment will be held December 11-14, 2018 in Washington, DC.Registration for the conference is now open. 

2019 National HIV Prevention Conference

The 2019 National HIV Prevention Conference (NHPC) will be held March 18-21, 2019 in Atlanta, Georgia. Check out the updated website for more information about tracks, session and abstract formats, and to view the tentative conference schedule. Abstracts will open May 21, 2018.

Resources

Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data—United States and 6 Dependent Areas, 2016

Letter from the Office of AIDS Research Director: Why Is U=U a Game Changer?

CDC Releases Updated Recommendations for Treatment of Latent TB Infection

Estimating Prevalent Diagnoses and Rates of New Diagnoses of HIV at the State Level by Age Group Among Men who Have Sex With Men in the United States

PositiveLinks: A Mobile Health Intervention for Retention in HIV Care and Clinical Outcomes with 12-Month Follow-Up

Proposed Changes to Title X: Implications for Women and Family Planning Providers

Prevalence and Predictors of Provider-Initiated HIV Test Offers Among Heterosexual Persons at Increased Risk for Acquiring HIV Infection — Virginia, 2016

2017 – Outbreaks of hepatitis A in multiple states among people who use drugs and/or people who are homeless

A Framework for Advancing Health Equity and Value: Policy Options for Reducing Health Inequities by Transforming Healthcare Delivery and Payment Systems

News Bulletin

Why National HIV Testing Day Matters

“In 2016, NASTAD founded the Center for Engaging Black MSM Across the Care Continuum, which is an online resource created in partnership with the Health Resources Services Administration’s HIV/AIDS Bureau. Our website, His Health, provides healthcare providers, public health professionals and students the opportunity to become well-versed in the health needs of Black men who have sex with men (MSM) through a wide range of tools including accredited continuing education courses, models of care and trainings.”

Ola Lokahi: Creating a Health Hawaii Together

NASTAD’s 2018 Lifetime Achievement Award Goes to Branch Chief Peter Whiticar

“Peter Whiticar, Chief of the Hawaii Department of Health’s Harm Reduction Services Branch, was recently presented with the 2018 Lifetime Achievement Award from the National Alliance of State and Territorial AIDS Directors (NASTAD). He received this well-deserved award at NASTAD’s annual conference in Washington, D.C., in May. NASTAD’s Lifetime Achievement Award is presented annually to current or former state health department HIV or hepatitis directors or senior staff members who have dedicated their career to working in state government to address the HIV and/or viral hepatitis epidemics.”

We Must Show Our Pride This HIV Testing Day

“Today, the Centers for Disease Control and Prevention (CDC) and the larger public health community mark National HIV Testing Day (NHTD), which is marked every year on June 27. It’s an opportunity to highlight the continued toll this epidemic has on our country, the need to talk openly about the stigma surrounding the disease, and the importance of knowing your risk factors and getting screened regularly. This is especially important for communities of color and those in the South, who bear the brunt of the domestic HIV epidemic. And current data suggests this disparity is only growing.”

National HIV Testing Day — tests are lagging and the end of the epidemic is far away

“On National HIV Testing Day 2018, we must acknowledge that we are far from ending the U.S. HIV epidemic and that our progress is uneven and fragile at best. HIV testing is the gateway to both prevention and care, and we continue to fail at providing this essential service to those most in need.”

White House wants to cut this public health service corps by nearly 40 percent

“The proposal is part of a plan announced last week by the Office of Management and Budget to overhaul the federal government. It would cut the size of the U.S. Public Health Service Commissioned Corps from its current 6,500 officers to “no more than 4,000 officers.” Administration officials, who have said the officers are “more expensive” than equivalent civilians, want “a leaner and more efficient organization” better prepared to respond to public health emergencies. They have not offered projections on how much might be saved.”

Trump keeps omitting LGBT people from HIV/AIDS statements

“For the second year in a row, President Trump has issued a statement recognizing National HIV Testing that omits any mention of the vulnerability of LGBT people to the disease. The lack of LGBT inclusion in statements on HIV/AIDS has been a consistent theme from Trump, who last year issued a statement on World AIDS Day that also failed to mention LGBT people being disproportionately impacted by the disease.”

Rising Cost Of PrEP To Prevent HIV Infection Pushes It Out Of Reach For Many

“Public health officials are expanding efforts to get the HIV prevention pill into the hands of those at risk, in a nationwide effort to curb infections. But the officials are hitting roadblocks — the drug's price tag, which has surged in recent years, and changes in insurance coverage that put a heftier financial burden on patients.”