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 March 23, lawmakers approved the final minibus of spending bills for fiscal year 2024 (FY2024), closing out a protracted spending cycle marked by partisan disagreements and repeat continuing resolutions (CRs). The spending package by and large extended FY2023 totals for the remainder of FY2024 as a result of non-defense discretionary budget caps set by the bipartisan debt ceiling compromise of 2023. All programs under the Centers for Disease Control and Prevention (CDC) National Center for HIV, Hepatitis, STIs, and Tuberculosis Prevention (NCHHSTP) and the Ryan White HIV/AIDS Programs were level-funded. Ending the HIV Epidemic Initiative (EHE) programs were also flat funded, despite the House proposal to eliminate the programs.
Although increasing funding for health programs remains urgently necessary, level-funding was the best-case scenario in FY2024 due to the tight fiscal spending environment and right-wing calls to slash spending. With FY2024 appropriations completed, lawmakers are expected to promptly take up FY2025 spending processes.
FY2025 Appropriations
On March 20, the House Appropriations Committee Subcommittee on Labor, Health and Human Services, Education, and Related Agencies (LHHS) and the House Committee on Ways and Means held hearings on the president’s budget request for FY2025. US Department of Health and Human Services (HHS) Secretary Xavier Becerra appeared before the committees to provide context and answer questions on the budget proposal. The Biden Administration released the Executive Budget Request to Congress, a non-binding proposal that lays out policy and spending priorities for federal agencies and programs in the upcoming fiscal year and typically kicks off spending negotiations, on March 11. The FY2025 budget called for modest increases to some health programs, but most HIV and hepatitis prevention programming were level-funded as a result of the budgetary caps imposed by the bipartisan debt ceiling compromise of 2023. Notably, the budget again included proposals to launch a national PrEP program and a national hepatitis C virus (HCV) elimination program.
House Advances Bill to Improve Fiscal Impact Analysis for Preventive Services
On March 19, the House of Representatives passed the Dr. Michael C. Burgess Preventive Health Savings Act (H.R.766), which would extend the timeframe of fiscal impact analyses conducted by the Congressional Budget Office (CBO) for bills that impact preventive health services. Under current law, CBO fiscal impact analyses are capped at a 10-year window, resulting in underestimates of the true projected cost-savings for legislation that improve preventive health service delivery for chronic conditions. Although the bill does not permit any projected cost-savings that accrue after the 10-year window to offset expenses under PAYGO rules, the description and estimate of the savings must be reported in the CBO projections. The inclusion of this data will help lawmakers to consider the true net benefits and downstream costs of innovative service delivery models.
Administration Activities
Biden Administration Releases FY2025 Executive Budget Request to Congress
On March 11, the White House released the Administration’s budget request to Congress for FY2025, a non-binding proposal that typically kicks off spending negotiations on Capitol Hill. The Administration also released the HHS Budget in Brief, which outlines $130.7 billion in discretionary funding for HHS. Notably, the FY2025 budget request includes legislative requests for a new 5-year national hepatitis C virus (HCV) elimination program, as well as a PrEP Delivery Program. In addition, for the first time, the budget request includes $10 million at the Department of Justice for efforts to modernize outdated criminal statues with a discriminatory impact on people living with HIV. It is important to note that this is a budget request and does not have the power of the law. Only Congress has the power to appropriate funds. Click here to read NASTAD’s memo outlining the Administration’s spending and policy priorities for the final year of the term.
2022 Overdose Mortality Data
On March 21, CDC National Center for Health Statistics released a data brief detailing drug overdose mortality data collected by the National Vital Statistics System in 2022. The report shows that the overall rate of drug overdose deaths remained at record-high levels, with a slight increase from 2021 to 2022. Age-adjusted rates of drug overdose deaths increased for most racial groups, with American Indian and Alaska Native non-Hispanic facing the highest rates of mortality. Additionally, the report shows increases in rates of polysubstance drug use and overdose deaths related to stimulant use. The report elevates the need to invest in community-based overdose prevention resources and programs that address polysubstance use and serve the communities most at-risk.
CDC Releases 2022 School Health Profiles
On March 20, CDC released the 2022 School Health Profiles survey results, which outlines how states, school districts, territories, and tribes are administering school health policies and practices. The survey includes assessments of programming and services related to HIV, including professional development and training of health education teachers, covering sexual health topics and education for students and families, providing students with referrals for sexual health services, and engaging in practices that foster a safe and supportive school environment for LGBTQ youth. The survey results can help policymakers and community leaders to address gaps in the health and education needs of students.
HHS Engaging with Drug Companies on First-ever Medicare Drug Pricing Negotiations
On March 4, HHS announced that all manufacturers participating in the first cycle of Medicare drug price negotiations have turned down initial offers from the Centers for Medicare and Medicaid Services (CMS). The 10 drug manufacturers responded with counteroffers, extending negotiations through the summer. If HHS and a participating manufacturer agree on a maximum fair price by the end of the negotiation period, those new negotiated prices will be published by September 1, 2024, and take effect beginning in 2026. The new negotiation process was authorized by the Inflation Reduction Act as a mechanism to reduce the cost of the most expensive drugs in Medicare plans. On March 1, a federal court ruled against a pharmaceutical manufacturer’s claim that the drug pricing program violated its rights as a company.
NASTAD Submits Comment on HBV Vaccination Quality Measure
On March 13, NASTAD submitted comment in support of the National Committee for Quality Assurance proposal to add preventive hepatitis B virus (HBV) vaccination as a new Adult Immunization Status indicator. Though HBV vaccination is now a routine childhood immunization, only 30% of all adults in the U.S. have been fully vaccinated. The inclusion of HBV vaccination in the Healthcare Effectiveness Data and Information Set (HEDIS) measures will build upon recent policy changes to increase utilization of HBV screening and immunization. Bundling HBV quality measures with the existing indicators will incentivize providers to screen patients and administer HBV vaccines, especially in health systems with value-based payment arrangements.
NASTAD Calls on CMS to Minimize Coverage Losses During the PHE Unwinding Process
On March 12, NASTAD joined a national coalition of organizations and called on the CMS Administrator to ensure states comply with federal obligations and preserve Medicaid coverage for as many eligible individuals as possible during the COVID-19 public health emergency (PHE) unwinding. Roughly half of Medicaid eligibility renewals are still incomplete, putting millions of people at risk of losing coverage due to administrative hurdles. The coalition highlighted the gains made in expanding affordable health coverage and reducing health disparities through PHE flexibilities in Medicaid enrollment and renewals, and urged CMS to continue to strengthen the Medicaid program as the PHE flexibilities are lifted.
CDC Updates Resource to Observe National Native HIV/AIDS Awareness Day
National Native HIV/AIDS Awareness Day is a day to promote HIV testing, prevention, and treatment in American Indian, Alaska Native, and Native Hawaiian communities. In 2021, for every 100 American Indian/Alaska Native people with HIV, 80 knew their HIV status. The CDC are pursuing a high-impact approach to maximize the effectiveness of HIV prevention interventions and strategies. Visit the CDC website for additional resources, including the GetTested Tool, an online tool that helps individuals find free, local, and confidential HIV and sexually transmitted infection testing.
Resources
Conference on Retroviruses and Opportunistic Infections (CROI) 2024:
- HIV diagnoses continue to fall in US states with high PrEP coverage, while others are left behind
- “The number of new HIV diagnoses has continued to drop steeply between 2012 and 2021 in US states with the highest coverage of PrEP (regular medication to prevent HIV), according to research presented by Dr Patrick Sullivan at the Conference on Retroviruses and Opportunistic Infections (CROI 2024) yesterday. An eightfold difference in annual changes to HIV diagnosis rates was seen between states with high PrEP coverage based on how many people need it, when compared to those states with the lowest PrEP coverage. Access to PrEP through drug assistance programmes and state-level Medicaid expansion remains a crucial, central factor.”
- People need pathways from PEP to PrEP – and back again
- “Services providing post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) need to build stronger connections between these two ways of preventing HIV infection, so as to help people who’ve used one method to access the other, according to experts at the Conference on Retroviruses and Opportunistic Infections (CROI 2024).
- Sexually transmitted infections in San Francisco have fallen since doxyPEP roll-out
- “Taking the antibiotic doxycycline after sex appears to have lowered the incidence of sexually transmitted infections (STIs) in San Francisco, according to researchers who presented some of the earliest real-world data yesterday at the Conference on Retroviruses and Opportunistic Infections (CROI 2024).”
Treatment Action Group: Tuberculosis Treatment Pipeline Report
“TAG is pleased to share the final installment of its flagship Pipeline Report series for 2023, which details the latest developments in tuberculosis (TB) treatment research. The only centralized resource of its kind, the TB Treatment Pipeline Report is for researchers, clinicians, drug sponsors, research funders, civil society, and TB-affected communities looking to better understand the state of the TB treatment pipeline and key issues to consider as the outputs of TB treatment research are being translated into policies.”
The AIDS Institute: Unchecked: Copay Accumulator Adjustment Policies in 2024
On February 29, The AIDS Institute released a new report analyzing the use of copay accumulator adjustment policies in 2024 marketplace health insurance plans sold to individuals and families. Click here to access state-level fact sheets.
KFF: Domestic HIV Funding in the White House FY 2025 Budget Request
“President Biden released his FY 2025 budget request on March 11, 2024. The President’s fourth and final budget request of his first term builds on past efforts to address the domestic HIV response…The request also includes discretionary funding levels for key programs aimed at addressing the domestic HIV epidemic.”
GU O’Neill Institute: Leveraging Success to End the HIV Epidemic
“In this Presidential and Congressional election year, we need to reflect on our achievements and what is needed to keep making progress against HIV. Our successes have been built on continued investments from the American people and bipartisan Congresses through Federal discretionary and entitlement programs. Many of our challenges are due to insufficient funding and persistent unmet need. In 2024, we need increased commitments from policymakers for the coming year and beyond and we need to be imaginative and innovative by proposing new ways to strengthen our communities.”
2024 Part B ADAP Monitoring Report
NASTAD is pleased to announce the release of the 2024 National Ryan White HIV/AIDS Program (RWHAP) Part B ADAP Monitoring Project Annual Report. The 2024 Annual Report includes longitudinal data spanning several domains widely considered vital to the success of ADAPs and, importantly, the identification of opportunities to help ensure the best possible health outcomes for PLWHA. These include longstanding data elements, notably program budgets and expenditures, clients enrolled and served, client demographics and insurance coverage types, and virologic suppression rates. Other datasets of potential interest include:
- ADAP client eligibility policy changes following release of Policy Clarification Notice 21-02, as of July 1, 2023
- ADAP medication purchasing mechanisms, as of July 1, 2023
- ADAP benefit management vendors, including pharmacy benefit managers, medical benefit managers, and insurance benefit administrators, as of July 1, 2023
- ADAP advisory committees, including their composition and responsibilities, as of July 1, 2023
NACCHO EHE Superstars Blog Series
Check out a new blog series highlighting collaborative work between health departments and community partners in jurisdictions working to improve community health and inequities through the national Ending the HIV Epidemic (EHE) Initiative. Visit this link to earn more about how the LA County Health Department is amplifying diverse voices through their EHE initiatives. Want to be featured in an upcoming EHE Superstars blog? Tell us about your Ending the HIV Epidemic activities at hiv@naccho.org!
CAI Webinar Recording: Ending the HIV Epidemic (EHE) by Addressing Methamphetamine Use Among Black Gay, Bisexual, Same-Gender-Loving Men with HIV.
On February 22nd, CAI’s TAP-in delivered the national webinar “Ending the HIV Epidemic (EHE) by Addressing Methamphetamine Use Among Black Gay, Bisexual, Same-Gender-Loving Men with HIV.” This was the fourth TAP-in national webinar addressing substance use disorders and EHE jurisdictions. Perspectives from community-based programs, individuals with lived experience, and researchers in the field are included. If you missed it, the webinar recording, and slide deck are available on TargetHIV.
CSTE Annual Conference Early Bird Registration
Registration for the 2024 CSTE Annual Conference in Pittsburgh, PA is now open! This year’s Annual Conference will take place June 9-13, 2024. An early bird discount is offered for registrations completed by 11:59 pm EDT on Thursday, May 2, 2024. Click HERE to register for the 2024 Annual Conference!
CSTE DMI Stories from the Field
Public health is innovating how we collect and use data to help people and communities thrive. CSTE’s Data Modernization Initiative (DMI) Stories from the Field show transformations in health departments across the country that reduce manual processes, solve problems through innovation, and use data in new and exciting ways. These successes are worth celebrating, and we hope you feel inspired to borrow the brilliance for positive impacts in your jurisdiction.
NCSD: National Network of Disease Intervention Training Centers (NNDITC)
NNDITC is now offering interactive training courses for 2024 on topics of STI/HIV interviewing, self-care for DI professionals, cultural humility, and much more! Register for an upcoming session at NNDITC.org.
NCSD: STI Engage: Shaping the Nation's Health
STI Engage 2024 is known as the place for STI professionals to hear from national leaders – government officials, researchers, clinicians – as well as their own peers, as always, with top-notch production, game-changing content, and a lot of fun. Building on the momentum of STD Engage 2023, when more than 1,200 STI professionals joined us in New Orleans, we’re bringing the STI sector’s signature conference to the nation's capital. Register & Book Your Hotel
NCSD: DIS Scholarships Available for STI Engage
NACCHO and NCSD are pleased to offer scholarships for disease intervention specialists (DIS) who work in local and state health departments to attend NCSD’s annual meeting, STI Engage! Scholarships will cover conference registration, lodging, travel, and per diem expenses. Apply Here
NCSD: DIS Funding Support Job Aid
While NCSD continues our national advocacy work to increase funding for DIS, our policy team created a job aid that provides strategies for funding and sustaining the DIS workforce. It includes ideas for alternative funding sources, data on the importance of DIS, and messaging about how DI professionals reduce STI transmission. Check It Out.
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 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.
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.
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.
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
Public Health Physician (40 hour) – Hartford, CT
The State of Connecticut, Department of Public Health (DPH) is seeking two Public Health Physicians to join our teams within our Infectious Diseases Section. These positions will help lead our critical programs: the Healthcare Associate Infections and Antimicrobial Resistance (HAI-AR) program and the HIV/STD/TB & Hepatitis C surveillance program. Apply by March 27.
Viral Hepatitis Prevention Coordinator – Austin, TX
Under direction of the Prevention Unit, provides highly advanced, senior-level consultative services and technical assistance as the DSHS viral hepatitis prevention coordinator. Oversees implementation and maintenance of viral hepatitis prevention efforts by identifying ways to integrate viral hepatitis prevention, vaccination, testing, and linkage to care into existing public health, clinical care, and community settings. Responsible for developing a DSHS viral hepatitis prevention plan as well as legislatively-mandated plans, including working with branch staff to solicit input from the public, including experts on Hepatitis, on the tenets of the plan. Apply by April 23.
News Bulletin
Rapid Rise in Syphilis Hits Native Americans Hardest
“Syphilis infections nationwide have climbed rapidly in recent years, reaching a 70-year high in 2022, according to the most recent data from the Centers for Disease Control and Prevention. That rise comes amid a shortage of penicillin, the most effective treatment. Simultaneously, congenital syphilis — syphilis passed from a pregnant person to a baby — has similarly spun out of control… And while infections have risen across the U.S., no demographic has been hit harder than Native Americans. The CDC data released in January shows that the rate of congenital syphilis among American Indians and Alaska Natives was triple the rate for African Americans and nearly 12 times the rate for white babies in 2022.” – KFF News
Bipartisan effort underway to eliminate Hepatitis C in U.S.
“A recent surveillance report from HepVu found the U.S. lacks the necessary funding and resources to combat viral hepatitis. Now, Louisiana and Maryland Senators are working on legislation to fund treatment which could change some American’s lives.
“The issue of viral hepatitis is significant,” said Boatemaa Ntiri-Reid, J.D., M.P.H, Senior Director of Syndemic Approaches at NASTAD.” – WSFA
Syphilis Is Killing Babies. The U.S. Government Is Failing to Stop the Disease From Spreading.
“Last June, Pfizer, the lone U.S. manufacturer of the injections, notified the Food and Drug Administration of an “impending stock out” that it anticipated would last a year…Across the country, physicians, clinic staff and public health experts say that the shortage is preventing them from reining in a surge of syphilis and that the federal government is downplaying the crisis. State and local public health authorities, which by law are responsible for controlling the spread of infectious diseases, report delays getting medicine to pregnant people with syphilis. This emergency was predictable: There have been shortages of this drug in eight of the last 20 years.” – ProPublica
Treating Kids' HCV Early May Boost Lifetime Health Outcomes and Save Money
“Treating hepatitis C virus (HCV) earlier in kids was associated with better lifetime clinical outcomes and lower healthcare costs compared with deferring treatment, a modeling study showed. Projected life expectancy was longest when treatment started at age 3 (78.36 life years) and decreased with treatment deferral to age 6 (76.10), age 12 (75.99) and age 18 (75.46), reported Megan Rose Curtis, MD, MS, of Brigham and Women's Hospital in Boston, and colleagues. Starting HCV treatment at age 3 was projected to cost $148,162 across a lifetime, which was less expensive than deferring treatment to age 6 ($164,292), 12 ($171,909), or 18 ($195,374), they wrote in JAMA Pediatrics.” – Medpage Today
STIs fall in SF after doxyPEP rollout
“The early rollout of doxyPEP in San Francisco has contributed to a decline in sexually transmitted infections, according to studies presented March 4 at the Conference on Retroviruses and Opportunistic Infections in Denver. DoxyPEP refers to taking a single dose of the antibiotic doxycycline within 72 hours after sex. "We are seeing early evidence of the potential for a population-level impact of doxycycline on chlamydia and syphilis rates," said Dr. Stephanie Cohen, director of HIV/STI Prevention for the San Francisco Department of Public Health. "I think this is quite an encouraging result, after over a decade of steadily rising STI rates.” – The Bay Area Reporter