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
House Speaker Race and FY2024 Appropriations
On October 25, the House of Representatives elected Rep. Mike Johnson (R-LA-04) as the new Speaker of the House, ending weeks of legislative gridlock in the lower chamber as the Republican caucus sought to replace ousted former Speaker McCarthy (R-CA-20).
With the Speaker role filled, the House of Representatives can now resume legislative procedures, including fiscal year 2024 (FY2024) appropriations negotiations.
On September 30, Congress passed a bipartisan continuing resolution (CR) (H.R.5860) that temporarily extends FY2023 funding levels through November 17, buying appropriators more time to negotiate on a bipartisan spending framework for FY2024 through the fall. Now, Speaker Johnson must work to build Republican support for a spending package ahead of the November 17 deadline afforded by the CR.
NASTAD will continue to monitor the congressional appropriations process and advocate for the highest possible funding for HIV, hepatitis, and drug user health programs.
Senate HELP Committee Advances NIH Director Nominee
On October 25, the Senate Committee on Health, Education, Labor, and Pensions (HELP) Committee advanced the nomination of Dr. Monica Bertagnolli to be Director for the National Institutes of Health (NIH). Dr. Bertagnolli currently leads the National Cancer Institute (NCI) since August of 2022 and will work to further implement Biden’s cancer moonshot agenda at NIH if confirmed. A bipartisan group of senators worked to secure a majority vote in favor of Dr. Bertagnolli, overruling the Senate HELP Committee Chair’s reluctance to support her nomination.
NASTAD Calls on Congress to Pass TEST Act
On September 25, NASTAD joined a coalition of 52 organizations and called on Congress to support the Temporary Emergency Scheduling and Testing of Fentanyl Analogues Act of 2023 (TEST Act). The TEST Act would temporarily extend the emergency scheduling of all fentanyl-related substances (FRS) while providing an off-ramp to study and de-schedule FRS that have a potential for beneficial pharmacological effect. Congress previously considered permanently classifying all FRS under Schedule I without the off-ramp, including passing the HALT Fentanyl Act (H.R. 467) in the House in May of 2023. The HALT Fentanyl Act would indiscriminately classify all FRS under Schedule I and imposes mandatory minimum sentencing for fentanyl-related charges, which would deter future FRS research and expands mass incarceration and criminalization for people who use drugs.
Administration Activities
CDC Releases Preliminary Data on EHE Core Indicators
On October 17, the Centers for Disease Control and Prevention (CDC) Division of HIV Prevention (DHP) published preliminary data tracking national progress on achieving the core indicators outlined by the Ending the HIV Epidemic Initiative. The surveillance data are presented on new HIV diagnoses reported to CDC through June 2023 and preexposure prophylaxis (PrEP) data reported through March 2023. The data show that, although PrEP coverage is improving overall, racial disparities in PrEP uptake and new HIV transmissions continue to pose major challenges to achieving EHE goals. Click here to read a Dear Colleague letter from leaders of the CDC National Center for HIV, Viral Hepatitis, STD, and TB Prevention and DHP highlighting the key findings of the data.
CDC Observes National Latinx AIDS Awareness Day
On October 15, CDC observed National Latinx AIDS Awareness Day (NLAAD), a day to promote HIV testing, prevention, and treatment and reduce HIV stigma among Hispanic/Latino people in the United States. This year, CDC called attention to the social and structural issues—such as discrimination, racism, HIV stigma, homophobia, poverty, and limited access to high-quality health care—that influence health outcomes and continue to drive many health inequities for Latinxs in the US. Click here to read a Dear Colleague letter from leaders of the CDC National Center for HIV, Viral Hepatitis, STD, and TB Prevention and DHP on the importance of NLAAD.
CDC Proposes New Guidelines for STI Post-Exposure Prophylaxis using Doxycycline
On October 2, CDC issued proposed guidelines for the use of doxycycline post-exposure prophylaxis (PEP) for prevention of bacterial sexually transmitted infections (STI). The agency issued the new guidelines after doxycycline PEP demonstrated benefits in reducing chlamydia, gonorrhea, and syphilis infections and represents a new approach to addressing STI prevention in populations at increased risk for these infections. Doxycycline PEP should be implemented in the context of a comprehensive sexual health approach including risk reduction counseling, STI screening and treatment, recommended vaccination, and linkage to HIV pre-exposure prophylaxis (PrEP), HIV care, or other services, as appropriate. CDC is accepting public comment on the new guidelines through November 16. Click here to read a Dear Colleague Letter with more information on the new guidelines.
SAMHSA Awards Nearly $35M for HIV Prevention and Care for Historically Underserved Populations
On October 4, the Substance Abuse and Mental Health Services Administration (SAMHSA) announced that it awarded nearly $35 million in grant funding to bring essential behavioral health services and HIV prevention and care to historically underserved populations. The awards include funding for the Minority AIDS Initiative and the Minority HIV/AIDS Fund to increase engagement in prevention and comprehensive care for racial and ethnic medically underserved individuals with substance use disorders (SUDs) and/or co-occurring SUDs and mental health conditions (COD) who are at risk for or living with HIV, including behavioral health services. Award recipients will take a syndemic approach to SUD, HIV, and viral hepatitis.
CDC MMWR: Hepatitis A outbreak-related deaths
“Recent hepatitis A outbreaks show hepatitis A vaccines are still not reaching adults at the highest risk of infection, and the consequences can be deadly.”
CDC DHP/HRSA HAB: HHS Regions 1 & 2Virtual Community Listening Session
Date: Thursday, November 2, 10:30 AM-12 PM ET
The CDC Division of HIV Prevention (DHP) and Health Resources and Services Administration’s (HRSA) HIV/AIDS Bureau (HAB) are hosting joint regional virtual community listening sessions continuing with HHS Regions 1 and 2 on Thursday, November 2, 10:30 AM-12:00 PM ET. The community listening sessions will provide a venue for discussion and collaboration focused on barriers to and opportunities for improving HIV diagnosis, treatment, prevention, and outbreak response.
CDC Observes National Gay Men’s HIV/AIDS Awareness Day
On September 27, CDC observed National Gay Men’s HIV/AIDS Awareness Day (NGMHAAD), a day to help end HIV stigma and encourage HIV testing, prevention, and treatment among gay and bisexual men. This year, CDC highlighted the success of the Together TakeMeHome (TTMH) program, which will distribute at least 1 million free HIV self-tests by mail over the next 5 years. Click here to read a Dear Colleague Letter from the CDC Division of HIV Prevention and the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, and access HIV prevention resources.
Resources
Ending the HIV Epidemic Jurisdictional Directory
NASTAD maintains an Ending the HIV Epidemic (EHE) Jurisdictional Directory. NASTAD has recently updated the 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. Health department staff members are encouraged to update their jurisdiction’s information using this brief form.
University of Pennsylvania Survey: PrEP Use Across EHE Jurisdictions
The Social Action Lab at the University of Pennsylvania is inviting health departments across the EHE jurisdictions to participate in a research study. The purpose of the study is to explore strategies to improve PrEP use across EHE jurisdictions. Through a survey link, the research team is looking to collect data on structural determinants of PrEP use and policy implementation factors in your EHE state/county. Participants will be invited to a PrEP promotion conference fully sponsored by the team at the University of Pennsylvania and to participate in research publications resulting from the project.
If you are interested in participating, please contact Bita Fayaz Farkhad at bitaf@upenn.edu to learn more and to receive the link to the survey. We hope you will consider participating.
Please contact Natalie Cramer or Kristina Santana with questions.
NASTAD Resource: Pre-Exposure Prophylaxis (PrEP), Post-Exposure Prophylaxis (PEP), and Other HIV Prevention Strategies: Billing and Coding Guide
The goal of this guide is to provide up-to-date information and best practices for coding, billing, and denial resolution for PrEP and PEP services. NASTAD developed this guide with funding from CDC PS19-1906 Component A. The guide describes the procedure and diagnosis codes accepted by public and private insurance, including the newly effective ICD-10-CM code for PrEP. The ICD-10-CM code (Z29.81 - Encounter for HIV pre-exposure prophylaxis) became effective October 1, 2023 and will chiefly be used as the primary diagnosis code on claims for which PrEP administration and counseling is the primary reason for the encounter. The guide also includes: descriptions of scenarios for PrEP initiation, follow-up visits for adherence, linkage, counseling services, and lab tests for HIV and other STIs; helpful decision trees, sample appeal letter templates; an overview of challenges in obtaining reimbursement; payer guidance and more.
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.
NCSD Clinic+ Doxy as STI PEP Webinar Series Part Two: Considerations in Implementation
Date: Monday, October 30th at 11:00 AM ET
Please join NCSD and Dr. Chase Cannon in conversation based around implementation of Doxy as STI PEP - key considerations for prescribing, experiences and lessons learned, and comparing and contrasting the current state of Doxy as STI PEP with HIV PrEP implementation. The registration link is here.
NACCHO Funding Opportunity: Harm Reduction and Academic Detailing NACCHO and CDC are pleased to announce a new Request for Proposals for health departments or other organizations to develop key messages on harm reduction that can be delivered through academic detailing. Up to 8 applicants will be awarded at up to $60,000 per site. Interested applicants are invited to learn more at virtual RFP Office Hours held weekly in October. Applications due November 6.
Register for NACCHO’s HIV Marketing Campaign Webinar
As part of NACCHO's marketing/communications webinar series, we'll be exploring what it takes to create a successful HIV focused marketing campaign. Join us as we chat with health departments who have ran impactful campaigns, such as Fulton County and Clark County, to learn some tricks of marketing our HIV focused messaging to the people. If your health department is considering their own marketing campaign, you don't want to miss this webinar! Click the link to register: https://naccho.zoom.us/webinar/register/WN_s3ie3HP5SteeaCGE5mNBaQ
CAI’s Technical Assistance Provider-innovation network (TAP-in): New Digital Marketing webinar recording available!
On October 12th, CAI’s Technical Assistance Provider-innovation network (TAP-in) delivered the webinar, Digital Marketing Strategies to End the HIV Epidemic. If you missed it, the webinar recording and slide deck are available on TargetHIV. This webinar discussed the importance of digital marketing to help advance programmatic goals for ending the HIV epidemic. Presenters shared their planning considerations for digital marketing and the Missouri and Fulton County EHE jurisdictions shared their firsthand experiences in implementing campaigns to increase linkage to and retention in care. The webinar also showcased CAI’s Imagine: Ending HIV. It’s Possible national campaign with its toolkit of customizable resources.
To request TA from TAP-in to support your HRSA EHE program or be added to the listserv to receive more information on future programming, please contact tap-in@caiglobal.org
Join CAI’s TAP-in EHE Community of Practice for EHE Managers and Coordinators
We welcome EHE managers and coordinators to join the monthly virtual CoP meetings which are a space to connect with your peers across the 47 HRSA-funded EHE jurisdictions that are working towards ending the HIV epidemic. CAI has completed four sessions so far with three more CoP sessions scheduled on November 9th, January 17th, and February 14th, from Noon to 1:30p Eastern. Our next topic is Linkage to Care Strategies. If you have any questions or would like to receive a registration link for future CoP sessions, please email us at tap-in@caiglobal.org and include “Community of Practice” in the subject line.
NCSD Release: First Known Survey of the Bicillin Shortages Impact on Clinics
NCSD conducted the first known survey on sexual health clinics’ experience of the worsening Bicillin L-A shortage. The survey of more than 100 sexual health clinics is the first attempt to gather information on the scope of the shortage and demonstrates the urgent need for federal leadership to help clinics and other healthcare providers navigate the shortage. The survey results can be found here.
National Network of Disease Intervention Training Centers Skill-Building Trainings
The National Network of Disease Intervention Training Centers (NNDITC) are offering free interactive, skill-building trainings for the disease intervention community. NNDITC will now be offering courses on Motivational Interviewing and Demystifying Sexual Orientation and Gender Identity starting this fall!
Register for upcoming courses at www.nnditc.org and follow along on LinkedIn.
2023 RWHAP Clinical Conference
Dates: December 3-5, 2023
Location: Portland, Oregon
Registration for the 2023 RWHAP Clinical Conference is now open. This conference provides state-of-the-art research, care, and treatment updates for experienced clinical decision makers and those integral to medical care provision housed under the Ryan White HIV/AIDS Program (RWHAP) funded sites. Details on covered topics, venue descriptions, information about continuing education credits, and updates on registration and travel will be available on the IAS-USA website and the AETC National Coordinating Resource Center (NCRC) website.
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
NASTAD RFP: Technical Assistance Providers- Hepatitis Technical Assistance Center
NASTAD’s Hepatitis team is seeking technical assistance providers with viral hepatitis expertise to support the capabilities of viral hepatitis prevention and surveillance personnel at state, territorial, and major city/county health departments through a new national technical assistance center. This project is a joint effort between NASTAD and the Centers for Disease Control and Prevention’s Center for State, Tribal, Local, and Territorial Support (CSTLTS) and the Division of Viral Hepatitis (DVH). We will consider all responses that are sent to hepatitisRFP@nastad.org by midnight PT on November 8, 2023. Please include the name of the project, “Technical Assistance Consultants- Hepatitis Technical Assistance Center” in the subject line.
Viral Hepatitis Prevention Coordinator; Texas Department of State Health Services (DSHS)
Prevention Program Manager; Bureau of HIV, STI, and Hepatitis; Iowa Department of Health and Human Services
News Bulletin
Alabama Public Health Leaders, Community Focus on Holistic Approach to HIV Epidemic
“Alabama is one of seven states with a substantial number of HIV diagnoses in rural areas that are a part of the Ending the HIV Epidemic in the U.S. (EHE) initiative. CAPT John Oguntomilade, BDS, MPH, PhD, EHE Initiative Coordination Lead for the Office of the Assistant Secretary for Health, recently met with state health officials, community members, and health center leaders in Montgomery to discuss EHE accomplishments and opportunities to optimize the impact of the EHE initiative.” – HIV.gov
The opioid crisis has gotten much, much worse despite Congress’ efforts to stop it
“Washington, despite a bipartisan desire to combat it, is finding its addiction-fighting programs are failing. In 2018, Republicans, Democrats and then-President Donald Trump united around legislation that threw $20 billion into treatment, prevention and recovery. But five years later, the SUPPORT Act has lapsed and the number of Americans dying from overdoses has grown more than 60 percent, driven by illicit fentanyl. The battle has turned into a slog.” - Politico
Heavy Drinking Not Tied to Lower Response to DAAs for Hepatitis C
“Alcohol use and alcohol use disorder (AUD) were not associated with lower odds of sustained virologic response to direct-acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection, according to a retrospective cohort study of veterans…’Our findings suggest that DAA therapy should be provided and reimbursed despite alcohol consumption or history of AUD,’ Rentsch and team concluded. ‘Restricting access to DAA therapy according to alcohol consumption or AUD creates an unnecessary barrier to patients accessing DAA therapy and challenges HCV elimination goals.’" - Medpage
DEA extends pandemic telehealth rules for prescribing controlled substances
“The Biden administration on Friday extended flexibilities regarding controlled substances to be prescribed via telemedicine. The Drug Enforcement Administration (DEA) said in a notice it would allow providers to continue using telemedicine to prescribe certain controlled substances through the end of 2024.” - The Hill
The ACA’s Promise of Free Preventive Health Care Faces Ongoing Legal Challenges
“An ongoing legal challenge is threatening the guarantee of free preventive care in the Affordable Care Act (ACA). Six individuals and the owners of two small businesses sued the federal government, arguing that the ACA provision “makes it impossible” for them to purchase health insurance for themselves or their employees that excludes free preventive care. The plaintiffs argue that they do not want or need such care. They specifically name the medication PrEP (used to prevent the spread of HIV), contraception, the HPV vaccine, and screening and behavioral counseling for sexually transmitted diseases and substance use; however, they seek to invalidate the entire ACA preventive benefit package.” – Commonwealth Fund