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
Lawmakers adjourned for the August Congressional recess having achieved little bipartisan agreement on a funding proposal for fiscal year 2024 (FY2024). The House and Senate issued competing spending proposals in July that adhere to budgetary caps set by the bipartisan debt limit compromise, but House Republicans are pursuing even steeper cuts in the FY2024 package. On July 14, the House Appropriations Health and Human Services, Education, and Related Agencies (LHHS) Subcommittee approved broad spending cuts that threaten funding for vital health programs, including axing funding for programs like the Department of Health and Human Services (HHS) Ending the HIV Epidemic Initiative and the Minority AIDS Initiative.
On July 27, the full Senate Appropriations Committee passed the upper chamber’s LHHS Subcommittee bill, approving spending levels that would preserve funding for many programs that were targeted for cuts. The funding disagreements between the two chambers of Congress indicate a lengthy FY2024 negotiations process that will extend beyond the September 30 funding deadline. As a result, lawmakers will need to pass a continuing resolution to temporarily extend funding levels until an agreement is reached or face a government shutdown. Additionally, appropriators must now deliberate on President Biden’s supplementary budget request to Congress issued on August 10. The bulk of the supplemental request calls for additional Ukraine aid and natural disaster support, but it also includes a $350 million request to support the Substance Abuse and Mental Health Services Administration (SAMHSA) State Opioid Response (SOR) Grant program, with $50 million set aside for the Indian Health Service (IHS).
NASTAD will continue to monitor the congressional appropriations process and advocate for the highest possible funding for HIV, hepatitis, and drug user health programs.
Administration Activities
USPSTF Issues Final Recommendation Statement for PrEP
The U.S. Preventive Services Task Force (USPSTF) published a final recommendation statement on pre-exposure prophylaxis (PrEP) for the prevention of HIV – providing an A grade recommendation. Based on its review of the evidence, the USPSTF recommends that healthcare professionals prescribe PrEP to people at increased risk for HIV to help prevent HIV.
PACHA Meeting Announced
The 78th Presidential Advisory Council on HIV/AIDS (PACHA) full council meeting will convene in Charleston, West Virginia, on Wednesday, September 20, 2023, from approximately 9:00 AM – 6:00 PM (ET). The meeting will focus on the response to HIV in the Appalachian region, including a discussion of the intersection of substance misuse and HIV in the region. As part of the meeting, the Council will host a “PACHA-to-the-People” community engagement session from 4:15 to 5:15 PM that afternoon and welcomes members of the community to join the discussion and share their ideas and recommendations about responding to HIV in the region.
The meeting will be livestreamed at www.hhs.gov/live. The meeting agenda will be posted on this web page several days prior to the meeting.
CMS Prompts State Medicaid Commissioners to Comply with Federal Requirements as they Unwind Expanded Medicaid Eligibility and Coverage
On August 9, Centers for Medicare and Medicaid Services (CMS) publicly posted correspondence issued to state Medicaid program commissioners in May of 2023 that reminded them of federal program requirements that must be followed as they unwind the Medicaid eligibility and coverage flexibilities that were authorized by the COVID-19 public health emergency (PHE), such as continuous enrollment. The letter serves as a warning to states that are leveraging the first post-PHE Medicaid redetermination process to cull Medicaid enrollment rates, which reached an all-time high during the PHE. HHS guidance, issued in 2022, estimated that as many as 15 million people would be disenrolled from the Medicaid program during the unwinding period. The letter could signal an increased focus on program monitoring and enforcement as the Biden Administration works to prevent future enrollment losses, which already total 4 million disenrollments in the past 4 months, with nearly three out of four disenrollments due to procedural challenges, like paperwork.
Dr. Jeanne Marrazzo to Lead NIH National Institute of Allergy and Infectious Diseases
On August 2, NIH announced that Dr. Jeanne Marrazzo was selected to lead the National Institutes of Health (NIH) National Institute of Allergy and Infectious Diseases (NIAID). Dr. Marrazzo is currently the Director of the University of Alabama at Birmingham Division of Infectious Diseases. At NIAID, Dr. Marrazzo will oversee research to advance the understanding, diagnosis, and treatment of infectious, immunologic, and allergic diseases. Dr. Marrazzo is well-known for her background in discovery and implementation science, especially for STIs and PrEP for HIV. NIAID has been operating under acting leadership since Dr. Fauci stepped down from the role in December of 2022. Additionally, Congress has not yet approved President Biden’s nomination of Dr. Monica Bertagnolli for Director of NIH, who would replace former Director Dr. Francis Collins.
NASTAD Submits Comments on CMS National Coverage Determination for PrEP
On August 11, NASTAD joined the HIV Health Care Access Working Group and the HIV Prevention Action Coalition of the Federal AIDS Policy Partnership and submitted comments in support of the CMS proposal to cover PrEP as a preventive service in Medicare Part B without cost-sharing, including oral and injectable PrEP medication and the requisite ancillary services needed to secure an initial prescription or renewal for PrEP. The advocates applauded the proposal for its potential to expand PrEP access, but urged CMS to include all clinical services required to prescribe PrEP in the coverage determination, and to refine risk-based language to ensure PrEP access reaches all who need it.
Resources
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.
NASTAD has just finished updating the Ending the HIV Epidemic (EHE) Jurisdictional Directory, which lists local and state points of contact for all EHE Phase 1 jurisdictional activities. This directory is used to communicate with EHE Phase 1 jurisdictions, disseminate resources, and gather information. We are asking health department staff members to review their jurisdiction’s information and submit necessary changes using this brief form by COB on Friday, September 15, 2023. We have added a mechanism to indicate entries in the EHE Directory that need to be removed based on feedback from jurisdictions the last time we went through this process. If the contact information for your jurisdiction currently listed in the EHE Jurisdictional Directory does not require an update, no action is required at this time.
NASTAD and RAISE Webinar Series
The Research Alliance in Implementation Science to End HIV (RAISE) Hub aims to advance the implementation of EHE initiatives through evidence-based interventions. NASTAD is proud to collaborate with The University of Washington/Fred Hutch Center for AIDS Research on the RAISE Hub on this initiative which includes a monthly webinar series. To learn more about RAISE and view previous webinars, click here.
NASTAD Statement: HIV Cluster and Outbreak Detection and Response (CDR) & Molecular HIV Surveillance (MHS)
This document serves as a resource for both NASTAD and its members for communications, community engagement, and advocacy purposes to reflect common concerns, issues, and priorities held by health departments around the implementation of CDR and MHS strategies. Specific areas of focus in the statement include community engagement, the protection of public health data, assessing and addressing HIV criminalization, supporting flexible implementation of CDR programs, and program utility and evaluation.
CDC DHP Resource: Success Stories: EHE in Action
The CDC Division of HIV Prevention (DHP) published two new EHE success stories:
- NASTAD: Expanding TelePrEP in EHE Jurisdictions Through Online Learning and Collaboration
- Baltimore City Health Department: Dismantling HIV and STI Testing Barriers in Baltimore City, MD with Self- and Mail-In Tests
CDC Publishes New Data from Medical Monitoring Project
The CDC published data from the 2021 cycle (June 2021–May 2022) of the Medical Monitoring Project (MMP). MMP is an annual, cross-sectional complex sample survey that reports nationally representative estimates of behavioral and clinical characteristics of adults with diagnosed HIV infection in the United States. This report provides information critical for achieving national HIV-related goals, including data used to monitor five National HIV/AIDS Strategy (NHAS) quality of life indicators and HIV stigma.
Georgetown Univeristy O’Neill Institute: The Minority AIDS Initiative (MAI) After Affirmative Action
“The Minority AIDS Initiative (MAI) was established by Congress in 1998 in response to the highly disproportionate impact of HIV in communities of color and the inadequate investment in Black and Latino communities over many years. Since its enactment, however, the HIV epidemic has become even more highly concentrated in communities of color. Some have questioned the ongoing viability of this program following the Supreme Court’s recent decision in Students for Fair Admissions, Inc. v. President and Fellows of Harvard College.”
Regional HIV and Aging Conference
Join us on Sept 18-19 in Sacramento, CA for the first ever Collaboration in Care Conference: Improving HIV and Aging Services! We're bringing experts from across the Western U.S. to share best practices in case management, clinical care, social services, community building, and more! Continuing education credits will be available for select sessions. Registration for this conference is FREE. The agenda and hotel accommodations can be found at our website: collaborationincare.org
We have secured a room block at the The Hyatt Regency - Downtown Sacramento at discounted rate of $189 per night before taxes and fees. Rooms may accommodate up to two people. The last day to register within the room block is August 28.
Registration is open on our eventbrite: https://collaborationincare2023.eventbrite.com
There are three different ticket types:
- For any direct service providers please use the “Service Provider” ticket
- For directors, managers, and administrators please use the “Administrator” ticket
- For those that work in government institutions and do not provide services or manage services, please use the “Government” ticket
This conference is organized by the Training & Health Equity Collaborative in partnership with Pacific AIDS Education & Training Center, UCLA CHIPTS, APLA Health, and San Francisco AIDS Foundation. Any questions may be sent to JB Del Rosario at janbing.delrosario@ucsf.edu.
New England Journal of Medicine:
- Free the PrEP — Over-the-Counter Access to HIV Preexposure Prophylaxis
- “Several barriers to access to preexposure prophylaxis for HIV could be alleviated by making it available over the counter. This step could particularly facilitate access among groups that face stigma.”
- Racial Inequality in Receipt of Medications for Opioid Use Disorder (OUD)
- “Racial and ethnic differences in the receipt of medications to treat OUD after an index event related to this disorder among patients with disability were substantial and did not change over time. The high incidence of ambulatory visits in all groups showed that disparities persisted despite frequent health care contact.”
CAI Resource: AETC ShareSpot – New Resources for Providers of HIV Services on Implementing Rapid Start
Dr. Tony Jimenez introduces new resources from CAI's Ryan White HIV/AIDS Program-funded Rapid Antiretroviral Treatment (ART) Dissemination Assistance Provider (DAP) project. The goal of the Rapid ART DAP project was to identify effective models for providing rapid start for those who test newly positive for HIV or who are re-engaging in care. A compendium of rapid start best practices was developed, including guidance for service workflow, planning, payment for rapid start, performance measurement and quality Improvement, and more. All Rapid ART DAP resources and tools are available on TargetHIV. Read more about this initiative and its resource collection on ShareSpot.
NCSD Training
The National Network of Disease Intervention Training Centers (NNDITC) are offering free interactive, skill-building trainings for the disease intervention community! Learn more & register for upcoming courses here: https://nnditc.org/training/learning-collaboratives/.
Bicillin L – A Critical Shortage Survey
NCSD is urgently seeking information from sexual health clinics about how the Bicillin shortage is affecting their work. A survey was released this week which will help us gauge the impact on care and the scope of the shortage. The survey will remain open to responses until Friday, September 1st. Click Here for Survey
DoxyPEP Command Center
NCSD recently release a Doxy as STI PEP Command Center, a resource of tools, templates, model policies, and an implementation toolkit for clinics wanting to begin offering doxycycline as STI PEP to patients in their community. https://www.ncsddc.org/resource/doxy-as-sti-pep-command-center/
NCSD Webinar: Doxy as STI PEP Series Part One: DoxyPEP 101
NCSD’s Clinic+ program will be hosting a three-part webinar series based around the intervention that is Doxy as STI PEP. In part one, Philip A. Chan, M.D., M.S., will cover the basics – a conversation for clinic folks, DIS, and anyone wanting to become a bit more familiar with Doxy as STI PEP. Part one will be dedicated to reviewing the current recommendations by the CDC, discussing implementation practices, and reviewing big takeaways, with plenty of time for a Q & A session. Parts two and three will take place in October and December.
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 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.
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.
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
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." The Application closes on September 1, 2023.
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 Bulletin
The White House proposes new plan to eliminate hepatitis C
“CBS News chief medical correspondent Dr. Jon LaPook joins "CBS Mornings" with an inside look at a new White House initiative to eliminate hepatitis C in the U.S., a disease that kills thousands of Americans every year despite being curable with treatments.”
CDC director overhauls leadership of center that oversaw response to Covid-19
“The new director of the Centers for Disease Control and Prevention, Mandy Cohen, is overhauling the leadership of the CDC center that led the agency’s Covid-19 response.
In an announcement to staff issued Tuesday, Cohen said José Romero, who headed the National Center for Immunization and Respiratory Diseases for the past 14 months, would be leaving the CDC at the end of August…Replacing Romero, at least on an acting basis, is Demetre Daskalakis, who has spent the past year in Washington as deputy director of the White House’s national mpox response team. The White House operation is being wound down and will be completed by the end of August.”
In the Fentanyl Crisis, Lawmakers Are Making the Same Mistakes
“Hundreds of fentanyl crime bills were introduced in at least 46 states during this past legislative session, according to the National Conference on State Legislatures. Many of those bills impose mandatory minimums for anyone convicted of possessing, distributing, selling, or manufacturing fentanyl or fentanyl analogs, also referred to as fentanyl-related substances. At the federal level, the Halt All Lethal Trafficking of Fentanyl Act (HALT Fentanyl Act), which has passed in the House of Representatives and currently sits in the Senate, would trigger new and increased mandatory minimum sentences for fentanyl-related substances. Essentially, lawmakers are relying on the same stale and ineffective strategies that have led to mass incarceration, more dangerous drugs, and an overdose crisis—and which have done nothing to make our communities safer.”