COVID-19 Updates and Resources

NASTAD continues to closely monitor the rapidly evolving public health responses to contain and mitigate coronavirus disease (COVID-19) in the United States. We are committed to providing NASTAD members with potentially useful information, as it becomes available, to help ensure the continuity of essential programming and the protection of people living with and vulnerable to HIV infection and viral hepatitis.   

If you have any questions or additional resources for this page, please email covid19@NASTAD.org

Antiretroviral (ARV) and Direct Acting Antiviral (DAA) Supply Chains

As outbreaks of COVID-19 continue, concerns regarding potential disruptions to supply chains of critical medical and pharmaceutical products cannot be discounted. NASTAD remains in close contact with the major manufacturers of brand-name ARVs and hepatitis C DAAs, none of which are currently reporting manufacturing concerns or supply shortages. Many wholesalers have implemented “fair share” allocation processes to manage prescription drug inventories in response to COVID-19-related spikes in demand by pharmacies.  To ensure that all pharmacies and direct purchasers – including ADAPs – receive their usual allocations to meet their average monthly dispenses, wholesalers may limit fulfillment of additional orders until all customers have received their usual monthly allocations. Thus, while federal, state, and payer policies are being loosened to support early refills and 60- or 90-day fills as a part of COVID-19 isolation requirements, quarantine recommendations, and social distancing efforts, pharmacies may experience challenges meeting this demand.  

Many pharmacies are implementing their own protocols for ensuring access to essential prescription drugs while maximizing social distancing. These include mail order delivery, courier delivery, curbside pickup, and designated pharmacy hours for individuals at increased risk for serious COVID-19 outcomes.  

NASTAD will continue to track pharmaceutical supply chain disruptions of significance to HIV and viral hepatitis programs. NASTAD members are strongly encouraged to contact Tim Horn regarding any supply chain disruptions or shortages. 

Evaluation of HIV Treatments for COVID-19  

NASTAD members have inquired about the potential for ARVs to be used to treat COVID-19 and potentially prevent or mitigate SARS-CoV-2 infection among people living with HIV. This interest is based, in part, on data from some small studies suggesting that the protease inhibitor Kalatra (lopinavir/ritonavir) was potentially effective against related coronavirus infections (SARS-CoV and MERS-CoV) and limited data suggesting the protease inhibitor darunavir (found in Symtuza, Prezcobix, and Prezista) has activity against SARS-CoV-2.

Several clinical trials evaluating Kaletra for COVID-19 are under way. However, results from one study involving patients with advanced COVID-19 disease and another involving patients with mild or moderate COVID-19 symptoms showed little benefit for improving clinical outcomes of the disease.

With respect to darunavir, Janssen Pharmaceuticals recently cautioned that it has no evidence to support the clinical use of its darunavir-based products, nor are there published data on the safety and efficacy of darunavir-based regimens for the treatment of COVID-19. Preliminary results from a single-center, open-label, randomized, controlled trial conducted at Shanghai Public Health Clinical Center (SPHCC) of Prezcobix in treating COVID-19 in 30 SARS-CoV-2-infected patients showed that Prezcobix was not effective. 

As per Interim Guidance for COVID-19 and Persons with HIV developed by the Department of Health and Human Services’ Antiretroviral and Opportunistic Infections Guidelines Panels:  

If protease inhibitors (PIs) are not already part of a person’s ARV regimen, their regimen should not be changed to include a PI to prevent or treat COVID-19, except in the context of a clinical trial and in consultation with an HIV specialist. 

This guidance important, in part, to safeguard against supply chain disruptions for adults and children currently using these regimens for the management of their HIV.  

NASTAD will continue to track the COVID-19 treatment pipeline, including ongoing evaluations of ARVs.

RWHAP Considerations and Resources

As jurisdictions implement and enforce isolation, quarantine, and social distancing protocols, RWHAP grantees – and ADAPs in particular – are developing policies to ensure continued access to medications and health care services for clients. In support of these efforts, HRSA’s HIV/AIDS Bureau (HAB) has launched a Frequently Asked Question (FAQ) webpage on the HAB website, which HAB is monitoring and updating as new information is made available.

Many ADAPs already have plans in place to ensure access to medications during times of disrupted access (e.g., a natural disaster). ADAPs should work with their PBMs and pharmacy networks to review and deploy existing policies aimed at easing access barriers. See the following resource for a summary of existing policies and flexibilities: AIDS Drug Assistance Program (ADAP) Emergency Preparedness Resource Guide. The following are considerations for health departments as they work to ensure the continued health and safety of people living with HIV:

  • Early refill and dispensing limit overrides: ADAPs have discretion to allow for early refill overrides as well as extend fills to 60-days. ADAPs should work with their PBMs and/or pharmacy networks to implement these policies.
  • Streamlined recertification and annual renewal policies: RWHAP Part B programs and ADAPs have discretion to streamline the recertification process, including utilizing self-attestation that there have been no changes in financial eligibility, residence, and third-party coverage for one of the two required recertifications per year (see HRSA/HAB PCN 13-02). Clients may "sign" the self-attestation virtually or at their next provider visit. In some cases, RWHAP Part B programs/ADAPs are setting up virtual signature or phone-based options via case management agencies). Though it is not required by HRSA/HAB, many RWHAP Part B programs/ADAPs collect viral load and/or CD4 labs at either annual or six-month recertification. Because social distancing may delay clients’ ability to access these labs currently, programs may waive or delay collection of that information.
  • Network exceptions: ADAPs may be able to work with PBMs and pharmacy networks to approve limited pharmacy network exceptions for individuals who may not have access to their regular pharmacy.
  • Testing: RWHAP Part B funds can also be used to cover COVID-19 testing for eligible clients via the Outpatient/Ambulatory Health Services category (or primary insurance cost sharing associated with COVID-19 testing via the Health Insurance Premium and Cost Sharing Assistance for Low-Income Individuals category).

HRSA has also released a COVID-19 resource page for 340B Drug Pricing Program participants and stakeholders.

Viral Hepatitis Program Resources  

There has been little research on the intersection of COVID-19 and viral hepatitis. Some of the resources below suggest that people with hepatitis B or hepatitis C are at increased risk of illness with COVID-19 if they have extensive liver damage or other underlying conditions, such as kidney injury, cardiovascular disease, and diabetes. NASTAD will update and add resources on COVID’s impact on people living with hepatitis as they become available.  

Videos: 

  • Dr. Saab Coronavirus and the Liver Overview (ALF, YouTube, March 20) - In this video, Dr. Sammy Saab from David Geffen School of Medicine at UCLA gives an overview of COVID-19 (Coronavirus) and answers your questions in the first of the American Liver Foundation Coronavirus series.   
  • Dr. Saab Coronavirus and the Liver Questions (ALF, YouTube, March 20) - The American Liver Foundation wants to provide an opportunity to ask any questions you may have and help ease any anxiety you may be feeling. Dr. Sammy Saab provides an overview of COVID-19 and how it affects Liver Disease patients and caregivers. 
  • COVID-19: A Message to the Community (NVHR, Vimeo, March 18) - Michael Ninbrug, Executive Director, Hepatitis Education Project 
  • Viral Hepatitis: COVID-19 Considerations (NVHR, Vimeo, March 18) - Robert G. Gish, MD

Partner Resources: 

Syringe Services Programs (SSPs) and Drug User Health Resources

In response to the outbreaks of COVID-19, and the potential for increased impact on vulnerable groups such as those with HIV, viral hepatitis, and people who use drugs (PWUDs), NASTAD encourages Health Department programs to offer additional support to programs and service providers who work with these groups, particularly Syringe Services Programs (SSPs) and drug user health organizations.

This additional support could entail:

  • Ensure that SSPs and Drug User Health programs are designated as essential services that may remain open in light of COVID restrictions on workplace and travel.
  • Offering emergency funding for additional harm reduction supplies so participants have adequate supplies for 2-4 weeks.
  • Encouraging delivery and mail-based provision of supplies, and virtual service where feasible.
  • Increasing mobile and outreach-based distribution efforts and peer distribution of SSP/harm reduction supplies.
  • Removing restrictive policies (i.e. 1 for 1 exchange) that limit the number or quantity of syringes participants can acquire.
  • Working with agencies to develop containment policies and protocols to ensure the health and safety of staff and participants.
  • Reserving motel/hotel or temporary housing for SSP participants and PWUDs in case of need of quarantine or self-isolation.
  • Providing washing facilities in areas that experience a high volume of public drug use or homelessness.
  • Encouraging the distribution of hand sanitizer, antibacterial wipes, and/or soap through harm reduction programs.
  • Encouraging shelters to allow for stability of beds for residents to minimize contact with pathogens.
  • Working with state and local MAT (medication-assisted treatment) providers and state behavioral health agencies to ensure access to 14-28 days of take-home MAT (see SAMHSA Guidelines below).

The following resources have been created by federal, state, and local agencies and community-based and non-profit partner groups and might be useful in your efforts. If you have additional resources that you have created or found useful on how to meaningfully support these vital programs in light of COVID-19, please feel free to send them to NASTAD’s Drug User Health team.

Incarcerated Individuals and COVID-19

Correctional and detention facilities present unique challenges for control of COVID-19 transmission among incarcerated/detained persons, staff, and visitors. Consistent application of specific preparation, prevention, and management measures can help reduce the risk of transmission and severe disease from COVID-19. The following resources are available regarding COVID-19 prevention and control in correctional facilities and prisons:

COVID-19-Related Xenophobia and Racism

NASTAD recognizes and condemns the recent uptick in xenophobic and racist attacks towards Asian American communities that has arisen as a result of this pandemic. NASTAD stands with our partners in acknowledging the rise of COVID-19 confirmed cases in the U.S. and globally requires a swift and robust public health response. We echo Jeffrey Caballero, the Executive Director of the Association of Asian Pacific Community Health Organizations, in the Joint Statement of Asian American and Pacific Islander Leaders and Over 260 Civil Rights Organizations Call on Congress to Denounce Anti-Asian Racism around COVID-19 in strongly condemning incidents of anti-Asian racism:

This is a global emergency that should be met with both urgency and also cultural awareness that COVID-19 is not isolated to a single ethnic population. Xenophobic attacks and discrimination towards Asian American communities are unacceptable and will not make our families safer or healthier.

We join our peers in strongly condemning anti-Asian stigma, harassment and discrimination and are committed to taking a stand against all forms of xenophobia and racism. NASTAD also strongly acknowledges that pandemics further exacerbate social prejudices, such as xenophobia, racism, and stigma, which target historically marginalized groups. This rhetoric further perpetuates the health inequities and disparities faced by people placed at risk, including people living with HIV and/or viral hepatitis, and people who use drugs, therefore NASTAD will continue to disseminate accurate and culturally responsive information. 

COVID-19 Testing 

As testing capacity for COVID-19 ramps up in both the public and private sectors, there may be particular considerations for individuals living with HIV and other chronic conditions. The Infectious Disease Society of America has released guidance for COVID-19 testing, including prioritization of testing for people living with HIV showing symptoms. Because availability of testing and access to testing sites varies by jurisdiction, clients should call their provider to advise on if a test is warranted and how to access one (see CDC guidance on COVID-19 testing). Drive-through testing sites are increasingly being used as a safe way to access testing while adhering to social distancing requirements. 

Legislative and Regulatory Responses

As health department responses to community outbreaks of COVID-19 continue to expand and evolve rapidly, federal and state policies are being updated to maximize the impact of disease containment and mitigation strategies.

Emergency Funding

Congress passed an emergency funding bill that was signed into law on March 6, providing $8.3 billion for COVID-19 response activities, including investments public health response activities, research (including vaccine and treatment development), testing capabilities, and medical supply medication procurement. The $800,000 that had been reprogrammed from NCHHSTP last month was returned in this bill.

The President signed Families First Coronavirus Response Act into law on March 18. The package provides free COVID-19 testing through commercial insurers, Medicare Part B, Medicare Advantage, Medicaid and CHIP, as well as funding for tests for people who are uninsured. The Federal Medical Assistance Percentage for Medicaid was temporarily raised by 6.2 percent. While businesses with over 500 employees are exempt from providing paid leave, it does include provisions for small businesses to provide 12 weeks of paid leave through an expansion of FMLA and 10 paid sick days for full time employees and less for part-time employees. Small businesses will receive tax credits for reimbursement of this expansion. It also includes funding for unemployment assistance and nutrition benefits.

On March 27, H.R. 748, the CARES Act, the third piece of major COVID-19 relief legislation, was signed into law. The package, which passed unanimously in the Senate and by voice vote in the House, provides $340 billion dollars in emergency appropriations, including an additional $4.3 billion to the Centers for Disease Control and Prevention (CDC), $65 million for HOPWA, $90 million for the Ryan White HIV/AIDS Program (RWHAP). It also includes direct cash payments to people, an expansion of unemployment insurance, and aid to large and small businesses. The section by section outline of health provisions can be found here and the appropriations provisions can be found here.  

The RWHAP funding will supplement existing grants for Parts A, B, C, and D for the COVID-19 response. This funding can be spent through September 2022. The funding will modify existing grants and cooperative agreements and will “be awarded using a data driven methodology determined by the Secretary.” The HOPWA funding is for additional housing and may be used for COVID-19 related isolation for family members not living with HIV. At least $50 million of the HOPWA funding will be awarded via formula. The CDC funding is for public health preparedness and response, which includes funding to state and local public health agencies. In addition, there is funding for surveillance and public health data infrastructure. NASTAD is working with national and federal partners to ensure coordination of broader COVID-19 CDC funding with HIV and hepatitis programs. 

Federal Public and Private Insurance Coverage Actions

The Families First Coronavirus Response Act (FFCRA) and the CARES act – two majors pieces of federal legislation responding the public health and economic crises wrought by COVID-19 – contain a number of provisions expanding access to services: 

  • Allows states to receive an increased federal Medicaid match (6.2%) as long as they meet the law’s maintenance of effort requirements, including maintaining eligibility standards and covering COVID-19 related testing, treatment, and vaccines for the duration of the public health emergency. 
  • Requires Medicaid, Medicare, and private insurance (individual and small group market) to cover COVID-19 related testing free to the consumer. 
  • Gives states the option to expand Medicaid to cover COVID-19 testing to uninsured individuals for the duration of the public health emergency via a State Plan Amendment.  
  • Requires Medicare Part D plans to provide 90-day prescriptions for beneficiaries. 

Justice in Aging provides a comprehensive summary of healthcare provisions in the CARES act and Kaiser Family Foundation provides a summary of the FFCRA provisions

CMS has released a number of fact sheets and guidance to instruct Medicaid, Medicare, and individual and small group coverage with regard to provision of a range of services associated with the COVID-19 outbreak. This includes information to healthcare facilities regarding increased and focused inspections, resources for billing for diagnostic testing (including release of new billing codes), guidance on new telehealth flexibilities, including HIPAA enforcement discretion to facilitate scale up of telehealth capabilities), recommendations for elective surgeries and procedures, and fact sheets and information regarding coverage and cost-sharing requirements for preventive services. Because a national emergency has been declared, CMS is also accepting applications for Medicaid 1135 waivers that allow states greater flexibility with regard to provider requirements, prior authorization requirements, and other eligibility rules. To date, 40 states have been approved for 1135 waivers.

State insurance regulatory actions

Several states departments of insurance have issued regulations and orders to ensure that individuals have access to COVID-19 testing and easy access to necessary medications should there be more aggressive containment measures in jurisdictions that prevent travel to pharmacies. These measures – adopted in California, Washington, and New York, as well as a growing list of additional states – include consumer protections like waiving cost sharing associated with COVID-19 testing; allowing early refills for prescriptions; suspending prior authorization for testing or treatment for COVID-19; providing easier access to telehealth medical advice and treatment; and allowing individuals to seek COVID-19 related services outside of their provider network. Additionally, many major commercial insurance plans have put in place similar policies that apply in states even without regulatory action.

Insurance Fraud and Scams 

Fraudulent schemes related to COVID-19 have arrived and are being detected in many forms, including peddling fake cures, phishing e-mails, non-existent charitable organizations, price gouging, and insurance fraud.  

Health Department Staffing Impact

NASTAD is aware that many HIV and hepatitis health department staff are being detailed to state and local COVID-19 efforts, putting an additional strain on already lean programs. Federal HIV and hepatitis partners – particularly those at CDC – are also being detailed away from their HIV and hepatitis posts. We are aware that a communication went out to CDC health department grantees from the Center for State, Tribal, Local, and Territorial Support (CSTLTS) entitled “Guidance for The Temporary Reassignment of State, Tribal, and Local Personnel During a Declared Federal Public Health Emergency.” The guidance details the process by which public health staff can be reassigned for emergency response and references additional CDC resources (available here). The Office of Management and Budget (OMB) has also released guidance with regard to federal grants and activities impacted by COVID-19 and flexibilities available to grantees as operations are affected.

Additional COVID-19 Resources

Federal Guidance/Resources

Multi-Language Resources

Compilation of multilingual resources:

If you have any questions or additional resources for this page, please email covid19@NASTAD.org