Inside This Issue: HIV care continuum, long-acting PrEP, funding awards and opportunities, COVID-19 treatment and research, and educational opportunities.
The HIV Care Continuum
CDC Report Summarizes Latest Data for U.S. HIV Prevention and Care Objectives
The U.S. Centers for Disease Control and Prevention (CDC) has published a new surveillance report, Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data: United States and 6 Dependent Areas, 2018. The 104-page report tracks progress toward achieving national HIV-related goals and objectives set forth in Healthy People 2020, the Ending the HIV Epidemic: A Plan for America (EHE) initiative, and the National HIV/AIDS Strategy 2020. For your convenience, we have summarized selected highlights below:
Concurrent HIV/AIDS Diagnoses: Overall, the percentage of persons with advanced HIV disease (stage 3, or AIDS) at the time of their HIV diagnosis – referred to hereafter as “concurrent HIV/AIDS diagnoses” – declined from 22.6% in 2014 to 20.8% in 2018. However, there were substantial variations among different groups. For example, in 2018, only 9.1% of newly diagnosed young persons aged 13 to 24 had a concurrent HIV/AIDS diagnosis, compared to 35.3% of newly diagnosed adults aged 55 or older.
Linkage to HIV Care: In 2018, the overall percentage of persons linked to HIV care was 80.2% within one month after HIV diagnosis and 87.8% within three months after diagnosis. Although the variation in linkage-to-care rates among different groups was relatively small, persons infected through injection drug (PWID) use tended to have somewhat lower linkage-to-care rates than persons in other HIV transmission categories.
Receipt of and Retention in HIV Care: The overall percentage of persons living with diagnosed HIV infection who received HIV care (defined as having at least one CD4 or viral load test during 2018) was 75.7%. The percentage who met the more restrictive criteria for retention in care (receipt of at least two CD4 or viral load tests three or more months apart) was 57.9%. PWID again tended to have somewhat lower receipt-of-care and retention-in-care rates than persons in other transmission categories.
Viral Suppression: In 2018, 64.7% of the total number of persons with an HIV diagnosis by year-end 2017 and alive at year-end 2018 had viral suppression. Viral suppression rates were relatively low among PWID compared to persons in other transmission categories. in addition, viral suppression rates tended to increase with age, rising from 60.3% in persons 13 to 24 years old, to 67.0% in those at least 55 years old. Among racial/ethnic groups, viral suppression rates were lowest among Blacks/African Americans at 59.9%.
Prevalence-Based HIV Care Continuum: Based on the latest surveillance data, CDC estimates that about 1,173,900 persons aged 13 years or older were living with HIV infection at the end of 2018. Of this total, about 1,012,040 (86%) had been diagnosed with HIV; 766,100 (65%) were in receipt of HIV care; 586,000 (50%) were retained in care; and 654,800 (56%) had viral suppression.
Other Prevention and Care Measures Studied: The surveillance report also contains data – with breakdowns by gender, age, race/ethnicity, transmission category, and geographic region – for the following prevention and care measures: indications for pre-exposure prophylaxis (PrEP) and PrEP coverage; deaths; survival for more than 3 years after an HIV or AIDS diagnosis; and perinatally acquired HIV infections.
Associated Slide Set: CDC has also produced Selected National HIV Prevention and Care Outcomes – a set of 37 slides highlighting key findings of the above report in a series of graphs, maps, text summaries, and flow charts.
NIH Study Finds Long-Acting PrEP Is Effective in MSM and Transgender Women
An experimental, long-acting form of the HIV drug cabotegravir injected once every 8 weeks has safely and effectively prevented HIV acquisition in men who have sex with men (MSM) and transgender women who have sex with men. These are the newly released findings of HPTN 083, the first clinical trial to compare the efficacy of long-acting cabotegravir (CAB LA) to daily oral PrEP using the FDA-approved fixed combination emtricitabine/tenofovir (FTC/TDF, trade name Truvada). HPTN 083 and an ongoing companion study (HPTN 084) evaluating the use of CAB LA for PrEP are sponsored by the National Institute of Allergy and Infectious Diseases.
Since its launch in 2016, HPTN 083 enrolled a total of 4,570 cisgender MSM and transgender women (TGW) who have sex with men at 43 sites in the U.S., Argentina, Brazil, Peru, South Africa, Thailand, and Vietnam. The study participants were randomly assigned to receive either: 1) cabotegravir (CAB) treatment, plus a placebo pill in place of a daily oral TDF/FTC pill; or 2) a daily oral TDF/FTC pill, plus a placebo in place of cabotegravir. Neither the participants nor the study team knew who was in which group. Participants in each group received both injections and oral tablets – each participant received one active drug and one placebo (no active drug) in order to maintain the blinded nature of the study.
In the more than 3 years since the study began, there were 50 incident HIV infections. Of this total, 38 incident HIV infections were in the TDF/FTC arm (HIV incidence rate 1.21%) and 12 incident HIV infections were in the CAB arm (incidence rate 0.38%). in other words, approximately three times the number of incident HIV infections were in the TDF/FTC arm than in the CAB arm. Considering these findings, the study’s Data and Safety Monitoring Board recommended that the blinded part of the study be stopped early, and NIAID agreed with that decision.
“Demonstrating conclusively that long-acting injectable cabotegravir is highly effective almost two years earlier than originally expected is exciting news,” according to HPTN 083 protocol chair Dr. Raphael Landovitz. “It is inspiring that we may soon have additional HIV prevention options for at-risk individuals who have difficulty with or prefer not to take pills.”
Accessing PrEP During the COVID-19 Pandemic
To ensure that people at risk for HIV infection continue to have access to pre-exposure prophylaxis (PrEP) and PrEP-related services during the COVID-19 pandemic, CDC recently published a Dear Colleagues letter from top CDC officials Dr. Eugene McCray and Dr. Jonathan Mermin. The letter gives guidance for providing PrEP when facility-based services and in-person patient-clinician contact are limited. Dr. McCray and Dr. Mermin note that reducing the number of new HIV infections remains a public health priority and that providing PrEP care is an essential health service. They go on to describe options for HIV testing of at-risk individuals, including the use of home specimen collection kits or HIV self-testing when it is infeasible to have lab work done at a medical facility.
In addition, Dr. McCray and Dr. Mermin encourage clinicians to consider prescribing a 90-day supply of PrEP medication to patients in order to minimize trips to the pharmacy and facilitate PrEP adherence. They also cite several programs to provide affordable PrEP medication, including HHS’s nationwide Ready, Set, PrEP program and the Medication Assistance Program (MAP) offered by Gilead Sciences, the manufacturer of the medications that have been approved for PrEP. Clinicians with additional questions are encouraged to call the toll-free PrEPline at: (855) 448-7737.
Funding Opportunities and Awards
HRSA Funding Opportunity to Support HIV Planning in Rural States
Earlier this month, HRSA’s Federal Office of Rural Health Policy (FORHP) announced a funding opportunity to assist in the development of an integrated rural health network for HIV care and treatment that will address key strategies identified in the EHE initiative. Rural public and nonprofit private healthcare provider organizations or providers of healthcare services are eligible to apply in seven states that have a substantial number of HIV diagnoses in rural areas. These states are: Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma and South Carolina. According to HRSA, the funding opportunity will make up to $1 million available to support as many as ten $100,000 one-year awards. Applications are due by July 10, with an anticipated project start date of September 1. For further information, please see the funding announcement or contact Jillian Causey by email: JCausey@hrsa.gov; or phone: (301) 443-1493.
$9 Million CDC Funding Opportunity for HIV Care of Prison Inmates
CDC recently announced a funding opportunity to support the continuity of HIV care for people with HIV who have been released from state prisons into the community. A total of up to $9 million is available to support as many as three awards of approximately $750,000 per year for four years. The funding must be used to develop effective, sustainable, and replicable program models that emphasize linkage to and retention in community HIV care, adherence to HIV treatment, and suppression of HIV viral load, according to HIV.gov. “The funded programs must also include strategies to identify people with HIV and HIV-negative persons who are at risk for HIV among sex and drug-injection partners and associates of program participants and link those individuals to care and prevention services.” Applications are due by June 29, with an anticipated award date of August 28. For further information, please visit CDC’s grant opportunity page.
HRSA Awards $15 Million in COVID-19 Workforce Telehealth Grants
HRSA recently awarded Telehealth workforce training grants totaling $15 million to 159 agencies funded under the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The grants cover the following five categories of telehealth workforce training:
- Geriatrics Workforce Enhancement Program ($4,350,000 to 48 grantees)
- Area Health Education Centers Program ($4,200,020 to 44 grantees)
- Centers of Excellence Program ($2,700,000 to 18 grantees)
- Nurse Education, Practice, Quality and Retention – Veteran Nurses in Primary Care Training Program ($449,995 to 7 grantees)
- Nurse Education, Practice, Quality and Retention – Registered Nurses in Primary Care Training Program ($3,299,982 to 42 grantees)
Selected COVID-19 News
Early Data Show Remdesivir Improves Recovery Time for COVID-19
A preliminary analysis of data from the Adaptive COVID-19 Treatment Trial (ACTT) indicates that treatment with the experimental antiviral drug remdesivir shortens the median recovery time of COVID-19 patients hospitalized with severe respiratory disease requiring supplemental oxygen. ACTT, which is sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), enrolled 1,063 participants over a two-month period between February 21 and April 19, 2020. The study participants were randomly assigned to receive either: 1) the local standard care and a 10-day course of the antiviral remdesivir intravenously; or 2) the local standard care and a placebo. The trial was double-blind, meaning neither the study researchers nor participants knew who was receiving remdesivir or the placebo.
When an independent data and safety monitoring board (DSMB) overseeing the trial conducted a preliminary review of the study data, they found that patients who received remdesivir had a median time to recovery of 11 days, compared with 15 days for those who received placebo. The preliminary results also suggested a survival benefit for remdesivir, with a mortality rate of 8.0% for the group receiving the drug, versus 11.6% for the placebo group.
“These preliminary findings support the use of remdesivir for patients who are hospitalized with COVID-19 and require supplemental oxygen therapy. However, given high mortality despite the use of remdesivir, it is clear that treatment with an antiviral drug alone is not likely to be sufficient,” the researchers note. “Future strategies should evaluate antiviral agents in combination with other therapeutic approaches or combinations of antiviral agents to continue to improve patient outcomes in COVID-19.”
Ongoing Coverage of COVID-19 Research in MMWR
CDC’s Morbidity and Mortality Weekly Report (MMWR) is continuing to focus heavily on COVID-19-related research – typically publishing several new reports each week – and then archiving them on a page devoted to studies on COVID-19 and SARS-CoV-2. Reports published in the past several weeks include the following:
- Universal and Serial Laboratory Testing for SARS-CoV-2 at a Long-Term Care Skilled Nursing Facility for Veterans – Los Angeles, California, 2020
- Decline in Child Vaccination Coverage During the COVID-19 Pandemic – Michigan Care Improvement Registry, May 2016-May 2020
- High COVID-19 Attack Rate Among Attendees at Events at a Church – Arkansas, March 2020
- Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration – United States, 2020
- Public Health Response to COVID-19 Cases in Correctional and Detention Facilities – Louisiana, March-April 2020
- Identification and Monitoring of International Travelers During the Initial Phase of an Outbreak of COVID-19 – California, February 3–March 17, 2020
- Preliminary Estimate of Excess Mortality During the COVID-19 Outbreak – New York City, March 11–May 2, 2020
- High SARS-CoV-2 Attack Rate Following Exposure at a Choir Practice – Skagit County, Washington, March 2020
Updated Fact Sheets and Infographics on HIV Among Asians and Pacific Islanders
In the run-up to National Asian and Pacific Islander HIV/AIDS Awareness Day, which was commemorated on May 19, CDC revised two of its population-specific fact sheets: HIV and Asians and HIV and Native Hawaiians and Other Pacific Islanders. These resources summarize information on new HIV diagnoses, HIV prevalence, knowledge of HIV status, deaths, the HIV care continuum, prevention challenges, and what CDC is doing to address the impacts of HIV on each group.
AIDSVu – an online, interactive tool that visualizes the impact of the HIV epidemic on communities across the U.S. – also published several new infographics about HIV testing, diagnoses, and trends among Asian Americans, Native Hawaiians, and Pacific Islanders.
KFF Issue Brief Summarizes on Ending the HIV Epidemic (EHE) Initiative
The Kaiser Family Foundation (KFF) recently published an issue brief – The Ending the HIV Epidemic (EHE) Initiative: What You Need to Know – that highlights important features of the plan. The KFF brief includes sections describing what the EHE initiative is, where its 57 priority jurisdictions are located, how the initiative is being funded, and how the key activities of EHE’s four “pillars” – diagnose, treat, prevent, and respond – are being used to reach the initiative’s goals. In addition, the issue brief describes the role of locally focused planning to meet individual jurisdiction’s particular cultural and epidemiological needs, and how the initiative fits into the larger healthcare policy environment.