Inside This Issue: 2022 National Drug Control Strategy; role of telehealth in HIV PrEP access; integrating mental health and HIV interventions; resources on transgender persons and HIV; funding opportunities; and more.
The Opioid Epidemic
White House Releases 2022 National Drug Control Strategy
Last month, the White House Office of National Drug Control Policy published the 2022 National Drug Control Strategy (Strategy), which is designed “to bend the curve on overdose deaths in the immediate term and reduce drug use and its damaging consequences over the longer term.” In recent years, drug overdose deaths have risen rapidly, reaching an estimated 106,000 during the 12-month period ending October 2021 – a 71% increase since 2016. This rate of increase was greater than for any other type of injury-related death in the United States. Synthetic opioids, including illicit fentanyl, are now a factor in about two-thirds of these overdose deaths.
The Strategy includes seven general goals and twenty specific objectives for reducing the demand for and availability of illicit drugs, as well as the consequences of illicit drug use. These would be achieved through a combination of:
- prevention and early intervention efforts, particularly among adolescents and young adults;
- harm reduction activities that are integrated into the U.S. substance use disorder (SUD) system of care, and that involve collaboration with public safety agencies;
- expanding and improving SUD treatment by supporting at-risk populations, meeting people where they are, and implementing payment reform;
- building a “recovery-ready nation” by supporting research on the science of recovery and eliminating barriers to, and increasing opportunities for, recovery among Americans;
- reducing the supply of illicit substances in the U.S. through domestic collaborative efforts, including information sharing among government agencies, as well as activities to deny and disrupt domestic production, trafficking, and distribution of illicit substances; and
- reducing the supply of illicit substances through international collaborative efforts.
“We are changing how we help people when it comes to drug use, by meeting them where they are with high-impact harm reduction services and removing barriers to effective treatment for addiction, while addressing the underlying factors that lead to substance use disorder head on,” notes Dr. Rahul Gupta, director of National Drug Control Policy. “We are also striking drug trafficking organizations where it hurts them the most, in their wallets, by disrupting the operating capital they need to sustain their criminal enterprise.”
For additional information on this topic, you can visit NEAETC’s Online HIV Resource Library page focusing on Substance Use and HIV.
New KFF Issue Brief Examines the Role of Telehealth in HIV PrEP Access
The U.S. Centers for Disease Control and Prevention (CDC) estimates that about 300,000 people in the U.S. were prescribed HIV pre-exposure prophylaxis (PrEP) during 2020 – which is only about one-quarter of the total number of people with an indicated need for PrEP. During the COVID-19 pandemic, the use of telehealth to provide PrEP and related services (tele-PrEP) has increased, but until now, relatively little has been known about the tele-PrEP environment.
To increase understanding of tele-PrEP, researchers from the Kaiser Family Foundation (KFF) conducted in-depth interviews during late 2021 with representatives from the major national telehealth companies that provide tele-PrEP as well as other select tele-PrEP programs. KFF has just published an issue brief summarizing key findings from these interviews. These findings include:
- “Tele-PrEP programs have different operational models and financing structures, each with implications for patient costs and company/program revenue.”
- “About half of respondents reported conducting visits primarily or exclusively via live video.”
- “Laboratory services, a central component to PrEP initiation and related ongoing care, and prescribing patterns also varied. For example, some respondents primarily used home lab collection kits while others referred patients to in-person labs.”
- “Some programs are primarily focused on PrEP provision, while others offer additional select services, and some provide PrEP as part of a comprehensive clinical program.”
- “Respondents offered a range of reasons for providing tele-PrEP. While the private companies stood to earn a profit from their PrEP programs, the predominant reason given for offering this service across all respondents was to provide wider access to PrEP and some tied this objective to reaching the national goal of ‘ending the HIV epidemic.’”
- “Clients served were mostly cisgender men who have sex with men, and in their 20s and 30s. Among interviewees who provided estimates, between 23% and 55% of patient populations were people of color.”
The Global HIV/AIDS Epidemic
UNAIDS Identifies Key Considerations for Integrating HIV and Mental Health Interventions
“As efforts to end the AIDS epidemic intensify, communities of people living with, at risk of, or affected by HIV, clinicians, researchers and advocates are increasingly calling for attention to support mental health and well-being in the context of HIV prevention, treatment, and care,” according to a new UNAIDS report, Integration of Mental Health and HIV Interventions: Key Considerations. “This requires a holistic approach to person-centred HIV services that ensures HIV prevention, treatment, and care address the needs of people with mental, neurological, or substance use conditions in all their diversity.”
The report stresses the importance of integrating HIV prevention, testing, treatment, and care with mental health services and care for people with HIV and other vulnerable population groups. It also provides a set of tools, best practices, and guidelines, and offers eight essential principles for integrating HIV and mental health services:
Integrated health services that are managed and delivered so people receive all aspects or some elements of one service incorporated into the regular functioning of another service.
People-centered services and care that adopt the perspectives of individuals, families, and communities, and see them as both participants and beneficiaries of health services and support that respond to and prioritize their individual needs.
Access to quality health services and support that are effective, safe, person-centered, timely, equitable, science-based, culturally grounded, efficient, age-responsive, gender- and sexual orientation-sensitive and tailored to needs.
A life-course approach that includes policies, strategies and services for HIV, mental health and psychosocial support that take into account health, well-being, and social needs across the stages of the life course from infancy through old age.
Human rights and access to justice that requires protection for all people, especially people living with HIV and other vulnerable populations, and people with mental health conditions across the life course.
Empowerment of people with mental health, neurological, or substance use conditions and psychosocial disabilities, including people living with, at risk of, or affected by HIV. This includes empowerment to be involved in mental health advocacy, law and policy-making, program planning and implementation, service provision, monitoring and evaluation, and research.
Gender equality in care that requires that services and interventions are gender-sensitive and consider gender perspectives.
A multisectoral approach that is a comprehensive and coordinated response for mental health. This requires partnerships between multiple sectors, such as health, education, employment, justice, housing and social services, and community and private sector engagement.
For additional information on this topic, you can visit NEAETC’s Online HIV Resource Library page focusing on Mental Health.
CDC Issue Brief Focuses on HIV in Transgender Communities
About one million people in the U.S. identify as transgender. CDC research has indicated that transgender women are among the groups most heavily impacted by HIV in the nation. A newly published issue brief summarizes current knowledge about HIV in transgender communities and ongoing efforts to improve HIV data for this population group. The brief identifies several systemic factors that contribute to the HIV epidemic among transgender people. These include:
- Many transgender people face stigma, discrimination, social rejection, and exclusion.
- Transgender people of color also face systemic racism, which can lead to HIV disparities.
- Provider insensitivity to transgender-specific health needs can be a significant barrier for transgender people with HIV who are seeking high quality treatment and care.
- The effectiveness of HIV behavioral interventions that have been adapted for use with transgender people is understudied.
- Transgender people are not being sufficiently reached by HIV PrEP.
The issue brief also provides an overview of CDC’s efforts to prevent HIV among transgender people, as well as an extensive reference list.
Slide Deck Highlights Demographics of RWHAP Transgender Clients
The Ryan White HIV/AIDS Program (RWHAP) currently serves more than half a million people. During 2020, 2.1% of the 561,129 RWHAP clients with a reported gender were transgender, according to a recently published slide deck summarizing the demographic characteristics of RWHAP transgender clients.
Of the approximately 11,600 transgender clients, 87.6% were transgender women, 8.7% were transgender men, and 3.7% had another gender identity. Nearly 60% of RWHAP transgender clients are between the ages of 25 and 44 years old, and the vast majority (>95%) of transgender clients were infected with HIV either through sexual contact alone or through sexual contact and injection drug use. In addition to data about the gender identify, age distribution, and transmission categories for RWHAP transgender clients, the slide deck presents data about race/ethnicity, housing status, health insurance coverage, poverty levels, and viral suppression rates.
HRSA Funding Opportunity to Increase Use of Long-Acting Injectable Antiretrovirals
In late April, the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau announced the grant opportunity, Increasing Uptake of Long-Acting Injectable Antiretrovirals Among People with HIV (HRSA-22-155). “This project is designed to develop protocols, implement them and modify as needed, to increase uptake of long-acting injectable antiretroviral medications among people of color with HIV, since long-acting injectable antiretroviral medications may offer benefits in addressing health inequities and achieving viral suppression,” according to HRSA. The agency plans to make a single $1.5 million award to an organization that will serve as a coordination and evaluation provider for the projects. The application due date is June 21.
IHS Announces $2.5 Million HIV/HCV Funding Opportunity
The Indian Health Service (IHS) recently announced the funding opportunity, Ending the HIV/HCV Epidemics in Indian Country (HHS-2022-IHS-ETHIC-0001). The purpose of this program is to support communities in: 1) reducing new HIV infections and its comorbidities, including hepatitis C (HCV) and sexually transmitted infections (STIs); 2) improving HIV-, STI-, and HCV-related health outcomes; and 3) reducing HIV-, STI-, and HCV-related health disparities among American Indian/Alaska Native (AI/AN) people. “In two separate but related parts, this initiative aims to implement effective and innovative strategies, interventions, approaches, and services to reduce new HIV and HCV infections among AI/AN communities in the U.S.,” according to IHS. The agency expects to make 14 awards totaling $2.48 million. The application due date is June 17.
Updated CDC Web Pages Organize HIV Information by Race/Ethnicity and Age
For years, CDC has published separate fact sheets about HIV in many specific groups of people, including youth, older persons, and several different racial and ethnic groups. In recent weeks, however, CDC has reorganized and combined the information in some of these fact sheets to create web pages that examine HIV more broadly by age and race/ethnicity.
As a result of this reorganization, CDC now provides HIV information in a graphically rich, easy-to-read format for some groups that had not previously had their own separate fact sheets, such as Multiracial and White persons, and people in the age ranges between youth and older age. Combining information for different age and racial/ethnic groups also allows easy comparison of HIV risk behaviors, PrEP coverage, HIV incidence, HIV diagnoses, knowledge of HIV status, and viral suppression rates among different groups.
CDC has also recently updated its HIV in the United States by Region web page, which provides information about HIV incidence, diagnoses, knowledge of status, and viral suppression for five regions: Northeast, South, Midwest, West, and U.S. dependent areas.
Recent Summaries and Research Reports
CDC’s COVID Data Tracker Weekly Review highlights key data from its COVID Data Tracker, narrative interpretations of the data, and visualizations from the week. Themes of recent Weekly Review issues include: community-level COVID data; being up-to-date with booster shots; catching up on medical visits and other care that was deferred as a result of the COVID-19 pandemic; and COVID-19 vaccination in children.
The Morbidity and Mortality Weekly Report (MMWR) is also providing continuing coverage of COVID-19-related research. CDC is archiving its MMWR reports on a page devoted to studies about COVID-19. For your convenience, we have compiled below links to recent MMWR papers:
Effectiveness of a COVID-19 Additional Primary or Booster Vaccine Dose in Preventing SARS-CoV-2 Infection Among Nursing Home Residents During Widespread Circulation of the Omicron Variant – United States, February 14-March 27, 2022