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 June 27, the House Appropriations Labor, Health and Human Services, Education, and Related Agencies (LHHS) Subcommittee marked up and approved the fiscal year 2025 (FY2025) subcommittee spending bill. The committee proposed significant cuts to health programs compared to fiscal year 2024, including a $215 million cut from CDC prevention programs, a $190 million cut from the Ryan White program and $15 million from the minority HIV/AIDs fund. Programmatic funding levels have not yet been released. The LHHS spending bills has been forwarded to the full House appropriations committee for a markup, which is expected to take place on July 10.
On June 18, Senate Appropriations Chair Patty Murray (D-WA) announced that the upper chamber will start to markup subcommittee bills after the July Fourth recess. The Senate is expected to approve funding levels at or above the statutory spending caps negotiated during the bipartisan debt limit compromise, teeing up party-line disagreements over federal spending totals since the Senate and House appropriations bills must be reconciled in order to become law.
NASTAD will continue to monitor the congressional appropriations process and advocate for the highest possible funding for HIV, hepatitis, and drug user health programs.
Hepatitis Caucus Encourages CMS to Improve Hep B Vaccine Access
On June 10, the Congressional Hepatitis Caucus sent a letter to Centers for Medicare & Medicaid Services (CMS) urging them to expand hepatitis B virus (HBV) vaccination access for seniors. Fifteen lawmakers signed on to the letter, calling on CMS to leverage the 2025 Medicare Physician Fee Schedule (MPFS) rulemaking process to expand the mass immunizer program to include HBV preventive vaccines. HBV vaccines are the only preventive vaccine covered under Medicare Part B that are excluded from the mass immunizer program and that require a physician order, posing barriers to vaccine access. The lawmakers highlight the proposed expansion as a critical step to eliminating the public health threat of HBV in the US.
CBO Calls for New Research for HCV Treatment
On June 14, the Congressional Budget Office (CBO) released a report providing an initial analysis of the potential federal budgetary effects of two policies that would increase treatment of HCV. The CBO found that savings from health care costs that would be avoided by increased hepatitis C treatment would more than offset direct spending on that treatment. The researchers underscored that outreach would be necessary to substantially increase testing and treatment rates. Additionally, CBO released a call for new research in order to inform further analysis to determine the effects of proposed federal policies, such as a national treatment program.
Administration Activities
HRSA Issues Guidance on Leveraging RWHAP Funding to Provide Expungement Services for People Living With HIV
On June 6, the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB) issued a program letter that provides guidance regarding how Ryan White HIV/AIDS Program (RWHAP) funds may be used to provide expungement services for people with HIV who have had legal system involvement. The expungement of criminal records is an effective way to remove barriers to care and services, protect privacy, mitigate stigma, and support successful reentry into the community. Additionally, HRSA HAB will host a June HAB You Heard webinar on Wednesday, June 26, from 3:00-4:00 pm ET that will include additional details.
CDC Issues First Guidelines for DoxyPEP
On June 4, the Centers for Disease Control and Prevention (CDC) issued clinical guidelines for the use of doxycycline postexposure prophylaxis (doxyPEP), a novel, patient-managed biomedical STI prevention strategy. CDC recommends that men who have sex with men (MSM) and transgender women (TGW) who have had a bacterial STI (specifically syphilis, chlamydia, or gonorrhea) diagnosed in the past 12 months should receive counseling that doxy PEP can be used as postexposure prophylaxis to prevent these infections. Additionally, CDC recommends that providers offer persons in this group a prescription for doxy PEP to be self-administered within 72 hours after having oral, vaginal, or anal sex. The recommended dose of doxy PEP is 200 mg and should not exceed a maximum dose of 200 mg every 24 hours.
HRSA HAB Releases New Housing Security Deposit Guidance
On June 26, HRSA/HAB released a new program letter that provides clarifying guidance regarding the use of RWHAP funds to cover housing security deposits for eligible clients. RWHAP funding may be used to pay for a RWHAP client’s security deposit if a RWHAP recipient or subrecipient has policies and procedures in place to ensure that the security deposit is returned to the RWHAP recipient or subrecipient and not to the RWHAP client. Click here to read the press release announcing the housing security deposit program.
FDA Approves First-Ever HCV RNA Point of Care Test
On June 27, the Food and Drug Administration (FDA) approved market authorization for the first point-of-care (POC) hepatitis C virus (HCV) RNA test in the US. The Xpert HCV test and GeneXpert Xpress System, manufactured by Cepheid, may be administered in settings operating under a CLIA (Clinical Laboratory Improvement Amendments) Certificate of Waiver, such as certain substance use disorder treatment facilities, correctional facilities, syringe service programs, doctor’s offices, emergency departments and urgent care clinics. The approval of a POC HCV RNA test is a critical step towards scaling up test-and-treat approaches, which may reduce patient loss to follow up and will boost elimination efforts across the US.
NIAID Updates Style Guide to Remove Language that Stigmatizes PLWHIV
In May 2024, the National Institutes of Health (NIH) National Institute of Allergy and Infectious Diseases (NIAID) Division of AIDS (DIADS) updated the NIAID HIV Language Guide to center person-first, inclusive, and respectful language that emphasizes humanity, highlights autonomy, and promotes the idea that someone’s health and health determinants are only facets of their full life and identity. The updates aim to eliminate the use of stigmatizing HIV terminology across NIH communications and grant and contract language. In addition, the US Food and Drug Administration (FDA) will host an informal meeting with members of the HIV community on June 28, 2024, at 1PM EST to hear perspectives on People-First Language and the Use of Appropriate Terminology.
ONDCP Hosts Second Roundtable with Naloxone Manufacturers
On June 4, the White House Office of National Drug Control Policy (ONDCP) convened a second roundtable with U.S. drug manufacturers that produce naloxone, an FDA-approved opioid overdose reversal medication. ONDCP officials reiterated the Biden-Harris Administration’s naloxone guiding principles, which center affordable naloxone access and public awareness of fentanyl. Additionally, the group of manufacturers announced that they are building capacity to produce an additional 25 million doses in 2025 to help saturate areas with high numbers and rates of opioid overdose.
Resources
EHE Success Stories and Innovations
As part of our ongoing commitment to foster collaboration and share best practices in public health, NASTAD is excited to announce an opportunity for jurisdictions to showcase their innovative initiatives on our microsite dedicated to public health advancements. NASTAD will be releasing a series of success stories highlighting EHE innovations across both CDC and HRSA funding streams that address the four pillars: diagnose, treat, prevent, and respond.
By sharing your innovations, you not only have the opportunity to showcase your jurisdiction's achievements but also to contribute to a global knowledge-sharing platform that can benefit public health practitioners, policymakers, researchers, and communities worldwide.
Please find the survey link attached HERE. Please reach out if you have any questions or need assistance completing the survey. Please contact EHESCP@nastad.org with any questions.
“In September 2022, CDC funded Emory University and its partners, Building Healthy Online Communities (BHOC), OraSure Technologies, Signal Group, and NASTAD to expand a nationwide HIV self-test (HIVST) distribution program with a goal of distributing at least 1 million HIVSTs over 5 years… During March 14, 2023–March 13, 2024, a CDC-funded program delivered approximately 440,000 mailed HIV self-tests to U.S. residents, including those disproportionately affected by HIV, 24.1% of whom had never previously received testing; 1.9% reported receiving a positive HIV test result. Many sought additional clinical services shortly after receiving their HIV results.”
CDC MMWR: Mpox Surveillance Based on Rash Characteristics
“Among 196 emergency department patients who had an mpox-like rash during June–December 2023, three cases were identified. All cases occurred among unvaccinated gay and bisexual men who have sex with men.”
SAMHSA NOFOs:
The Substance Abuse and Mental Health Services Administration (SAMHSA) issued two funding opportunities supported by the Minority AIDS Initiative (MAI). In one, SAMHSA is seeking applications for $5.7 million to support substance use prevention and treatment services that adopt a syndemic approach for racial and ethnic minority individuals at risk for or living with HIV. In the other, SAMHSA announced the availability of $2.6 million to expand the number of programs delivering integrated, primary care, behavioral health, infectious disease, and harm reduction services to people experiencing unsheltered homelessness using a portable clinical care approach.
- MAI Substance Use Disorder Prevention and Treatment Pilot Program
- SAMHSA anticipates awarding up to eight programs of up to $700,000 per year for up to five years. At least one award will be made to American Indian/Alaska Native (AI/AN) tribes, or tribal organizations pending sufficient application volume. Applications are due Friday, July 12, 2024.
- MAI: Integrated Behavioral Health and HIV Care for Unsheltered Populations Pilot Project
- A total of $2.6 million is available to support up to four programs with awards of up to $650,000 per year for up to three years. One award will be made to an applicant serving people experiencing unsheltered homelessness in a rural area, pending sufficient application volume. Applications are due July 8, 2024.
This series promotes policy-based achievements across the STI sector, with the goal of connecting peers and partners who want to replicate, adapt, or learn from shared successes. Check out the latest publication about syphilis testing in detention centers in Colorado, a partnership between local and state health departments.
CAI at the 2024 National Ryan White Conference
CAI is looking forward to learning, engaging, and networking with our fellow EHE colleagues at the upcoming 2024 National Ryan White Conference this August. During the hybrid event, CAI TAP-in team members and participating EHE jurisdictions will present from eight accepted abstracts, providing information and data on effective and resourceful approaches for opt-out testing and linkage to care in rural communities, housing, Rapid ART in emergency departments and Ryan White clinics, HIV cluster response, and more ways to reach EHE goals. TAP-in staff are also presenting during two HAB-sponsored sessions, "Inspire. Connect. Take Action! Expanded Access, Social Media Campaigns, and Innovative Partnerships in EHE Jurisdictions" and "Housing Institute 301: Housing Outcomes and the Future.”
To learn more about TAP-in's work, visit our page at TargetHIV. 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.
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.
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
Director, HIV Prevention – Tennessee Department of Health
This role is responsible for overseeing and administering the entire portfolio of HIV Prevention activities supported by TDH and our community-based organization partners statewide. In addition to leading an internal team of eleven direct and shared staff, this role will also be responsible for maintaining strong relationships with a wide variety of external stakeholders, including our CBO partners, metro Health Department leadership, and the United Way of Middle TN.
News Bulletin
Appeals court finds 'Obamacare' pillar unconstitutional in suit over HIV-prevention drug
“A federal appeals court on Friday found unconstitutional a key component of the Affordable Care Act that grants a health task force the effective authority to require that insurers both cover an array of preventive health interventions and screenings and refrain from imposing out-of-pocket costs for them. The lawsuit centered on the objections of a coalition of small businesses in Texas to the requirement that they cover a drug for HIV prevention, known as PrEP, in their employee health plans. The appeals court did not, however, overturn the related ACA pillar; the practical, immediate impacts of its ruling apply narrowly to the plaintiffs in this case.” – NBC News
‘A mixed bag’: Fifth Circuit rules on ACA preventive services legal case
“The Fifth Circuit Court of Appeals has issued a decision in a major legal case that observers have said could fundamentally alter the preventive services provision in the Affordable Care Act. The plaintiffs, Braidwood Management, argued the preventive services provision, which private plans and Medicaid expansion programs are required to cover without cost-sharing, is unconstitutional…Its ruling upholds a lower court's decision declaring nationwide coverage through the Preventive Services Task Force under the ACA as unconstitutional, and said the plaintiffs in this case do not need to cover these preventive services through their health plans. The nationwide injunction imposed by the lower court was overturned, effectively keeping the provision temporarily intact for the majority of Americans.” – Fierce Healthcare
Americans With HIV Are Living Longer. Federal Spending Isn't Keeping Up.
“More than half of the people living with HIV in the United States are, like Reid, older than 50. Researchers estimate that 70% of people living with the virus will fall in that age range by 2030. Aging with HIV means an increased risk of other health problems, such as diabetes, depression, and heart disease, and a greater chance of developing these conditions at a younger age. Yet the U.S. healthcare system isn't prepared to handle the needs of the more than half a million people -- those already infected and those newly infected with HIV -- who are 50 or older, say HIV advocates, doctors, government officials, people living with HIV, and researchers. They worry that funding constraints, an increasingly dysfunctional Congress, holes in the social safety net, untrained providers, and workforce shortages leave people aging with HIV vulnerable to poorer health, which could undermine the larger fight against the virus.” – MedPage Today
Gilead’s twice-yearly shot to prevent HIV succeeds in late-stage trial
“Gilead’s experimental twice-yearly medicine to prevent HIV was 100% effective in a late-stage trial, the company said Thursday. None of the roughly 2,000 women in the trial who received the lenacapavir shot had contracted HIV by an interim analysis, prompting the independent data monitoring committee to recommend Gilead unblind the Phase 3 trial and offer the treatment to everyone in the study. Other participants had received standard daily pills.” – CNBC
AMA's House of Delegates Says Yes to Drug Decriminalization
“The American Medical Association (AMA) voted to support eliminating criminal penalties for drug possession for personal use at the annual House of Delegates meeting in Chicago on Wednesday…’ We have tried for decades to criminalize our way out of a substance use crisis in this country, and it has not worked ... We need to move to something different and better, something that actually works.’” – MedPage Today
Supreme Court overturns opioid settlement with Purdue Pharma that shielded Sacklers
“After the Supreme Court struck down a controversial bankruptcy plan from Purdue Pharma, the maker of OxyContin, those who sued the drug company were left uncertain about when promised funds would be available to combat addiction and other damage from the ongoing drug epidemic. The ruling upended a carefully-crafted settlement worth roughly $8 billion, and involving the Sackler family, which owns Purdue, and all the individuals, states and local governments that had sued over harms from the opioid epidemic. In a 5-4 decision, the justices focused on the part of the Purdue bankruptcy plan that shielded members of the Sackler family from future opioid-related lawsuits.” – NPR