Ending the HIV Epidemic Newsletter
NASTAD, in collaboration with 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 the community. For questions, comments, or content contributions, please contact Mike Weir.
Hill Happenings
FY2024 Appropriations
On July 14, the House Subcommittee on Labor, Health and Human Services, Education, and Related Agencies (LHHS) approved broad spending cuts in its fiscal year 2024 (FY2024) appropriations bill, threatening funding for vital health programs. The bill quantifies House Republicans’ commitment to reduce federal spending, proposing deep programmatic cuts across Centers for Disease Control and Prevention (CDC) divisions and the elimination of certain federal health programs. Notably, the bill eliminates funding for the Ending the HIV Epidemic Initiative at the CDC and the Health Resources and Services Administration (HRSA), which would undermine the US public health system’s capacity to prevent new HIV transmissions and provide access to care.
Overall, the proposed bill would cut 18% of the CDC’s budget and 12% of HHS’s budget, eliminate 61 programs, and include drastic cuts and setbacks in HIV/AIDS programming, such as:
- $238 million cut from the Ryan White HIV/AIDS Program
- $220 million cut from the CDC National Center for HIV, Hepatitis, STD, and TB
- $32 million cut from the Minority HIV Fund
- Elimination of Ending the HIV Epidemic funding at CDC and HRSA/RWHAP
- $3.8 billion cut from the National Institutes of Health
- Eliminate the Title X family planning program
Click here to read NASTAD’s full statement condemning the House LHHS cuts to health programs.
In order to become law, however, the proposed spending cuts in the House must be approved by the Senate, where Democrats hold the majority. On June 22, the Senate Appropriations Committee approved topline spending numbers for FY2024 spending bills, setting topline spending levels above those set by the House. Although legislative text is not yet available, the Senate LHHS bill markup is set for September 27. Given the proximity to the September 30 fiscal year deadline, lawmakers are expected to pass a continuing resolution (CR) to temporarily extend fiscal year 2023 spending levels while appropriators negotiate through the fall.
NASTAD will continue to monitor the congressional appropriations process and advocate for the highest possible funding for HIV, hepatitis, and drug user health programs.
NASTAD Calls on Congress to Restore Axed DIS Funding
On July 11, NASTAD joined the National Coalition of STD Directors (NCSD) and called on the new CDC Director, Dr. Mandy Cohen, to restore $400 million in funding for the Disease Intervention Specialist (DIS) workforce that was rescinded as a result of the bipartisan debt ceiling compromise. Without replacement funding, almost 3,000 DIS positions across the country will lose funding, limiting the public health system’s ability to quickly detect new transmission of infectious diseases and implement effective interventions to prevent outbreaks. Additionally, the funding claw back will strain health departments’ preparedness to respond to current and future outbreaks, including mpox and syphilis, and threatens to further entrench health disparities.
Administration Activities
CMS Signs National Coverage Determination for PrEP
On July 12, Centers for Medicare & Medicaid Services (CMS) announced a proposed National Coverage Determination for Pre-Exposure Prophylaxis (PrEP) Using Antiretroviral Drugs to Prevent Human Immunodeficiency Virus (HIV) Infection and a request for public comment. If implemented, the national coverage determination would authorize CMS to cover PrEP using antiretroviral drugs approved by the US Food and Drug Administration (FDA) to prevent HIV infection in individuals at high risk of HIV acquisition, including both oral and injectable formulations. Advocates applauded CMS for initiating the process to finalize the policy proposal, which would reduce barriers to PrEP access. However, the coverage determination does not include all recommended ancillary services, like STI and renal function screenings. Comments are due by August 11.
White House Releases Plan to Address Emerging Threat of Xylazine in Illicit Opioid Supply
On July 11, the White House released its plan to address the public health threat of xylazine combined with fentanyl. Xylazine, a veterinary sedative that is increasingly present in the illicit opioids supply, causes severe wounds and increases the risk of fatal overdose above that posed by fentanyl alone. The plan, which was prompted by an April 2023 designation of xylazine combined with fentanyl as an emerging health threat, proposes to boost point-of-care drug testing for xylazine and fentanyl to empower community-based harm reduction programs and people who use drugs to reduce the harms of their drug use. Additionally, it proposes to collect data on xylazine-related mortality and compile best practices for treatment providers, boost xylazine interdiction efforts across the supply chain to prevent diversion, and explore drug scheduling of xylazine.
HRSA Issues Dear Colleague Letter Alerting Providers of Rising Syphilis Rates in Native Communities
On July 6, HRSA issued a Dear Colleague Letter alerting providers of increasing syphilis rates within American Indian/Alaskan Native (AI/AN) communities. HRSA and the Indian Health Service (IHS) identified highly impacted jurisdictions in Alaska, Arizona, Montana, Nebraska, New Mexico, Oregon, and South Dakota. HRSA encourages providers to fully implement the CDC recommendation for universal screening and testing for at-risk populations to intervene on the troubling epidemiologic trend. Nationally, CDC data indicate that the rate of primary and secondary syphilis among AI/AN in 2021 was 42.2 per 100,000 (nearly 5 times that of white individuals), up 520 percent from 8.0 per 100,000 among AI/AN in 2016.
Resources
NASTAD Webinar Series: Strategic Implementation Activities for Accelerating Ending the HIV Epidemic Efforts
NASTAD is pleased to announce a four-part webinar series, “Strategic Implementation Activities for Accelerating Ending the HIV Epidemic Efforts”. This series will highlight innovative approaches employed by Phase 1 Jurisdictions for Ending the HIV Epidemic (EHE) activities.
The second webinar, “Strategic Communications and Education for Improving PrEP Uptake” was held on Thursday, July 13. The recording and slides for the first two webinars can be viewed here.
The third webinar in the series, “Leveraging Partnerships and Funding to Support EHE and the Syndemics”, will be held on Thursday, August 3, from 2:00 to 3:00 PM ET. Register for the webinar here.
CAI Webinar: Why Wait? Start Now! What Jurisdictions Can Do to Support Adoption of Rapid Start.
On July 19th, CAI’s Technical Assistance Provider-innovation network (TAP-in) delivered the webinar, Why Wait? Start Now! What Jurisdictions Can Do to Support Adoption of Rapid Start. If you missed it, the webinar recording and slide deck will be available soon on TargetHIV.
“Routine xylazine testing in suspected overdose deaths is critical for surveillance; further investigation of xylazine’s effects on humans is needed to guide prevention efforts. Overdose prevention and response messages should emphasize the need to seek treatment beyond naloxone administration.”
HIV Cluster Detection and Response Learning Collaborative: Apply Now
CAI’s Technical Assistance Provider – innovation network (TAP-in), together with the New York State AIDS Institute’s Center for Quality Improvement and Innovation (CQII), is launching an HIV Cluster Detection and Response Learning Collaborative. This Collaborative aims to improve HIV cluster detection and response efforts to reduce the number of new HIV diagnoses and better link people newly diagnosed with HIV to care. Join other EHE jurisdictions funded by HRSA to participate in a 15-month learning collaborative that will build community partnerships, share lessons learned from other jurisdictions, discover the latest evidence-based practices, and provide strategies for updating HIV cluster and detection plans. For more information and to apply.
CSTE Technical Assistance Request Form - EHE Jurisdictions
CSTE, in collaboration with CDC, NASTAD, and Tsuro Consulting, is offering virtual technical assistance to support Ending the HIV Epidemic (EHE) Phase 1 jurisdictions. The aim of this offering is to support EHE jurisdictions seeking assistance with implementing EHE plans. TA topics include data analysis, data visualization, statistical modeling, and data mapping. For technical assistance, please complete the CSTE Technical Assistance Request Form - EHE Jurisdictions. Please reach out to Symone Richardson with any questions.
CSTE Infectious Disease Peer-to-Peer TA Consultancy Form - HIV
The CSTE Infectious Disease Program is pleased to offer coordination of peer-to-peer technical assistance. CSTE's HIV peer-to-peer technical assistance will be conducted virtually at this time. To give or receive peer-to-peer technical assistance, please complete the CSTE Infectious Disease Peer-to-Peer TA Consultancy Form.
If you have any questions regarding HIV peer-to-peer technical assistance, please reach out to Symone Richardson at srichardson@cste.org. If you have any questions about completing the consultancy form, please reach out to Akila Simmons at asimmons@cste.org.
CSTE VHA HIV Reporting Toolkit
CSTE recently released the CSTE VHA (Veterans Health Administration) HIV Reporting Toolkit! The purpose of the toolkit is to inform state, tribal, local, and territorial (STLT) public health agencies and VHA medical centers on best practices for HIV case reporting to improve VHA HIV reporting to public health agencies.
The CSTE VHA HIV Reporting Toolkit can be accessed on the CSTE HIV Subcommittee webpage and is also attached. Please be sure to complete the evaluation of the toolkit that can also be found on the subcommittee webpage. For optimal use of the toolkit, please download and open the PDF in a system viewer other than a web browser.
HIV CDR ILC Success Story Collection
CSTE and NASTAD are collaborating to collect HIV cluster detection and response success stories to highlight through the HIV Cluster and Outbreak Detection and Response (CDR) Implementation Learning Collaborative (ILC). We are looking for success stories from state, tribal, local, or territorial public health agencies that describe a successful initiative focused on 1) effective CDR planning, policies, procedures, and/or implementation strategies 2) innovations in CDR implementation to strengthen CDR planning and activities 3) effective approaches to meaningful engagement with local partners and community members involved in CDR activities.
Please submit success stories using CSTE’s Stories from the Field form (select “HIV - Cluster Detection and Response” as the “Story Topic Area”). Any story of a success, no matter how big or small, is welcome! If you have any questions, please email Symone Richardson at srichardson@cste.org.
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.
Job Postings
Manager, Health Systems Integration
This NASTAD team member plays a vital role in expanding the organization’s Health Systems Integration objectives, including providing technical assistance and systems coordination support to Ryan White HIV/AIDS Program (RHWAP) Part A and B recipients as part of the Ending the HIV Epidemic: A Plan for America (EHE) initiative. Under supervision from the Associate Director and in close collaboration with the Director, Health Systems Integration, the Manager will lead many of the program’s EHE systems coordination and technical assistance efforts. These efforts include the support of content creation management, technical assistance management, and systems-level engagement of health departments and other healthcare delivery systems. Technical assistance responsibilities include supporting EHE jurisdictions and ensuring that all technical assistance/systems coordination requests are resolved promptly and efficiently.
Senior Manager, Health Systems Integration
This NASTAD team member will provide programmatic support and leadership to NASTAD’s Health Systems Integration team while ensuring the alignment of NASTAD’s technical assistance, capacity building, and advocacy work as it relates to insurance coverage (including the Centers for Medicare & Medicaid Services) and access, public health financing, and partnerships, health systems integration and population health data. The Senior Manager, HSI is integral to the implementation of major components of the Health Systems Integration portfolio across federal cooperative agreements related to various areas that support Ending the HIV Epidemic efforts such as health care financing (340B pricing), health systems strengthening (policies and procedures), and healthcare access (ADAP and RWHAP) and wells as health systems modernization (data integration and data systems design) through systems coordination and leveraging population health data integration to achieve improved outcomes. This role plays a vital role in supporting NASTAD’s strategic priority areas through, supporting public health partnerships, programmatic strategies, learning and analyzing evidence to determine best practices. The Senior Manager will provide overall technical expertise in some of the following area: drug pricing, dissemination and replication of evidence information intervention and promising system integration practices, health care access, policy, and legislative affairs.
EHE Program Coordinator – Palm Beach County
The Palm Beach County Ending the HIV Epidemic Program is hiring for a Program Coordinator. This is a new position that will work on much of the administrative planning, reporting and implementation of our EHE activities. This position coordinates and supervises assigned programs or projects involving contracts and grants. Provides support for public outreach intended to broaden and enhance the general public's knowledge of issues related to the Ending the Human Immunodeficiency Virus (HIV) Epidemic Program. Directs and coordinates the planning, implementing and monitoring of EHE services for people with HIV. Initiates, markets and coordinates all activities of programs/projects/contracts/grants. Develops contracts related to the work of the EHE initiative and monitors implementation; develops grant budgets; assists with preparation of program budgets; serves as related program information and referral source; liaises with other County, state, federal and community agencies. Work is performed under general supervision of an administrative superior and is reviewed through conferences, reports and evaluation of results obtained.
To apply please visit this link and search for the position by name "Program Coordinator" or Department "Community Services/Ryan White Act Care Program" and select "apply"
RFP for Consultants for the EHE Mentorship program
NASTAD is seeking applications from experienced professionals to provide subject matter expertise on End the HIV Epidemic. Consultants with experience facilitating and developing materials for cohort-style shared learning institutes. Also having expertise working with health departments and other public health systems, particularly urban and/or rural ones. The consultants selected will inform the implementation of NASTAD’s EHE Mentoring Program and contribute to technical assistance (TA) to participants in the Mentoring Program at NASTAD.
News
CDC data amplifies calls for funding hepatitis plan
“Only one-third of individuals diagnosed with hepatitis C have been cured in the decade since cures for the disease became available, according to a study published Thursday from the Centers for Disease Control and Prevention…The Food and Drug Administration approved the first highly effective direct-acting antiviral drugs to cure hepatitis C in 2013. Treatment occurs over the course of eight to 12 weeks and has a 95 percent success rate. But almost 15,000 Americans still die from hepatitis C annually.”
HIV Cases Will Spike if Health Care Doesn’t Cover Prevention, Warn Experts
“Nearly 30 groups representing the HIV community and health care providers filed briefs urging a U.S. Court of Appeals not to end the requirement that health care insurers must cover certain preventive services without cost sharing, notably pre-exposure prophylaxis (PrEP), the daily pills and long-acting injectables that prevent HIV. Other preventive care is at stake as well, including diabetes and cancer screenings and HIV and hepatitis tests. The U.S. Court of Appeals for the 5th Circuit is reviewing the decision earlier this year in Braidwood v. Becerra, in which a conservative Texas judge ruled that health care providers don’t have to cover services recommended by the U.S. Preventive Services Task Force (USPSTF). The plaintiffs in the case argued that providing PrEP amounted to promoting homosexuality.”
New law modernizes Kentucky statutes related to HIV
“House Bill 349, which the General Assembly passed earlier this year, modernizes a handful of statutes related to the disease. The bill made the distribution of self-test kits legal and eliminated felony charges for people living with HIV attempting to donate organs or other tissue, something the federal HOPE Act did nearly a decade ago. Kentuckians can now self-test for HIV in the privacy of their own home. The change went into effect Thursday.”