Inside This Issue: NHBS report on HIV in people who inject drugs; international partnership to fight cervical cancer and HIV; $117 million award in Ending the HIV Epidemic initiative; integration of hepatitis, STD, and TB work; updates to opportunistic infections and latent TB guidelines; and resources supporting the Ready, Set, PrEP Program.
The U.S. HIV Epidemic
NHBS Report Provides Latest HIV Data for Persons Who Inject Drugs
Late last month, CDC published the latest report from the National HIV Behavioral Surveillance (NHBS) program, HIV Infection Risk, Prevention, and Testing Behaviors Among Persons Who Inject Drugs: 23 U.S. Cities, 2018. The surveillance report, which is the fifth of its kind focusing on persons who inject drugs (PWID), summarizes data gathered from approximately 11,400 PWID surveyed in 23 major U.S. cities during 2018. Selected highlights of the CDC analysis are summarized below. Please note that the behavioral data are based on self-reports.
HIV prevalence by age among PWID: 6.4% overall, and rising with increasing age from 2.2% (ages 18-24 years) to 4.5% (25-29 years), 4.6% (30-39 years), 7.6% (40-49 years), and 8.0% (50 years or older).
HIV prevalence by race/ethnicity: 12.5% among Native Hawaiian or other Pacific Islanders; 9.8% among Asians; 8.9% among Blacks/African Americans; 8.0% among Hispanics or Latinos; 4.5% among American Indian or Alaska Natives; 4.2% among persons of multiple races; and 3.8% among Whites.
HIV testing rates: Overall, about 55% of the NHBS survey participants were tested for HIV during the 12 months before the survey; 90% had ever been tested. Ever-tested rates generally increased with age, rising from about 74% (ages 18-24 years) to 93% (ages 40-49). However, the ever-tested rates among PWID aged 50 and over was slightly lower (91%) than for persons 40-49. The percentage of PWID tested for HIV in the previous 12 months varied relatively little by gender, age, and race/ethnicity, with all subgroups in these categories ranging from about 50% to 60%.
Condomless sex: Among the HIV-negative PWID surveyed, about 69% reported having condomless vaginal sex with female partners, 26% reported having condomless anal sex with female partners, and 4% reported having condomless anal sex with male partners. Among the HIV-positive PWID surveyed, about 35% reported having condomless vaginal sex with female partners, 16% reported having condomless anal sex with female partners, and 20% reported having condomless anal sex with male partners.
Sharing of Syringes and Injection Equipment: Among the HIV-negative PWID who participated in the NHBS survey, about 60% reported any receptive sharing of syringes and other injection equipment in the 12 months before the survey, and 44% reported distributive sharing. The figures for HIV-positive PWID were lower, with about 51% reporting any receptive sharing of syringes and other injection equipment in the 12 months before the survey, and 25% reporting distributive sharing.
Sexually transmitted infections (STIs): The percentage of PWID surveyed who reported a diagnosis of any bacterial STI (chlamydia, gonorrhea, or syphilis) during the 12 months before the survey interview was about 6% overall, and was higher among HIV-positive PWID (12%) than among HIV-negative PWID (5%).
Hepatitis C Virus (HCV) Testing and Diagnosis: About 80% of the HIV-negative PWID and 81% of the HIV-positive PWID participating in the NHBS survey had ever been tested for HCV. About 43% of HIV-negative and 54% of HIV-positive PWID participants had been diagnosed with HCV. The percentage of HIV-negative PWID participants with HCV diagnoses increased from about 24% (ages 18-24 years) to 50% (ages 50 and older). In contrast, HCV diagnosis rates were around 50% or higher for all age groups among the HIV-positive participants.
Receipt of HIV prevention: During the 12-month period before taking the survey, about 53% of the participating PWID reported that they had received syringes from syringe services programs (SSPs), 31% reported receiving syringes from pharmacies, and 49% reported receiving injection equipment from SSPs. About 53% of the participants reported receiving free condoms, and 32% reported taking part in an individual or group-level HIV prevention intervention. Only about 1% of the HIV-negative PWID surveyed said they had used pre-exposure prophylaxis (PrEP) in the previous 12 months, and just one-quarter (26%) said they had ever heard of PrEP.
Receipt of HIV care and treatment: Among self-reported HIV-positive PWID, about 90% reported having ever visited a healthcare provider about HIV, 47% reported doing so within one month after their diagnosis, and 74% reported visiting a healthcare provider for HIV care in the six months before the NHBS survey. About 70% of self-reported HIV-positive PWID said they were currently taking HIV drugs.
The Global Epidemic
UNAIDS and IAEA Partner to Fight Cervical Cancer and HIV
Last month, UNAIDS and the International Atomic Energy Agency (IAEA) signed a memorandum of understanding (MOU) to work together in fighting cervical cancer and HIV. Cervical cancer and HIV are closely linked. Globally, cervical cancer is the most common cancer among women with HIV – who are up to five times more likely to develop the disease compared to women without HIV infection. In addition, women infected with certain types of the human papillomavirus have an elevated risk of acquiring HIV.
In 2018, an estimated 311,000 women died of cervical cancer worldwide, with 85% of deaths occurring in low- and middle-income countries, where vaccination, screening, and treatment programs are limited. The high mortality rate from cervical cancer globally could be greatly reduced by increasing the available services in those countries, according to UNAIDS.
In their MOU, UNAIDS and IAEA pledged to support national strategies and programs to develop integrated workplans for HIV and cervical cancer. They also agreed to mobilize resources to expand prevention, diagnosis, and treatment services, train health professionals, and raise awareness about the links between HIV and cervical cancer.
Funding Awards and Opportunities
HHS Awards $117 Million in Support of its Ending the HIV Epidemic Initiative
On February 26, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), awarded a total of $117 million to expand access to HIV care, treatment, medication, and prevention services. This investment is an important component of the Ending the HIV Epidemic (EHE) initiative, which has the goal of reducing the number of new U.S. HIV infections 90% by 2030. This funding will be used to identify at-risk individuals and engage in preventive services, test for HIV, and prescribe PrEP when appropriate. People who are either newly diagnosed with HIV, or who were previously diagnosed but are not currently in care, will be linked to HIV care, treatment, and support services. These activities should help people with HIV reach viral suppression, which both benefits their health and reduces HIV transmission to others. “Today’s awards bolster HRSA programs that play a critical role in communities hardest hit by the HIV epidemic to ensure people have access to the services they need,” noted HRSA Administrator Tom Engels.
CDC HIV Funding Notice Allows for Integration with Hepatitis, STD, and TB Activities
A recent CDC Notice of Funding Opportunity Announcement (NOFO) supporting implementation of the EHE initiative allows the recipients to use up to 10% of the core funding provided to integrate specific viral hepatitis, sexually transmitted disease (STD), and tuberculosis (TB) activities. This flexibility is designed to give eligible jurisdictions more opportunities to strengthen integrated services in response to these related epidemics.
The NOFO, Integrated HIV Programs for Health Departments to Support Ending the HIV Epidemic in the United States, indicates that the applicants are eligible to use up to 10% of the approved total funding amount to:
- enhance and expand integrated screening activities (such as screening for STDs, viral hepatitis, and/or TB), conducted in conjunction with HIV testing, with accompanying referral for prevention and care services; and
- diagnose and treat STDs for uninsured or underinsured people receiving care in not-for-profit or governmental clinics, when conducted in conjunction with HIV testing and provided that these facilities document their ability to provide safety-net STD clinical preventive services as per CDC guidance.
Applications for funding must be submitted no later than March 25, and awards are expected to be made around June 1.
Updates to Opportunistic Infections and Latent TB Guidelines
The Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV have recently been updated to include guidance on the use of specific drugs and combination treatments for opportunistic infections in pregnant women with HIV. These include:
- Several new hepatitis C treatments: “Data on the use of these new drugs in pregnancy are limited, but they can be used if the benefit is felt to outweigh the potential risks,” according to the guidelines.
- The new oral antifungal drug isavuconazole (brand name Cresemba): “Use in pregnancy is not recommended.”
- The tuberculosis drug rifapentine: “Given malformations and fetal loss noted in animal studies, use of alternate drugs for tuberculosis treatment and prophylaxis in pregnancy are recommended.”
The National Tuberculosis Controllers Association and CDC have also recently updated their Guidelines for the Treatment of Latent Tuberculosis Infection. Although these updated guidelines cover all persons with latent tuberculosis infection (LTBI), there are special recommendations for persons with both LBTI and HIV, because of potential interactions between TB drugs and the antiretroviral drugs used to treat HIV infection.
New Materials Supporting Ready, Set, PrEP Program
HHS has developed a wide variety of downloadable resources to support its Ready, Set, PrEP program, which was launched late last year. The program is designed to make PrEP medications available at no cost to qualified persons who lack insurance coverage for prescription drugs. HHS recently added Spanish-language versions for many of the program’s resources, including: fact sheets for consumers, healthcare professionals, and the Indian Health Service; posters; info cards; and social media graphics tailored for Facebook, Instagram, and Twitter.
In related news, the HHS Office of Infectious Disease and HIV/AIDS Policy (OIDP) recently posted answers to participant questions that came up during and after its Ready, Set, PrEP program webinar held on January 29. The questions and answers are grouped into four categories: program eligibility requirements; enrollment; doctor visits and lab tests; and educational and promotional resources for the program. OIDP has also made available the slide set for the webinar.
2020 Conference on Retroviruses and Opportunistic Infections
As this issue of In Brief went to press, the 2020 Conference on Retroviruses and Opportunistic Infections (CROI) was under way in Boston, Massachusetts. On March 6, conference registrants were advised not to attend CROI 2020 in person due to growing concerns about the global COVID-19 outbreak. However, the conference was held virtually for the first time.
For persons interested in following news from CROI, we recommend the following websites:
- Conference on Retroviruses and Opportunistic Infections – the official website for CROI, will have links to the conference agenda, abstracts, presentation slides, and video or audio recordings of speaker presentations and workshops.
- AIDSmap, Healio Infectious Disease News, HIV.gov, NATAP, Poz, Science Speaks Blog, and TheBodyPro sites are also expected to report on research and other news developments from CROI.
We plan to provide extensive coverage of the 2020 CROI in the next issue of In Brief.