Eugene McCray, M.D.Director, Division of HIV/AIDS Prevention

HIV Prevention in the U.S. Working Towards Reducing

New Infections for the Greatest Impact

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Division of HIV/AIDS Prevention

CDC New Health Official OrientationAtlanta, GA

May 14, 2015

DIVISION OF HIV/AIDS PREVENTION

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Division of HIV/AIDS Prevention

Revised 04/16/2015

OVERVIEW

State of HIV in the U.S.

Strategic Frameworks for Prevention

Best Practices

STATUS OF HIV IN THE U.S.

1.2 M 1 in 7 1.2 million people living with HIV 1 in 7 people do not know their status

50k 4 in 10 3 in 10Approximately 50,000 new infections annually 4 in 10 people living with HIV 3 in 10 people living are in HIV medical care with HIV achieve viral suppression

NHAS AND DHAP STRATEGY

The goals of The National HIV/AIDS Strategy (NHAS) and the Division of HIV/AIDS Prevention’s (DHAP) Strategic Plan are aligned to ensure the greatest impact:

• Decrease incidence of HIV• Increase access to care and

improving health outcomes for people with HIV

• Reduce HIV-related health disparities

• Intensify efforts in communities hardest hit by HIVAvailable for download at:

https://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf

HIGH-IMPACT PREVENTION (HIP) Applying the science of implementation to maximize

impact

• Primary goal is to prevent the largest possible number of new HIV infections and reduce disparities

• Framework for using data to maximize impact of available resources and technologies

• Directs effort and resources to the right places, populations, and strategies

www.cdc.gov/hiv/policies/hip.html

Health Departments • Flagship prevention program (PS 12-1201)

• Surveillance program

• MSM testing, retention and care program

Care and Prevention in the U.S. (CAPUS) Funding of CBOs

• Community prevention projects

• YMSM and Transgender prevention projects & initiatives

Funding of CBAs for services improvement to high risk populations

Strategic partnership initiatives

HIV/AIDS PREVENTIONHigh Impact Funding

Activities

PrEP/nPEP Guidelines New HIV Testing Algorithm Male circumcision (Post public comment

revision) Framework for Prevention with HIV Negative

At-Risk Individuals (i.e., risk reduction) Compendium of EBIs Prevention with Positives

Guidelines

HIV/AIDS PREVENTION High Impact Policy

Activities

PRIORITY ACTIVITIES

Improving Surveillance Strengthen surveillance systems by collecting better

quality and more data

Expanding HIP Activities Transition CBOs and CBAs into HIP activities within

jurisdictions with high numbers of HIV infection in the U.S. Focus Areas: HIV testing; linkage; and referrals to

partner services; support services for HIV-positive persons and high-risk persons with unknown/negative serostatus

Reducing New Infections Among those at high risk including gay and bisexual

men and transgender persons (i.e., PrEP implementation)

NATIONAL & STATE HIV PREVENTION PROGRESS REPORTS

Data show significant progress and continued challenges/gaps

Achieving goals will depend on accelerated progress

Multiple factors will affect results: High-Impact Prevention implementation Increased access to health care– Reduced funding for HIV prevention– Growing number of people living with HIV

who need services

Available for download at: www.cdc.gov/hiv/policies/npr

http://www.cdc.gov/hiv/policies/progressreports/spr.html

DE

MARICTNJ

MDDC

NH

VT

Virgin Islands, U.S.

Puerto Rico

AREAS WITH LAWS AND REGULATIONS FOR REPORTING ALL CD4 AND VIRAL LOAD

VALUES, OCTOBER 2014

Not all values

All values, specified

Laboratory reporting(laws and regulations)

All values, not specified

BEST PRACTICES: Addressing priorities & overcoming barriers

BEST PRACTICE: Testing

The Expanded Testing Initiative funded 25 jurisdictions to increase the number of persons aware of their infection (2007-2010)

2.7 million persons were tested for HIV, there was a newly diagnosed HIV positivity rate of 0.7%, and an estimated 3381 HIV infections were averted

Of newly identified confirmed HIV-positives 74.3% were linked  to HIV medical care; 71.8% and 58.6% were also referred to partner services and other prevention services

Incorporated now into health department FOA (category B)

BEST PRACTICE:Prevention Programs for High-Risk

Populations

Illinois Department of Health Co-locates medical and social services in East St.

Louis to promote access to comprehensive health care, HIV/STD testing and treatment, psychosocial, GED completion, and job placement for young lesbian, gay, bisexual, and LGBT persons of color.

Georgia Department of Public Health Uses surveillance data to create maps with HIV care

continuum outcomes by county, zip code, and census tract to prioritize planning decisions about testing, linkage, and retention efforts.

BEST PRACTICE: PrEP

New York State Department of Health Convened a statewide stakeholder committee to plan

for PrEP introduction and scale-up of access Worked with the Medicaid office to enable coverage

for PrEP Published state-specific guidelines Provided funding for pilot PrEP delivery sites

Washington State Department of Health Created a drug assistance plan to provide medication

for PrEP to uninsured persons at high risk of acquiring HIV infection

BEST PRACTICE:Linkage to and Engagement in Care

.Louisiana Department of Health

LaPHIE is an electronic exchange of health info between the DOH and 8 medical centers

Exchange surveillance data to alert clinicians that a patient is out of care or unaware of infection

BEST PRACTICES:Prevention for People Living with HIV

and their Partners

Florida State Department of Health Conducts Couples HIV Testing and Counseling (CHTC)

trainings in collaboration with state and local Health Departments

Offering couples a set of evidence-based

interventions once their status is known can reduce HIV incidence within couples, and if implemented with sufficient scale and coverage can potentially reduce population-level HIV incidence as well.

BEST PRACTICESRaising Awareness

South Carolina Aggressively engages in social marketing campaigns

to raise awareness about HIV A partner in the Act Against AIDS Campaign along

with 19 of the nation’s African American and Latino organizations and the Start Talking. Stop HIV campaign

www.cdc.gov/actagainstaids.gov

BEST PRACTICESPolicy Research

HIV Criminalization CDC Legal Assessment Project

provides information that policy makers use in drafting/revising criminalization laws

Current HIV exposure laws

Evidence about the risks of transmission

Source: Lehman JS, Carr, MH, Nichol AJ, et al. Prevalence and public health implications of state laws that criminalize potential HIV exposure in the United States. AIDS Behav 2014.

“Given that HIV-specific criminal laws may have wide-ranging social implications, states are

encouraged to utilize the findings of this paper as a basis to re-examine those laws, assess the

laws’ alignment with current evidence regarding HIV transmission risk, and consider whether current laws are the best vehicle to

achieve their intended purposes.”

CONCLUSION Continued and intensified efforts needed to

improve outcomes along the HIV care continuum

Success needed at each step of the continuum to increase viral suppression among persons living with HIV Diagnosis Linkage to and engagement in medical care ART prescription

Sustained effort from all jurisdictions needed to implement effective strategies to improve the health of people living with HIV and reduce new infections

“The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination.”

—Vision of the National HIV/AIDS Strategy

DHAP

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionDivision of HIV/AIDS Prevention

Publications and Resources

Available by visiting the DHAP website:

www.cdc.gov/hiv/dhap/about.html

Division of HIV Prevention Centers for Disease Control and

Prevention Corporate Square, Atlanta GA

MS D-21