Ending the HIV Epidemic 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.
Hill Happenings
FY2022 Appropriations and Build Back Better Act
Democrats on the Hill are working to resolve year-end spending hurdles in order to advance the Build Back Better Act, President Biden’s broad-reaching social spending package. Two weeks after averting a government shutdown, Democrats are close to resolving the federal debt limit crisis. On December 7, the House of Representatives advanced a bill that unlocks an expedited voting process in the Senate, allowing Senate Democrats to avoid the Senate filibuster and raise the debt limit through a simple majority. The Senate passed the measure on December 9, empowering Democrats to raise the debt limit by a specific dollar amount on party lines. Democrats must now raise the debt limit by December 15 in order to avoid a default on the national debt.
With the debt limit crisis on a firm path to resolution, Senate Democrats are shifting their focus to advancing the House-approved Build Back Better Act (H.R. 5376) by the year’s end. On December 6, Senate Leader Chuck Schumer (D-NY) issued a Dear Colleague Letter outlining the timeline for advancing the Democratic caucus’ legislative priorities. With a packed legislative calendar that includes Senate confirmation hearings and advancing the Build Back Better Act through the lengthy budget reconciliation process, Democrats are unlikely to begin Fiscal Year 2022 (FY2022) appropriations discussions in earnest until the new year. NASTAD will continue to monitor the FY2022 appropriations and budget reconciliation process to advocate for the highest funding levels on behalf of HIV and hepatitis programs.
Schiff, Smith Introduce PrEP Access and Coverage Act of 2021
On December 1, Congressman Adam Schiff (D-CA-28) and Senator Tina Smith (D-MN) introduced the PrEP Access and Coverage Act of 2021, a bill intended to address PrEP underutilization and reduce disparities in PrEP access. The bill would ensure that health insurers provide comprehensive coverage for PrEP by eliminating out-of-pocket costs and other restrictions for the preventive medication and ancillary services. Additionally, the legislation would direct the Secretary of the Department of Health and Human Services (HHS) to establish community public health campaigns and provide grants for jurisdictions to increase access to PrEP for uninsured individuals. NASTAD supports the legislation and endorsed the bill.
Bipartisan Group of Lawmakers Introduce World AIDS Day Resolution
On December 1, Senators Cory Booker (D-NJ) and Dan Sullivan (R-AK) introduced a resolution commemorating and supporting the goals of World AIDS Day, which is observed annually on December 1. The resolution recognizes current efforts made by the United States and international organizations in combatting HIV/AIDS while also encouraging greater coordination between the global community to end the HIV epidemic by 2030, including setting a goal to achieve zero new HIV infections and AIDS-related deaths. A companion resolution was introduced in the House by Representatives Barbara Lee (D-CA-13) and Jenniffer González-Colón (R-PR-At-Large), who also call for an End to HIV Discrimination. NASTAD formally endorsed the resolution.
Administration Activities
Biden Administration Releases Updated National HIV/AIDS Strategy
President Biden announced the release of the updated National HIV/AIDS Strategy (NHAS) for 2022-2025. The NHAS provides the framework and direction for the Biden Administration’s policies, research, programs, and planning that will lead to ending the HIV epidemic in the US by 2030. The updated NHAS incorporates the latest epidemiological data and biomedical prevention science on HIV and includes support for harm reduction services and SSPs. Additionally, the updated NHAS encourages reform of state HIV criminalization laws and includes a greater focus on addressing the social determinants of health.
HRSA HAB EHE Data Report Is Now Available
The Health Resources and Services Administration’s (HRSA) HIV/AIDS Bureau’s (HAB) released its inaugural Ending the HIV Epidemic in the U.S. Initiative (EHE) Data Report, 2020. The newly released publication features national-level aggregate data submitted to the EHE Triannual Module data system by HAB EHE recipients and subrecipients during the 2020 calendar year.
Although the EHE initiative budget year is March through February, the EHE Triannual Module data are reported based on the calendar year (January through December). To align data reporting with the calendar year, two reporting periods were established for the initial data year (2020): March through August (6 months), and September through December (4 months). The report includes all EHE Triannual Module data reported by HAB EHE-funded service providers for March through December 2020.
Biden Administration Commemorates World AIDS Day
World AIDS Day, observed annually on December 1, is an opportunity for people around the world to bring attention to the HIV epidemic, increase HIV awareness and knowledge, speak out against HIV stigma, and call for ending the HIV epidemic in the US and globally. The U.S. Government’s theme for this year’s World AIDS Day is Ending the HIV Epidemic: Equitable Access, Everyone’s Voice, HHS, Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA) leaders issued statements in commemoration of the 33rd World AIDS Day, noting the special significance of this year’s event in light of the COVID-19 pandemic and the 40-year anniversary of the first detected cases of HIV/AIDS. On November 30, President Biden issued a presidential proclamation commemorating World AIDS Day. The President called attention to the challenges that the world is facing in ending the HIV epidemic and recommitted the US Government to ending the HIV epidemic domestically and abroad.
ONDCP Releases Model Law to Help States Expand Access to SSPs
On December 8, the Director of the White House Office of National Drug Control Policy (ONDCP) released a new model law, the Model Syringe Services Program Act, to help states ensure access to safe, effective, and cost-saving syringe services programs. The Model Syringe Services Program Act provides a template of suggested legislative provisions that can be enacted in states across country so that they can expand access to syringe services programs. Specifically, the Act contains language that would authorize the establishment of comprehensive syringe services programs.
CDC Releases Updated Clinical Practice Guidelines for PrEP
On December 8, the Centers for Disease Control and Prevention (CDC) published updates to the Clinical Practice Guideline for Preexposure Prophylaxis for HIV Prevention and Clinical Providers Supplement. The updated guidance reflects the current scientific evidence base for PrEP, incorporates recent and potential FDA actions on PrEP medications, clarifies specific aspects of clinical care, and improves usability and increases implementation of the guideline. Click here to read a Dear Colleague letter from the Director of the CDC Division of HIV Prevention that details the changes included in the update.
Vice President Harris Announces $1.5 Billion Investment to Diversify Health Workforce
On November 22, Vice President Harris announced a $1.5 billion investment to help diversify the nation’s health care workforce and foster equitable health care in underserved communities. The funding will address workforce shortages and health disparities by providing scholarship and loan repayment funding for health care students and professionals, in exchange for a service commitment in hard-hit and high-risk communities. The financial resources will support the National Health Service Corps, Nurse Corps, and Substance Use Disorder Treatment and Recovery programs. The new investment was recommended by the Presidential COVID-19 Health Equity Task Force in order to reduce health disparities in systemically underserved communities that were significantly impacted by the COVID-19 pandemic.
CDC Data Show Alarming Increase in Overdose Deaths
On November 17, the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS) released provisional drug overdose death data that show a 28.5 percent increase in overdose deaths from April 2020 to April 2021. For the first time in the nation’s history, 100,000 Americans died from drug overdose in a single year. The data release follows the launch of the Department of Health and Human Services (HHS) Overdose Prevention Strategy on October 27, which focuses on prevention, harm reduction, evidence-based treatment, and recovery support to stem the overdose crisis.
FDA Reclassifies Hepatitis C Diagnostic Tests to Facilitate Regulatory Approval
On November 19, the HHS Food and Drug Administration (FDA) issued Final Orders that reclassify hepatitis C (HCV) diagnostic tests from Class III to Class II, easing administrative burdens that complicate the marketing clearance process for the viral assays. In particular, the reclassification will allow diagnostic manufacturers to avoid the stringent FDA premarket approval process and instead seek marketing clearance through the 510(k) pathway. The policy change is intended to increase access to HCV tests, reducing testing disparities and making progress on the viral elimination goals laid out in the Viral Hepatitis National Strategic Plan.
HHS Announces Telehealth Funding for Title X Grantees
On November 23, HHS announced the availability of new funding to enhance and expand the telehealth infrastructure and capacity of Title X family planning providers. HHS will distribute $35 million in one-time grants appropriated under the American Rescue Plan Act of 2021 to Title X grantees in order to increase Title X service delivery networks via telehealth.
Resources
Systems Coordination Provider Project
NASTAD Systems Coordination Provider (SCP) staff continues to participate in HRSA Ending the HIV Epidemic Programmatic Site Reviews through February 2022. NASTAD SCP staff attended three reviews in November. The site visits serve as an opportunity for the SCP and CAI, the Technical Assistance Provider (TAP), to provide an overview of the SCP and TAP-in projects and hear directly from jurisdictions about their EHE program and activities. NASTAD’s Systems Coordination Provider (SCP) staff continues to participate in HRSA Ending the HIV Epidemic Programmatic Site Reviews through February 2022. The site visits serve as an opportunity for the SCP and CAI, the Technical Assistance Provider (TAP), to provide an overview of the SCP and TAP-in projects and hear directly from jurisdictions about their EHE program and activities. To request systems coordination support: scpta@NASTAD.org
NASTAD SCP is implementing a mentoring program. The EHE mentoring program is a 3-6 month-long intensive strategy for assisting health department staff in EHE jurisdictions focused on transforming leaders and developing emerging talent, improving systems and operations, and ensuring data-driven service outcomes. The mentoring program is a collaborative learning opportunity for new EHE Coordinators and Managers who are interested in strengthening their effectiveness by enhancing their skills to develop as emerging leaders. For additional information, please contact Darion Banister.
Invitation to Apply: Partner Services Learning Collaborative
NASTAD, in partnership with the University of Washington and the National Coalition of STD Directors (NCSD), is pleased to announce the launch of a new Partner Services Learning Collaborative. The learning collaborative is a virtual peer learning group for select Phase 1 EHE Jurisdictions interested in modernizing their HIV/STI field services. The first cohort will take place over an 18-month period between February 2022 and August 2023. Applications are due by January 3, 2022.
The learning collaborative will address the following:
- Integrating linkage to PrEP into HIV/STI partner services
- Improving the HIV case-finding effectiveness of partner services
- Integrating linkage and relinkage to care in partner services (i.e., data to care)
- Field services data management and use of newer technologies
- Prioritization of field services work
- Implementation of cluster detection and response
By the end of the learning collaborative, participants will have increased capacity to:
- Increase linkage to PrEP
- Increase linkage and relinkage to HIV care (among persons receiving partner services)
- Improve HIV surveillance data
- Increase HIV/STI case-finding
NASTAD will select between 5-15 jurisdictions to participate in the first cohort of the Partner Services Learning Collaborative. Participation in this learning collaborative is open to CDC PS20-2010 Component A and Component C health department staff as well as county or city health department staff in Phase 1 EHE Jurisdictions. In some instances, depending on how partner services are organized in your area, jurisdictions may elect to have a mix of state and local health department staff participate in the collaborative. Participating staff should be involved in field services, field services supervision, epidemiology, and program leadership.
EHE Phase 1 Jurisdictions interested in participating should submit a complete application here. For any questions, please contact Krupa Mehta.
CDC Foundation - Enhancing Community Capacity to Support HIV Self-Testing Programs RFP
The CDC Foundation was awarded a federal grant to work on the Enhancing Community Capacity to Support HIV Self-Testing Programs in partnership with CDC's Division of HIV Prevention. This funding opportunity aims to support efforts to expand the reach and impact of HIV Self-Testing programs by building the capacity of community-based organizations serving communities within 57 priority jurisdictions identified by the CDC’s Ending the HIV Epidemic in the U.S. initiative. The goal of this RFP is to contract with a national or regional HIV prevention-focused organization to serve as a technical assistance provider and to provide capacity-building opportunities to community-serving organizations. Applications are due by Monday, January 17, 2022 at 12:00 PM ET.
NASTAD/JSI Connecting Care Podcast: The Case for Safe Consumption Spaces: Reducing Fatal Overdoses and Increasing Linkage to Care
In response to an increased risk of overdose, several communities in the U.S. are considering establishing spaces for people to use substances safely. These spaces have been referred to as Supervised Injection Facilities, safe consumption spaces, harm reduction spaces, or overdose prevention sites. Over the past few years, these spaces have garnered more support for their proven ability to reduce overdoses and meet other medical and psychosocial needs for people who use them. This month, our hosts talk through the benefits that these spaces have on HIV prevention, linkage to care and needed support services, fatal overdose prevention, and what it takes to get a sanctioned overdose prevention space in the U.S.
O’Neill Institute “Big Idea” & Issue Brief: Data Modernization is Needed for a Syndemic Approach to Fighting HIV
In many communities, HIV exists as part of a syndemic that also encompasses other infectious diseases, non-communicable diseases, poverty, unemployment, substance use disorders, and systemic discrimination. Our national approach to monitoring discrete health conditions is outdated making it difficult to adopt syndemic strategies for improving community health.
NASTAD announces the release of PrEP Coverage Check—a PrEP Verification Tool
This tool aims to assist PrEP navigators and enrollment assisters in quickly verifying whether PrEP medications are covered in select health plans throughout the 2022 Open Enrollment Period. On November 18, NASTAD held a webinar to introduce and walk through the new tool. The webinar recording and slides can be accessed here.
Access this resource and stay tuned for ongoing updates! Please contact NASTAD’s PrEP Team with any questions.
Heterosexual sex accounts for 23% of new HIV diagnoses annually. Heterosexual adults are underrepresented in preexposure prophylaxis (PrEP) research and campaigns. Increasing PrEP awareness and use in this population is needed to prevent HIV transmission and end the HIV epidemic in the United States. Tailored PrEP campaigns and routine screening can increase PrEP awareness and use among heterosexual adults, particularly among Hispanic persons.
This analysis of national surveillance data found that the estimated number of new HIV infections among MSM did not change overall during 2010–2019; infections decreased among White MSM but not among Black MSM or Hispanic/Latino MSM. Most measures of use of HIV prevention and treatment services were lower among Black MSM and Hispanic/Latino MSM than White MSM and younger MSM compared with other age groups. Improving access to and use of HIV services for MSM, particularly Black MSM, Hispanic/Latino MSM, and younger MSM, is essential to ending the HIV epidemic in the United States.
NACCHO NOFOs: New Funding Opportunities for Harm Reduction Monitoring & Evaluation
With support from the Centers for Disease Control and Prevention (CDC) and in partnership with the University of Washington (UW), NACCHO is pleased to announce new funding opportunities to promote monitoring and evaluation (M&E) of syringe services programs (SSPs) and support the use of data for SSP program improvement. NACCHO will provide up to $90,000 for SSPs to implement data analysis and/or evaluation projects and up to $50,000 for SSPs to participate in a learning collaborative related to the implementation of point in time surveys. Applications for the data analysis RFA are due January 13 and applications for the point in time survey learning collaborative are due January 6. NACCHO hosted an informational webinar on Monday, December 13th. The recording can be accessed here. For additional information, including to access the RFAs, register for the webinar, or sign up for office hours, visit here.
The purpose of this funding opportunity is to increase the capacity of SSPs to implement Point in Time surveys and support the use of collected data for SSP program improvement through participation in a Learning Collaborative. The funding opportunity will also seek to evaluate and demonstrate the effectiveness of a Learning Collaborative approach as a means of building SSP capacity for M&E and inform and strengthen future SSP M&E technical assistance opportunities and resources, including for Point in Time Surveys. Through this Request for Applications (RFA), NACCHO will issue contracts of up to $50,000 to SSPs to support participation in and evaluation of the Learning Collaborative, including completion of deliverables related to the implementation of a Point in Time survey. Applications are due on January 6, 2022. Access the RFA here.
Funding Opportunity on HIV and Aging
HRSA HAB has released three notices of funding opportunities (NOFOs) related to HIV and aging. Aging with HIV is an important matter within the Ryan White HIV/AIDS Program (RWHAP). Nearly half of people served by the RWHAP were aged 50 years and older in 2019. The health care and psychosocial concerns change as people with HIV grow older and their health care and social services providers need to respond differently. All funded organizations will work collaboratively to achieve the purpose of the NOFOs. Applications for the three NOFOs are due January 25, 2022.
2022 Model and Innovative Practice Award Applications Now Open
NACCHO’s annual award cycle for local health departments is now open, and local HIV programs are encouraged to use this opportunity to share about your ongoing Ending the HIV Epidemic work. In particular, the Innovative Practice Awards recognize adaptations and innovations created in response to the COVID-19 pandemic and related challenges such as changes in staffing structures and outreach practices. These awards are vital to highlighting and sharing promising practices at the local level. Please consider this opportunity to showcase your teams’ hard work and/or share this opportunity with your local health department partners! For questions, contact model-practices@naccho.org and CC ehe@naccho.org.
Updated PrEP Guidelines: What Local Health Departments Should Know
Join NACCHO on January 17 at 2 PM EST to learn about recent updates to the CDC's Clinical Guidelines for Pre-Exposure Prophylaxis (PrEP) for HIV Prevention. Local health departments (LHDs) can use these guidelines to promote PrEP and educate providers in their communities. Participants will also learn about the landscape of LHD engagement in PrEP prescribing, referrals, and promotion. The webinar will feature guest speakers from CDC's Division of HIV Prevention. Register for the webinar here.
NACCHO HIV, STI, and Viral Hepatitis Team is Hiring
Director of HIV and Harm Reduction
The Director will oversee HIV, Viral Hepatitis, and Harm Reduction projects of the HIV, STI, Viral Hepatitis and Harm Reduction portfolio at NACCHO. With the Senior Director, they are responsible for developing the strategic direction for this work, integrating these activities within the unit portfolio and across the organization, and ensuring results.
Program Analyst for HIV, STI, and Viral Hepatitis
The Program Analyst will support projects and activities within the HIV, STI and Viral Hepatitis program portfolio, including cooperative agreements with, CDC's Division of STD Prevention, and grant funding from industry and other funders. The ideal candidate will possess interest and experience in the prevention, care, and treatment of STls, HIV, and/or viral hepatitis (primarily hepatitis B and C), as well as health department programming, the healthcare system, public health policy, and the provision of technical and capacity building assistance.
Call for Abstracts: 2022 CSTE Annual Conference
The Call for Abstracts for the 2022 Council of State and Territorial Epidemiologists (CSTE) Annual Conference in Louisville, KY is now open. The deadline for abstract submission is Thursday, January 6, 2022 at 11:59 pm EST. Submit an Abstract TODAY!
To submit an abstract for the 2022 CSTE Annual Conference, please follow the link below for additional information and complete all required fields in the process by the deadline. Information provided in the abstract submission guidelines relate to an in-person event with some virtual components. Presenting authors will be notified of Planning Committee decisions by Friday, March 25, 2022. Click here to review the 2022 Abstract Submission Guidelines.
Join NACCHO and NCSD to Discuss 340B Drug Pricing Program
Would your health department benefit from understanding and utilizing the 340B Drug Pricing Program? Join NACCHO and the National Coalition of STD Directors (NCSD) on January 25, 2022 at 2:00pm ET as we explore the basics and beyond of 340B. Learn how the 340B Drug Pricing Program can support health department operations—saving money, generating revenue, and expanding sexual health services. Interested? Register here.
Social Determinants of Health (SDH) Monthly Highlight
NASTAD is conducting an ongoing monthly series that highlights the intersection of HIV prevention and care with a specific social determinant of health (SDH). December’s topic is transportation. According to the Boston University Center for Innovation in Social Work & Health HIV, Housing & Employment Project, “Transportation is a necessary element of any intervention working to improve access to care for clients with HIV. Several studies have reported transportation as a barrier to HIV treatment. However, there are few interventions or best practices focused on reducing transportation barriers for people with HIV. It has become increasingly clear that interventions need to focus on holistic approaches to improving transportation availability to all populations.” Read the Spotlight here. You can also review “Transportation vulnerability as a barrier to service utilization for HIV-positive individuals,” here.
EHE Community of Practice (CoP) on NASTAD’s Online Technical Assistance Platform (OnTAP)
NASTAD and NACCHO manage a virtual Community of Practice (CoP) to support peer-to-peer learning and mentorship for EHE jurisdictions. The EHE CoP is housed on NASTAD’s online technical assistance platform (OnTAP) for those leading their jurisdictions' EHE efforts at local and state health departments, to share resources and news, discuss challenges and successes, access notes from monthly EHE Office Hours calls, and request technical assistance (TA). If you need access to OnTAP, please contact Krupa Mehta.
Ending the HIV Epidemic Jurisdictional Directory
NASTAD maintains an Ending the HIV Epidemic (EHE) Jurisdictional Directory. Health department staff members are encouraged to update their jurisdiction’s information using this brief form.
Jurisdictional Map of Phase 1 EHE Final Plans
NASTAD released a resource that provides access to Phase 1 EHE websites and plans. Please email Krupa Mehta additional Phase 1 EHE plans for inclusion in this resource as well as any changes to existing plans.
News Bulletin
Racism in Medical Settings May Reduce Willingness to Take HIV Meds
“People living with HIV who experienced racism at clinic visits were two times less likely to take their antiretroviral medications as directed, according to data published in AIDS and Behavior. Other types of stigma and concerns about unwanted disclosure of HIV status also played a role. The results won’t surprise many Black, Latino and other people of color living with HIV. Medical racism has long been a factor affecting engagement in HIV care, which has been linked to a higher likelihood of an undetectable viral load and its health benefits.”
These States Are Falling Further Behind in Providing HIV PrEP
“We know that transgender and gender-nonconforming people — particularly Black and Brown transgender women — are disproportionately affected by HIV. While prevalence for adults in the United States is less than 0.5%, prevalence among TGNC communities is 9.2%. Looking at these numbers, we must also recognize that this is an estimate. For reasons related to safety and access, the information and data that we have on transgender communities is often limited. As the population of openly queer and transgender people increases, we must recognize that these numbers are more drastic than even this current dataset.”
A Closer Look at the Remaining Uninsured Population Eligible for Medicaid and CHIP
“Recent policy attention has focused on efforts to reduce the number of uninsured people in the U.S. by expanding eligibility for coverage assistance, including enhanced premium subsidies in the Affordable Care Act (ACA) Marketplace and filling the Medicaid ‘coverage gap.’ A new KFF analysis shows that a majority of the 27.4 million people who remained uninsured in 2020 already are eligible for financial assistance for coverage through Medicaid/the Children’s Health Insurance Program (CHIP) or the Marketplace, suggesting that policies in the Build Back Better Act as well as outreach for the current ACA open enrollment period could help reduce that number.”
The uninsured are eager for Congress to fill a coverage gap — even for a few years
Since she was diagnosed with HIV in the 1990s, Deneen Robinson has worked as an advocate, promoting health, abortion rights and AIDS education for other Black women. But it was not until June, when her job as a policy director for a Dallas nonprofit organization was eliminated — leaving her with insurance premiums she no longer could pay — that Robinson discovered a gap she had never known existed.