Inside This Issue: News on HIV transmission, hepatitis C, the global HIV/AIDS epidemic, funding opportunities, educational resources, and social media and digital communication.
CDC Recommends More Effective Implementation of HIV Partner Services for Blacks
Although U.S. Blacks have disproportionally high rates of HIV infection, a new CDC study finds that fewer than half of the sex- or needle-sharing partners notified through HIV partner services were tested for the virus. For the study, CDC analyzed 2016 data from the National HIV Prevention Program Monitoring and Evaluation system submitted by 59 health departments. Among 49,266 persons diagnosed with HIV who were identified as potential candidates for partner services (index patients), 21,191 (43%) were Black. Three-quarters (76%) of the Black index patients were interviewed for HIV partner services, and a total of 11,088 Black partners were named by index patients, of whom 78% were notified of their potential HIV exposure.
However, fewer than half (47%) of those notified were tested for HIV infection. Among the partners tested, one in six (17%) received a new HIV diagnosis. The prevalence of newly diagnosed HIV infection was particularly high among Black partners who were gay, bisexual, and other men who have sex with men (MSM) (37%) or who were transgender persons (38%).
According to CDC, “The high HIV positivity rates among Black partners and Black MSM partners who were tested are consistent with previous findings that indicate partner services is an effective, high-yield strategy for identifying undiagnosed HIV infections. Prevention efforts that promote HIV testing and consistently include partner services might increase early diagnosis and improve HIV-related health outcomes among Blacks, particularly among Black MSM and transgender persons.”
High STD Rates Among U.S. Gay and Bisexual Men Contribute to New HIV Infections
Approximately 10% of all new HIV cases among U.S. gay, bisexual, and other men who have sex with men are attributable to gonorrhea and chlamydia infections – the two most common reportable STDs in the nation, according to a recent modeling study published in the journal Sexually Transmitted Diseases. This model supports research indicating that infection with these STDs increases a person’s risk of transmitting or becoming infected with HIV. The study authors estimate that 2,600 HIV infections could be averted annually in the U.S. through the immediate and universal elimination of gonorrhea and chlamydia through an idealized STD control intervention.
Although substantial progress has been made toward ending the HIV epidemic in the U.S., the number of new STD cases has risen to all-time highs, and investments in STD prevention have declined during the past 15 years, according to the National Coalition of STD Directors (NCSD). “The historic levels of STDs imperil our progress towards ending HIV, noted David Harvey, NCSD executive director. This study “serves as a stark reminder that HIV and STD prevention must go hand-in-hand. We can’t hope to end HIV without also addressing STDs.”
Hepatitis C Infection
Major Progress Against Hep C Globally Will Require Vast Improvements in Screening, Prevention, and Treatment
A comprehensive package of prevention, screening, and treatment interventions could avert 15.1 million new hepatitis C virus (HCV) infections and 1.5 million cirrhosis and liver cancer deaths globally by 2030, according to a new study modeling the potential impacts of HCV interventions globally. This would be the equivalent of an 80% reduction in incidence and a 60% reduction in deaths compared with 2015.
The study researchers modeled the individual and combined impacts of key interventions to improve HCV screening, prevention, and treatment. They calculated that implementing comprehensive blood safety and infection control measures would reduce the number of new HCV infections in 2030 by 58%, compared to if things continue as they are. By extending harm reduction services to 40% of people who inject drugs, the number of new HCV infections could be reduced an additional 7%. Together, these interventions would prevent 14.1 million new infections by 2030, but the reduced number of infections would not immediately translate into reduced mortality.
The researchers found that, to reduce future HCV mortality rates more substantially, it will be essential to expand access to direct-acting antivirals (DAAs). According to their model, replacing older treatments with DAAs in all countries and offering DAAs to all patients at the time of diagnosis could prevent 640,000 deaths from liver cancer and cirrhosis by 2030.
The implementation of all three of these interventions together with HCV screening to ensure that 90% of people living with HCV are diagnosed and offered treatment by 2030 would result in the greatest reductions in HCV incidence and mortality – averting 15.1 million new hepatitis C infections and 1.5 million cirrhosis and liver cancer deaths globally by 2030.
The projected reduction in HCV incidence from the combined interventions would reach the World Health Organization (WHO) target to reduce the number of new HCV infections 80% by 2030, but narrowly miss the WHO target to reduce mortality by 65% - which would instead be reached by 2032. “Even though it narrowly falls short of the WHO targets for 2030, the impact our estimates suggest would be a tremendous stride forwards,” noted the study lead researcher Alastair Heffernan of Imperial College London.
Global HIV/AIDS Epidemic
KFF Updates Resources on PEPFAR and the Global HIV/AIDS Epidemic
The Kaiser Family Foundation (KFF) has recently published updates to several HIV/AIDS resources, including the following:
- The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) – This 9-page fact sheet examines the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and its role in addressing global HIV/AIDS, including key activities, results, and funding.
- PEPFAR Reauthorization: Side-by-Side of Legislation Over Time – This 15-page issue brief provides a detailed comparison of PEPFAR’s authorizing legislation over time and highlights those authorities that are time-bound.
- The Global HIV/AIDS Epidemic – This 9-page fact sheet provides information on current HIV prevalence and incidence, prevention and treatment strategies, and the global and U.S. responses to the epidemic.
RWHAP Funding Opportunities on Opioid Use Disorders and Sexually Transmitted Infections
The Health Resources and Services Administration’s HIV/AIDS Bureau (HRSA/HAB) recently released two funding opportunity announcements with deadlines in early spring 2019. Strengthening Systems of Care for People Living with HIV and Opioid Use Disorder (HRSA-19-038), is a new initiative in the Ryan White HIV/AIDS Program (RWHAP) Part F Special Projects of National Significance. The 3-year initiative will provide an estimated total of $3.5 million funding to an estimated one to four entities referred to as System Coordination Providers (SCPs). The SCPs will assist states in leveraging resources at the federal, state, and local levels for people living with HIV (PLWH) and opioid use disorder (OUD). According to the grant opportunity synopsis, “Specifically, the goal of this initiative is to strengthen system-level coordination and networks of care between the RWHAP recipients and other federal, state, and local entities funded to respond to the opioid epidemic to ensure PLWH and OUD have access to behavioral health care, treatment, and recovery services.” The closing date for applications is April 16.
The second funding opportunity is for Enhancing Linkage of STI and HIV Surveillance Data in The Ryan White HIV/AIDS Program cooperative agreement (HRSA-19-039). The purpose of this health information technology capacity-building demonstration project is to improve linkage, re-engagement in care, and health outcomes for PLWH in the RWHAP. HRSA will fund a Technical Assistance Provider (TAP) to identify jurisdictions (state, city, and/or local health departments) and provide programmatic technical assistance to enable them to create or improve data sharing across their sexually transmitted infection (STI) and HIV surveillance systems. The TAP will assess jurisdictional barriers to data sharing across STI and HIV surveillance departments and develop tools to address these barriers. Estimated total program funding is $1.4 million, and the closing date for applications is April 8.
New Professional Resources Focusing on HIV/HCV Coinfection
The Department of Health and Human Services (HHS) Viral Hepatitis Blog recently highlighted five new resources about coinfection with HIV and HCV. The target audience for these coinfection resources is healthcare providers and others who work with people living with HIV and HCV.
The Myths About Treating Substance Users with Hepatitis C Virus infographic identifies common misconceptions associated with treating HCV in people who use drugs and are living with HIV. People with active substance use disorders have been cured of HCV and have low rates of reinfection. This resource was developed by the AIDS Education and Training Centers (AETC) HIV/HCV Coinfection Community of Practice & Learning as part of its HIV/HCV Co-infection: An AETC National Curriculum toolkit.
AETC’s Passport to Cure – an interactive patient engagement brochure available in both English and Spanish – has been revised to include updated HCV medication information.
Elimination of Hepatitis C in Individuals with HIV Infection is a presentation slide set from the HIV/HCV Coinfection Session at the 2018 National Ryan White Clinical Conference held in December 2018.
Updated guidance regarding HIV/HCV coinfection is included in HHS’s Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States. This update describes the need for providers to counsel patients about the importance of HCV testing and follow-up for pregnant women and for infants exposed to HCV.
Viral hepatitis training resources compiled by CDC. These include online trainings offered by CDC itself, as well as those available from the University of Washington, Medscape, and the American Association for the Study of Liver Diseases. These online courses offer CME/CE credits and cover a variety of viral hepatitis topics.
New Resources from AIDSinfo and CDC
HHS’s AIDSinfo site and the CDC recently updated several resources focusing on issues related to HIV and pregnancy and on the epidemiology and impact of HIV on African Americans.
The updated AIDSinfo consumer fact sheets, available in both English and Spanish, highlight strategies used before and after childbirth to prevent mother-to-child transmission of HIV. Each fact sheet includes a summary of key points, together with links to additional information and resources.
- Preventing Mother-to-Child Transmission of HIV (Spanish version)
- HIV Medicines During Pregnancy and Childbirth (Spanish version)
- Preventing Mother-to-Child Transmission of HIV After Birth (Spanish version)
The updated CDC fact sheets are:
CDC also recently launched a redesigned National HIV Awareness Days website that compiles a variety of resources related to 12 awareness days. These resources include downloadable posters, text, and graphics that agencies and other organizations can use to promote specific awareness days and associated events.
Social Media and Digital Communication
More Digital Tools and Tips from HIV.gov
In its ongoing series focusing on digital marketing and health communication, HHS’s HIV.gov blog site has published several new posts to help agencies and organizations learn more about digital tools, harness their potential, and protect privacy of personal data. These include:
Experts Weigh-In on Artificial Intelligence – This blog item summarizes the recent Pew Research Center report, Artificial Intelligence and the Future of Humans, which looks at how artificial intelligence (AI) “will affect what it means to be human, to be productive, and to exercise free will.” The report includes expert opinions and predictions about AI’s potential impacts on the diagnosis and treatment of illness and on promoting health.
A New Content Strategy for a New Year – This post has tips for organizations interested in developing a “content strategy” for all their communications. According to Usability.gov, a content strategy involves “the planning, creation, delivery, and governance of content,” with the goal of creating “meaningful, cohesive, engaging, and sustainable content.”
How to Work with Community Influencers to Reach Your Audience – This item discusses what "influencer marketing" is, and why it is a good fit for some public health and community organizations.
Are You Designing for Translation? – This post discusses key considerations when developing health resources and designing web pages in languages other than English.
Three Steps to Creating Strong Passwords – This item advises people to update their passwords regularly and provides guidance on how to develop passwords that are strong, memorable, and difficult for others to guess.