Policy Updates: Hill Happenings and Administration Activities
Hill Happenings
FY2024 Appropriations
On July 14, the House Subcommittee on Labor, Health and Human Services, Education, and Related Agencies (LHHS) approved broad spending cuts in its fiscal year 2024 (FY2024) appropriations bill, threatening funding for vital health programs. The bill quantifies House Republicans’ commitment to reduce federal spending, proposing deep programmatic cuts across Centers for Disease Control and Prevention (CDC) divisions and the elimination of certain federal health programs. Notably, the bill eliminates funding for the Ending the HIV Epidemic Initiative at the CDC, which would undermine the US public health system’s capacity to prevent new HIV infections and provide access to care.
Overall, the proposed bill would cut 18% of the CDC’s budget and 12% of HHS’s budget, eliminate 61 programs, and include drastic cuts and setbacks in HIV/AIDS programming, such as:
- $238 million cut from the Ryan White HIV/AIDS Program
- $220 million cut from the CDC National Center for HIV, Hepatitis, STD, and TB
- $32 million cut from the Minority HIV Fund
- Elimination of Ending the HIV Epidemic (EHE) funding at CDC
- $3.8 billion cut from the National Institutes of Health
- Eliminate the Title X family planning program
Click here to read NASTAD’s full statement condemning the House LHHS cuts to health programs.
In order to become law, however, the proposed spending cuts in the House must be approved by the Senate, where Democrats hold the majority. On June 22, the Senate Appropriations Committee approved topline spending numbers for FY2024 spending bills, setting topline spending levels above those set by the House. Although legislative text is not yet available, the Senate LHHS bill markup is set for September 27. Given the proximity to the September 30 fiscal year deadline, lawmakers are expected to pass a continuing resolution (CR) to temporarily extend fiscal year 2023 spending levels while appropriators negotiate through the fall. NASTAD will continue to monitor the congressional appropriations process and advocate for the highest possible funding for HIV, hepatitis, and drug user health programs.
NASTAD Calls on Congress to Restore Axed DIS Funding
On July 11, NASTAD joined the National Coalition of STD Directors (NCSD) and called on the new CDC Director, Dr. Mandy Cohen, to restore $400 million in funding for the Disease Intervention Specialist (DIS) workforce that was rescinded as a result of the bipartisan debt ceiling compromise. Without replacement funding, almost 3,000 DIS positions across the country will lose funding, limiting the public health system’s ability to quickly detect new transmission of infectious diseases and implement effective interventions to prevent outbreaks. Additionally, the funding claw back will strain health departments’ preparedness to respond to current and future outbreaks, including mpox and syphilis, and threatens to further entrench health disparities.
Administration Activities
CMS Signs National Coverage Determination for PrEP
On July 12, Centers for Medicare & Medicaid Services (CMS) announced a proposed National Coverage Determination for Pre-Exposure Prophylaxis (PrEP) Using Antiretroviral Drugs to Prevent Human Immunodeficiency Virus (HIV) Infection and a request for public comment. If implemented, the national coverage determination would authorize CMS to cover PrEP using antiretroviral drugs approved by the US Food and Drug Administration (FDA) to prevent HIV infection in individuals at high risk of HIV acquisition, including both oral and injectable formulations. Advocates applauded CMS for initiating the process to finalize the policy proposal, which would reduce barriers to PrEP access. However, the coverage determination does not include all recommended ancillary services, like STI and renal function screenings. Comments are due by August 23.
White House Releases Plan to Address Emerging Threat of Xylazine in Illicit Opioid Supply
On July 11, the White House released its plan to address the public health threat of xylazine combined with fentanyl. Xylazine, a veterinary sedative that is increasingly present in the illicit opioids supply, causes severe wounds and increases the risk of fatal overdose above that posed by fentanyl alone. The plan, which was prompted by an April 2023 designation of xylazine combined with fentanyl as an emerging health threat, proposes to boost point-of-care drug testing for xylazine and fentanyl to empower community-based harm reduction programs and people who use drugs to reduce the harms of their drug use. Additionally, it proposes to collect data on xylazine-related mortality and compile best practices for treatment providers, boost xylazine interdiction efforts across the supply chain to prevent diversion, and explore drug scheduling of xylazine.
HRSA Issues Dear Colleague Letter Alerting Providers of Rising Syphilis Rates in Native Communities
On July 6, the Health Resources and Services Administration (HRSA) issued a Dear Colleague Letter alerting providers of increasing syphilis rates within American Indian/Alaskan Native (AI/AN) communities. HRSA and the Indian Health Service (IHS) identified highly impacted jurisdictions in Alaska, Arizona, Montana, Nebraska, New Mexico, Oregon, and South Dakota. HRSA encourages providers to fully implement the CDC recommendation for universal screening and testing for at-risk populations to intervene on the troubling epidemiologic trend. Nationally, CDC data indicate that the rate of primary and secondary syphilis among AI/AN in 2021 was 42.2 per 100,000 (nearly 5 times that of white individuals), up 520 percent from 8.0 per 100,000 among AI/AN in 2016.
Resources
“Routine xylazine testing in suspected overdose deaths is critical for surveillance; further investigation of xylazine’s effects on humans is needed to guide prevention efforts. Overdose prevention and response messages should emphasize the need to seek treatment beyond naloxone administration.”
NASTAD Webinars: Syphilis and Drug User Health Webinar Series
The NASTAD Drug User Health Team is pleased to announce an upcoming webinar series exploring syphilis among communities of people who use drugs, in partnership with AIDS United, NACCHO, NCSD, and the Northwest Portland Area Indian Health Board. This webinar series consists of five monthly sessions where those working on STIs – specifically syphilis – and those working in harm reduction and drug user health will be brought together to learn from each other, share promising practices, and highlight effective cross-sector partnerships. To join the webinars please register for them here:
- “Solo Makes You Go Slow”: Local Partnerships Addressing Syphilis Among People Who Use Drugs – Tuesday, July 25, from 3-4:30 pm ET
Job Postings
NASTAD
- Intern, Policy and Legislative Affairs
- Health System Integration
Harm Reduction Fulfillment Specialist – Tumwater, WA
The Harm Reduction Fulfillment Specialist works with local governmental and non-governmental partners to increase equitable access to harm reduction supplies including the opioid overdose reversal medication naloxone. The Specialist coordinates with the Overdose Education and Naloxone Distribution Consultant and the Syringe Service Program Coordinator to support program partners to: Receive, place, and track orders for naloxone and other harm reduction supplies; Resolve supply and shipping issues; Report naloxone and harm reduction supply distribution data as required by state and federal funding sources; Coordinate with medical supply producers and distributors; Support other OEND and SSP needs to ensure that program partners receive prompt and accurate access to harm reduction supplies. This position is eligible for partial tele-work (mobile work). The duty station is Tumwater, WA. It is expected the incumbent will work in-person at the assigned duty station approximately twice monthly. Apply by July 24.
Drug Trends and Technology-Based Drug Checking Analyst – New York City, NY
NYC DOHMH is looking for an analyst to work on our drug checking initiative. Currently operating in four SSPs across the city, including one of the OPCs, drug checking technicians use Bruker Infrared technology to test samples from SSP participants and provide individualized harm reduction education. This is a great opportunity for someone with strong data skills and an interest in drugs and toxicology. Please send out far and wide and feel free to reach out if you have any questions.
Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
- Chief, Prevention Branch, DVH
- NCHHSTP/DVH is recruiting for an exceptional candidate for the position of Prevention Branch Chief, Division of Viral Hepatitis (DVH), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP). The incumbent will serve as Chief in the Prevention Branch, Division of Viral Hepatitis, and will participate in the division’s senior management team responsible for directing the development, administration, implementation, and evaluation of national programs to prevent and control viral hepatitis. The incumbent provides advice to the Division Director on medical and scientific policy and practices associated with program, education, and research activities in support of viral hepatitis prevention and control, including harm reduction.
Prevention Coordinator, Boulder County AIDS Project – Boulder, Colorado
The primary duties of this position are to provide HIV/HCV/STI testing, syringe access, and street outreach services, as well as outreach education at community partner locations and events. This position provides these services in collaboration with other Prevention Department staff and key community partners, as well as enters data into databases and completes monthly reports. This position reports directly to the Prevention Director and attends staff, department, and community partner meetings.
Florida Department of Health – Palm Beach County
To apply, please send resumes to Robert Scott, Robert.Scott@flhealth.gov. These are all $20/hr, in-office roles with possible remote flexibility.
- EHE Navigator: This position’s work will be actively guided by the Palm Beach County Ending the Epidemic (EHE) Plan, including the four pillars and their goals, objectives, strategies and activities. Incumbent will assist in the planning, coordination, implementation and monitoring of the goals, objectives, strategies and activities set forth in the Palm Beach County Ending the Epidemic (EHE) Plan, in collaboration with other Area 9 EHE funding recipients, to include, but not limited to: Palm Beach County, FoundCare, and Florida Community Health Centers.
- PrEP Navigator: This position’s work will be actively guided by the Palm Beach County Ending the Epidemic (EHE) Plan, including the four pillars and their goals, objectives, strategies and activities. Incumbent will link high-risk negative persons to available Pre-Exposure Prophylaxis (PrEP) and non-occupational Post Exposure Prophylaxis (nPEP) services with the goal of significantly reducing the number of new HIV infections among high-risk populations. Incumbent will assess and increase the knowledge, desirability, accessibility, and adherence of PrEP among referred high-risk individuals.
- Digital Media Manager: This position is responsible for developing and coordinating the area HIV digital media presence through multiple platforms. Developing digital marketing strategies, creating social media content, collaborating with community partner organizations, and creating new ad campaigns to advance Ending the HIV Epidemic (EHE) in Palm Beach County. Tracking data from digital campaigns to assist with EHE goals.
Deputy Medical Director, HIV/STI/Viral Hepatitis/Harm Reduction – Nashville, TN
This position will serve as the Statewide Deputy Medical Director in the HIV/STI/Viral Hepatitis section. The position has cross-cutting responsibility in all program areas with potential for promotion in succession plans. Primary responsibilities include leadership and oversight of cross-cutting programs related to End the Syndemic Tennessee to tackle HIV, sexually transmitted infections, viral hepatitis, and substance use disorder in an integrated manner with an outward-facing, community-engaged process.
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.
Communicable Disease Epidemiologist – Cheyenne, Wyoming
This position will serve as the Communicable Disease AIDS Drug Assistance Program (ADAP) Coordinator, Wyoming TB Controller, and Disease Intervention Specialist (DIS) for the Communicable Disease (CD) Treatment Program. Assist in outbreak response to ensure the safety of Wyoming residents; by interviewing cases for exposure information, updating news outlets on the progress of outbreak control, and analyzing exposure data utilizing epidemiological and statistical methods.
Open Positions – New York State
The New York State Department of Health, in partnership with Health Research, Inc, has various job openings, including some within the AIDS Institute. Please visit this link to learn about their current opportunities.
News Bulletin
CDC data amplifies calls for funding hepatitis plan
“Only one-third of individuals diagnosed with hepatitis C have been cured in the decade since cures for the disease became available, according to a study published Thursday from the Centers for Disease Control and Prevention…The Food and Drug Administration approved the first highly effective direct-acting antiviral drugs to cure hepatitis C in 2013. Treatment occurs over the course of eight to 12 weeks and has a 95 percent success rate. But almost 15,000 Americans still die from hepatitis C annually.”
HIV Cases Will Spike if Health Care Doesn’t Cover Prevention, Warn Experts
“Nearly 30 groups representing the HIV community and health care providers filed briefs urging a U.S. Court of Appeals not to end the requirement that health care insurers must cover certain preventive services without cost sharing, notably pre-exposure prophylaxis (PrEP), the daily pills and long-acting injectables that prevent HIV. Other preventive care is at stake as well, including diabetes and cancer screenings and HIV and hepatitis tests. The U.S. Court of Appeals for the 5th Circuit is reviewing the decision earlier this year in Braidwood v. Becerra, in which a conservative Texas judge ruled that health care providers don’t have to cover services recommended by the U.S. Preventive Services Task Force (USPSTF). The plaintiffs in the case argued that providing PrEP amounted to promoting homosexuality.”
New law modernizes Kentucky statutes related to HIV
“House Bill 349, which the General Assembly passed earlier this year, modernizes a handful of statutes related to the disease. The bill made the distribution of self-test kits legal and eliminated felony charges for people living with HIV attempting to donate organs or other tissue, something the federal HOPE Act did nearly a decade ago. Kentuckians can now self-test for HIV in the privacy of their own home. The change went into effect Thursday.”