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
FY2025 Appropriations
On May 16, the House Appropriations Committee released topline spending levels for the 12 fiscal year 2025 (FY2025) federal spending bills. Democrats panned the proposals, which called for lower totals than the statutory spending caps negotiated during the bipartisan debt limit compromise. On May 23, the House Appropriations Committee (HAC) approved the topline levels, allowing subcommittees to begin working on bill text. If approved, the HAC bills would slash the Labor, Health and Human Services, and Education, and Related Agencies (LHHS) budget by 11%. However, the House version must be approved by the Senate, which is unlikely to approve budget cuts that exceed the statutory spending caps.
Additionally, the HAC is moving forward with an ambitious schedule to pass FY2025 spending bills by the summer. A House subcommittee markup on the FY2025 Labor, Health and Human Services, Education, and Related Agencies (LHHS) Bill is set for June 27, with a full Appropriations Committee markup scheduled for July 10. The HAC is aiming to finalize the bills by the week of July 29.
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 Finance Committee Holds Hearing on Fentanyl Crisis
On May 23, the Senate Committee on Finance held a hearing titled, Front Lines of the Fentanyl Crisis: Supporting Communities and Combating Addiction through Prevention and Treatment. The hearing, led by Committee Chairman Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID), discussed ways to prevent opioid overdose deaths and remove barriers to treatment for substance use disorder, such as insurance barriers for medications for opioid use disorder (MOUD) and the availability of substance use disorder services for those enrolled in Medicaid and CHIP.
NASTAD Calls on Congress to Fund Housing Programs that Serve People Living With HIV
On May 3, NASTAD joined a coalition of over 390 organizations and called on Congress to provide strong funding for housing programs that serve people living with HIV (PLWH) at the Department of Health and Human Services (HHS) and the Department of Housing and Urban Development (HUD). The coalition highlighted the important role of the HUD Housing Opportunities for Persons With HIV/AIDS (HOPWA) program, which provides funding to support stigma-free, community-based, and cost-effective housing and supportive services to PLWH. Notably, the coalition requested $150 million to launch a new housing component under the HHS Ending the HIV Epidemic Initiative (EHE).
NASTAD Calls on Congress to Fund the Public Health Workforce Loan Repayment and Bio-Preparedness Workforce Pilot Programs
On May 14, NASTAD joined a coalition of over 140 organizations and called on Congress to provide strong funding for health workforce programs at the Health Resources and Services Administration (HRSA) in FY2025. The coalition highlighted the Public Health Workforce Loan Repayment Program, which provides financial incentives to bring public health and infectious disease professionals into settings where they are crucially needed, including HIV and hepatitis programs at local, state, and Tribal public health agencies across the country. Additionally, the coalition called for $50 million to launch a new Bio-Preparedness Workforce Pilot Program.
NASTAD Calls on Congress to Fund Antimicrobial Resistance Programs
On May 14, NASTAD joined a coalition of over 140 organizations and called on Congress to provide strong funding for domestic and global antimicrobial resistance (AMR) programs in FY2025. The coalition highlights the importance of utilizing the One Health ecological framework approach, which encompasses human, animal, and environmental health with increased funding for surveillance, prevention, stewardship, research, and innovation, to minimize the health system costs and significant morbidity and mortality associated with AMR. The coalition called for increased funding to programs at the Food and Drug Administration and Department of Health and Human Services (HHS), including the Centers for Disease Control and Prevention (CDC) Antibiotic Resistance Solutions Initiative, Advanced Molecular Detection (AMD) Initiative, and programs at the National Institutes of Health.
NASTAD Calls on Congress to Fund CDC Programs Addressing SDOH
On May 14, NASTAD joined a coalition of over 80 organizations and called on Congress to provide strong funding for the CDC National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) Social Determinants of Health Program. The non-medical drivers of health, including the social, economic, and environmental conditions collectively referred as the Social Determinants of Health (SDOH), are estimated to contribute 80-90% to a person’s health outcomes, while traditional healthcare only accounts for 10-20%. Health departments and public health organizations are uniquely situated to address the broader non-medical needs in communities by gathering data from multiple sources, identifying gaps in services, building collaborations across sectors, and with community-based organizations, and identifying and addressing policies that inhibit overall health and well-being.
Administration Activities
CDC Releases New HIV Surveillance Data
On May 21, the CDC published three new HIV surveillance reports:
- Estimated HIV Incidence and Prevalence in the United States, 2018-2022
- Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data, United States and 6 Territories and Freely Associated States, 2022
- Diagnoses, Deaths, and Prevalence of HIV in the United States and 6 Territories and Freely Associated States, 2022
“The estimated number of new HIV transmissions in 2022 was 31,800, a decrease of 12% compared with 2018 (36,200), driven by a 30% decrease among young people aged 13-24 years. Data also show significant declines geographically, with estimated new HIV transmissions decreasing 16% in the South in 2022 compared with 2018. In 2022, HIV incidence in EHE jurisdictions decreased 21% among persons aged ≥ 13 years, compared with the 2017 EHE baseline year.
CDC has paused PrEP coverage reporting for one year to address a formula error that affects a subset of race/ethnicity data, update overall PrEP coverage estimates using newly available data sets, and determine the best way to present PrEP coverage. CDC believes this update will yield greater precision and a more complete picture of the PrEP coverage landscape in the United States. CDC plans to resume PrEP coverage reporting in the next Monitoring Report, currently scheduled for publication in June 2025. Until updated estimates are published, CDC advises against citing specific PrEP coverage data points and instead recommends referencing general trends and disparities.”
CDC Releases Doxy PEP Guidelines
The CDC published clinical guidelines on counseling patients regarding doxycycline post-exposure prophylaxis (or doxy PEP) for bacterial sexually transmitted infection (STI) prevention. Doxy PEP has proven to reduce the risk of getting a bacterial STI for gay, bisexual, and other men who have sex with men and transgender women at increased risk for these infections (specifically, syphilis, chlamydia, gonorrhea).
CDC recommends healthcare providers discuss doxy PEP with all gay, bisexual, and other men who have sex with men and transgender women with a history of at least one bacterial STI (syphilis, chlamydia, gonorrhea) in the last 12 months. If offering doxy PEP, healthcare providers should write a prescription for self-administration of 200 mg of doxycycline within 72 hours of sex.
These guidelines were finalized after careful consideration of the comments CDC received earlier from the public and experts, as well as consideration of the available scientific evidence on this topic. CDC believes this is the right step for right now to protect the nation’s health, although we are constantly learning more about how to prevent STIs. CDC will continue to adjust the recommendations as additional data are available.
OIDP Opens Public Comment Period on Proposed Viral Hepatitis Quality Measures
On May 7, the Department of Health and Human Services (HHS) Office of Infectious Disease and HIV/AIDS Policy (OIDP) announced that it will solicit public comment on potential viral hepatitis quality measures in Medicaid for implementation at the state and territory level. The comment opportunity comes after a March 7 virtual HHS Viral Hepatitis Quality Measures Technical Consultation Meeting, where state leaders and others working with viral hepatitis quality measures discussed the feasibility of testing and implementing a measure at the state level and outlined progress from state officials who have implemented or plan to implement viral hepatitis quality measures on screening and treatment. On May 8, OIDP released a Federal Register Notice Announcement that invites public comment on potential quality measures for hepatitis C screening and treatment initiation, or other viral hepatitis measures to consider. Submit comments via email to OIDPViralHepatitis@hhs.gov by June 7. Please reach out to the NASTAD Policy & Legislative Affairs team if you would like to provide input on NASTAD’s comment submission.
HHS OIDP Announces Rebrand of PACE Program as OIDP Engagement Teams
On May 8, HHS OIDP announced that it renamed the Prevention through Active Community Engagement (PACE) program to OIDP Engagement Teams to better represent the program’s work addressing syndemics, health equity, and engaging priority jurisdictions of the EHE initiative. The OIDP Engagement Teams were launched in 2019 to enhance HIV service delivery in regions most affected by HIV and bridge the community/federal communication gap between federal partners, states, counties, community-based organizations, and other local entities. The teams empower partners through technical assistance, resources, and training to ensure effective outreach and expansion of testing, prevention, and treatment services for populations impacted by the public health syndemic of HIV, viral hepatitis, STIs, COVID, mpox, substance use and mental health disorders.
White House Issues Proclamation on National Hepatitis Testing Day
On May 19, the White House issued a Presidential Proclamation in observance of National Hepatitis Testing Day, held annually on May 19. The proclamation encourages public health practitioners and providers to help spread the word on hepatitis B virus (HBV) and hepatitis C virus (HCV) and test more people, especially among disproportionately impacted communities. Additionally, the proclamation highlights President Biden’s proposed HCV viral elimination plan and encourages broader HBV vaccination.
DEA Releases 2024 National Drug Threat Assessment
On May 9, the US Drug Enforcement Administration released the 2024 National Drug Threat Assessment (NDTA), DEA’s comprehensive strategic assessment of illicit drug threats and trafficking trends endangering the United States. The report highlights the growing role of synthetic drugs in the US drug supply, including the severe morbidity and mortality associated with fentanyl and other synthetic opioids like nitazenes, and the growing role of methamphetamine in drug trafficking and overdose. The report also assessed the threat of xylazine, an adulterant increasingly found in the opioid drug supply that is associated with injection-site wounds.
Resources
CDC MMWR:
- Monkeypox Virus Infections After 2 Preexposure Doses of JYNNEOS Vaccine — United States, May 2022–May 2024
- “To optimize protection, persons recommended to receive mpox vaccination should complete the 2-dose JYNNEOS vaccination series. No additional vaccine doses are recommended at this time.”
- Notes from the Field: Clade II Mpox Surveillance Update
- “Following the peak of the 2022 mpox outbreak (more than 3,000 cases per week), cases declined sharply and remain lower (approximately 59 reported cases per week from October 1, 2023–April 30, 2024).”
HRSA HAB Webinar: Innovative HIV Care Strategies Using a Comprehensive Approach to Address the Needs of Priority Populations
Date: Thursday, June 7, 2024, 12:00-1:30 pm ET
The HRSA-funded Integrating HIV Innovative Practices (IHIP) project is hosting a webinar featuring two interventions that use a comprehensive approach to address specific challenges faced by people of color with HIV. CE credit is available for individuals who attend the live webinar. The featured interventions include:
- The Black Women's Project offers tailored interventions that address the barriers to care faced by Black cisgender and transgender women with HIV. Through a holistic approach encompassing enhanced case management, trauma-informed care, peer/patient navigation, self-efficacy gender-affirming support, and intimate/domestic partner violence support, this project is paving the way for improved health outcomes and empowerment of Black women.
- Curing Hepatitis C Among People of Color with HIV supports a multifaceted approach to help people with HIV prevent hepatitis C virus (HCV) infection or reinfection. This includes expanding capacity for HCV prevention, testing, care, and treatment; improving coordination of care for those with both HIV and HCV; collaborating with SAMHSA-funded substance use disorder treatment providers; and enhancing health department surveillance systems.
The AIDS Institute: Pre-Exposure Prophylaxis: Coverage, Compliance, and Ending the HIV Epidemic
“Four years after the requirement for health plans to cover PrEP without copayments went into effect, health plan documents too often do not properly describe that benefit for enrollees and prospective enrollees. Our report urges insurers to ensure that they are complying with the PrEP coverage requirement and update their coverage materials and websites. We also urge federal and state regulators to take steps to ensure that the plans within their jurisdiction are properly covering PrEP free of cost. Public health organizations and marketplaces should also do more to educate communities with greater HIV risk about no-cost PrEP and PrEP-related services.”
NCSD’s state policy team analyzed state legislation across several jurisdictions to identify policy mechanisms that aim to expand insurance coverage for STI-related care. Learn more about recent state policy trends in insurance coverage for STI services, including best practices for policy development, messaging, and coalition-building.
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.
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
Integrated Care Behavioral Health Clinician – Grand Junction, CO
The Behavioral Health Clinician is responsible for assessing and responding to requests for mental health or substance use/addictions counseling for people living with HIV/AIDS and as well as other underserved individuals. This position helps manage group-counseling services including oversight of volunteer facilitators, scheduling, group admissions, advertising, and evaluation.
Program Content and Training Specialist, Supporting Harm Reduction Programs (SHaRP) – University of Washington
This position is part of a cooperative agreement award from the Centers for Disease Control and Prevention to provide technical assistance about monitoring and evaluation to syringe services programs (SSPs) as part of the National Harm Reduction Technical Assistance Center. One of the primary projects of this award is to provide technical assistance (TA) to SSPs for monitoring and evaluation activities. The University of Washington is working in collaboration with the CDC, SAMHSA, NASTAD, the National Harm Reduction Coalition, and other TA partners to provide a suite of technical assistance support to individual programs.
News Bulletin
Walgreens is launching a generic version of over-the-counter Narcan
“Walgreens said Wednesday that it will sell its own generic version of over-the-counter Narcan, the lifesaving opioid overdose reversal drug that first rolled out to drugstore shelves last fall. Its version of the antidote, a drug called naloxone, will cost $34.99 for two doses, $10 cheaper than the brand-name version from Emergent BioSolutions that’s also sold at Walgreens and other major pharmacy chains across the U.S. Walgreens' generic version will be available on store shelves nationwide by the end of the month, the company said. It is already available to buy online.” – NBC News
Florida Passes Bill Allowing Pharmacists to Provide PEP to Prevent HIV
“Florida pharmacists will soon be able to provide more HIV care to their clients, thanks to a bill signed by Republican governor Ron DeSantis. Specifically, pharmacists can screen for HIV and provide post-exposure prophylaxis (PEP), which refers to medication people take to prevent HIV transmission shortly after a high-risk exposure.
The law takes effect July 1, according to a news release from Rep. Gallop Franklin (D–Tallahassee), who sponsored the bill and is also a pharmacist.” – POZ
Liver Cancer Screening Benefits Patients With Cirrhosis, Study Suggests
“Screening for hepatocellular carcinoma (HCC) in liver disease patients with cirrhosis may indeed lead to a survival benefit, a retrospective analysis of data from two large U.S. health systems suggested.” – MedPage Today
HPV Vaccination Reduces Risk of Multiple Types of Cancer in Men and Women
“Vaccination against human papillomavirus (HPV) reduced the risk of multiple types of cancer in both men and women, a large retrospective cohort study showed.
The risk of head and neck cancer and all HPV-associated cancers in men decreased by more than 50%. Consistent with previous reports, vaccination reduced the risk of cervical cancer by 29%, cervical cancer precursor lesions by 50-60%, and all HPV-related cancers in women by 27%. The risk of head and neck cancer in women decreased by 33%, but the difference compared with unvaccinated women did not reach statistical significance.” – MedPage Today
CDC says vaccination could protect the U.S. from more dangerous mpox virus
“As concerns mount about a large outbreak of an especially virulent form of mpox in central Africa and an uptick in U.S. cases since early last year, the mpox vaccine appears to give long-term protection, the Centers for Disease Control and Prevention reported Thursday. In a separate report, the CDC indicated that overall new mpox infections across the U.S. have remained at a steady, low level — about 60 cases weekly, compared with 3,000 cases a week at the outbreak’s summer 2022 peak — in recent months. However, cases so far this year are elevated nationally compared with the same period in 2023 and have seen a sharp increase in New York City.” – NBC News