Inside This Issue: Preserving HIV services during COVID-19 pandemic, COVID-19 data reporting, IAS virtual updates on HIV treatment, revised opportunistic infection guidelines, HIV/AIDS timelines, COVID-19 news, and educational resources.
COVID-19 and HIV
Strategies for Preserving HIV Services During the COVID-19 Pandemic
In recent weeks, UNAIDS and other organizations have published several reports and articles that discuss strategies for reducing the negative impact of the COVID-19 pandemic on communities affected by HIV and the programs that serve them. For your convenience, we’ve provided links and brief descriptions of these publications below:
Five Strategies for Preserving Key Population-Focused HIV Programmes in the Era of COVID-19: “Key populations – men who have sex with men, people who use drugs, sex workers, and transgender people – are particularly vulnerable to HIV service interruptions and additional harm during the COVID-19 pandemic,” according to Rose Wilcher, director of the LINKAGES and EPiC projects of FHI 360. In an article on International AIDS Society website, Wilcher and a colleague delineate five strategies to preserve important population-focused HIV services and promote the safety and well-being of staff and clients during the pandemic: 1) decentralize services to access points preferred by key populations; 2) scale up multi-month dispensing and community refills of antiretroviral drugs, pre-exposure prophylaxis, and other medications; 3) maximize online service delivery options; 4) address the health and safety needs of implementers and beneficiaries; and 5) Monitor the impact of COVID-19 on programmes and make data-driven course corrections.
Strategic Considerations for Mitigating the Impact of COVID-19 on Key-Population-Focused HIV Programs: According to UNAIDS, “This strategy is intended to support KP[key population]-focused HIV programs mitigate the impact of COVID-19. Developed for KP-focused HIV programs implemented or supported by FHI 360 in the Caribbean, Asia, and Africa, it may be used and adapted more broadly. Mitigation strategies refer to efforts to reduce exposure to and impact of COVID-19 on HIV program beneficiaries and staff and safely maintain HIV services within KP-focused HIV programs.”
Maintaining and Prioritizing HIV Prevention Services in the Time of COVID-19: This brief, which was prepared by the Global HIV Prevention Working Group, “outlines several critical actions and temporary modifications that can be considered to ensure continued effective HIV prevention and related services in the time of COVID-19.”
Rights in the Time of COVID-19: Drawing on the experience of the global response to HIV, UNAIDS outlines the elements of an effective community-led response to COVID-19. “Our response to COVID-19 must be grounded in the realities of people’s lives and focused on eliminating the barriers people face in being able to protect themselves and their communities,” UNAIDS notes. “Empowerment and guidance, rather than restrictions, can ensure that people can act without fear of losing their livelihood, sufficient food being on the table, and the respect of their community.”
HRSA Shares New COVID-19 Data Report Resources
HRSA’s HIV/AIDS Bureau (HAB) recently shared two resources that will help organizations that receive funding under the Coronavirus Aid, Relief, and Economic Security (CARES) Act submit their required monthly COVID-19 Data Report (CDR). The CARES Act provides funding for eligible health care providers – including current HRSA Ryan White HIV/AIDS Program (RWHAP) recipients – to prevent, prepare for, and respond to coronavirus disease.
“The CDR will collect aggregate information on the number of RWHAP-eligible clients and immediate household members tested for COVID-19, the number of RWHAP-eligible clients newly diagnosed (or presumed positive) with COVID-19, the cumulative number of RWHAP-eligible clients with COVID-19, the number of RWHAP-eligible clients and immediate household members who received services in each RWHAP service category . . . and the types of services provided using telehealth technology,” according to HAB. The CDR Instruction Manual (currently in draft form) provides guidance on the collection, reporting requirements, and submission of required COVID-19 data, as well as a frequently-asked questions section with links to additional resources.
HAB has also made available a recording and slide set for the HRSA’s recent “Preparing for the 2020 COVID-19 Data Report Submission Webinar” held last month. The webinar topics include: a description of what the CDR is; the purpose of data collection for the report; guidance on how to complete the CDR; available technical assistance and other resources; and a question-and-answer session.
HIV Treatment and Care
IAS-USA Virtual HIV Updates this Summer
The International Antiviral Society-USA (IAS-USA) will offer three virtual updates on HIV care and treatment issues during late June and July. The sessions will cover antiretroviral therapy (ART), new ART drugs and treatment strategies, and the management of COVID-19 and HIV. Although each session will have a regional focus, all sessions will be open to everyone regardless of their location. Here are the dates, times, and links for the upcoming virtual updates:
- West Coast: Monday, June 29 (10:00 a.m. – 3:15 p.m. Pacific Daylight Time)
- East Coast: Tuesday, July 14 (10:00 a.m. – 2:50 p.m. Eastern Daylight Time)
- Midwest: Thursday, July 30 (10:00 a.m. – 2:45 p.m. Central Daylight Time)
Each session listing includes a program description, the session chairs, registration details, and information about how participants may obtain Continuing Education Credits.
Revised Opportunistic Infections Guidelines Include Updates on Candidiasis and Herpes Simplex Virus
HHS has updated its Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV (OI Guidelines) to include new information about the management of candidiasis and herpes simplex virus (HSV) in people with HIV. The OI Guidelines have undergone extensive revisions relating to the treatment of candidiasis and its management during pregnancy. There is now a warning against the use of the antifungal drug fluconazole for the treatment of candiasis in women during the first trimester of pregnancy due to the potential risk for miscarriage.
The revisions to the HSV section of the OI Guidelines include new information about the seroprevalence of HSV-1 and HSV-2 infections in the U.S., as well as new and additional guidance about the testing, prevention, and treatment of HSV infections.
Documenting the History of the HIV/AIDS Epidemic
On June 5, 1981, the first U.S. cases of what would later become known as AIDS were reported in CDC’s Morbidity and Mortality Weekly Report. In recognition of the 39th anniversary of a date that is often considered to be the start of the HIV/AIDS epidemic, we are providing links to several HIV/AIDS timelines that document the challenges, losses, and triumphs that have occurred over the decades.
- A Timeline of HIV and AIDS (HIV.gov) “reflects the history of the domestic HIV/AIDS epidemic from the first reported cases in 1981 to the present – where advances in HIV prevention, care, and treatment offer hope for a long, healthy life to people who are living with, or at risk for, HIV and AIDS.”
- The HIV and AIDS Timeline (CDC) provides a graphically rich history of the epidemic from the first reported cases to CDC’s guidance regarding COVID-19 and HIV in 2020.
- A Living History Timeline (Health Resources and Services Administration – HRSA) focuses on the Ryan White HIV/AIDS Program. It begins with the funding of HRSA’s first AIDS program in 1986 – about four years before the passage of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act in August 1990 – and continues to the present, with information on HRSA’s role in the Federal Ending the HIV Epidemic initiative.
- Ending the HIV Epidemic: A Timeline (HIV.gov) highlights activities that have occurred since the launch of the Ending the HIV Epidemic: A Plan for America initiative in February 2019.
- The FDA Approval of HIV Medicines (AIDSinfo) infographic timeline lists the names, the year of approval, and the drug classes of the more than 50 individual HIV drugs and fixed-dosed combinations that the U.S. Food and Drug Administration has approved since 1987. A related document, FDA-Approved HIV Medicines, provides the precise approval dates, together with more detailed information about each drug or fixed-combination.
- The History of HIV Vaccine Research (National Institute of Allergy and Infectious Diseases) documents events from the identification in 1984 of HIV as the pathogen responsible for AIDS through highlights of vaccine development research in 2017.
Recent COVID-19 News and Research
KFF Examines Health Disparities in COVID-19
The Kaiser Family Foundation (KFF) has recently published two brief reports that examine the risk of developing serious illness from COVID-19 for all non-elderly adults, as well as for different demographic groups. Overall, about one in five adults (21%) between the ages of 18 and 64 years have a higher risk of developing serious illness if they become infected with coronavirus, due to an underlying health condition, according to KFF. Underlying conditions that increase the risk of serious illness from COVID-19 include heart disease, chronic obstructive pulmonary disease, uncontrolled asthma, diabetes, and extreme obesity. Since the prevalence of these conditions varies substantially among persons from different racial/ethnic groups and income ranges, the proportion of non-elderly adults at higher risk for serious illness from COVID-19 also varies by race/ethnicity and income.
According to a recent KFF issue brief, 34% of American Indian/Alaska Native (AI/AN) and 27% of Black non-elderly adults are at higher risk of serious illness from COVID-19 due to underlying health conditions, compared to 21% of White, 20% of Hispanic, and 12% of Asian non-elderly adults. By income, 35% of non-elderly adults from households with annual family income under $15,000 are at higher risk of serious illness from COVID-19 due to underlying conditions, compared to just 16% of those from households with family incomes of $50,000 or more.
Another recent issue brief from KFF examines the disproportionate number of COVID-19 cases and deaths among AI/AN people in some states. In particular, while AI/AN people comprise only 4% of the population of Arizona, as of May 11, they accounted for 11% of confirmed COVID-19 cases and 18% of COVID-19 deaths. In New Mexico, over half (57%) of confirmed COVID-19 cases were among AI/AN people, even though they comprise only 9% of the population. In Wyoming, this disparity was even higher: While AI/AN people comprise only 2% of the state’s total population, they accounted for nearly a third (30%) of all confirmed COVID-19 cases.
“AI/AN people face barriers to health care that may make it challenging to obtain coronavirus testing and treatment services,” according to KFF. “Addressing the needs of AI/AN people as part of COVID-19 response efforts will be key to prevent further widening of their already large health and economic disparities and fulfilling the federal trust responsibility to provide health care to AIAN people.”
COVID-19 News from 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:
- SARS-CoV-2 Infections and Serologic Responses from a Sample of U.S. Navy Service Members – USS Theodore Roosevelt, April 2020
- First Reported Cases of SARS-CoV-2 Infection in Companion Animals – New York, March-April 2020
- Knowledge and Practices Regarding Safe Household Cleaning and Disinfection for COVID-19 Prevention – United States, May 2020
- COVID-19 Monitoring and Response Among U.S. Air Force Basic Military Trainees – Texas, March-April 2020
- Evidence for Limited Early Spread of COVID-19 Within the United States, January-February 2020
- Impact of the COVID-19 Pandemic on Emergency Department Visits – United States, January 1, 2019-May 30, 2020
- Universal and Serial Laboratory Testing for SARS-CoV-2 at a Long-Term Care Skilled Nursing Facility for Veterans – Los Angeles, California, 2020
Other Educational Resources
Comprehensive COVID-19 and HIV FAQ
A group of ten HIV organizations has recently updated their online publication,
COVID-19 and People Living with HIV Frequently Asked Questions, to include guidance on ways individuals can help reduce their risk of being exposed to COVID-19 during protests. The 13-page document provides succinct answers to more than 30 questions organized into the following topic categories:
- general COVID-19 information;
- COVID-19 and HIV;
- HIV medication access;
- staying home: social or physical distancing; and
- smoking and drug use.
An “additional resources” section at the end of the document also includes links to resources on health policy, clinical guidelines, and affected communities from a range of agencies and organizations. The ten organizations responsible for developing and distributing the FAQ are: AIDS United, HIV Medicine Association, Latino Commission on AIDS, NASTAD, NMAC, Positive Women’s Network, Prevention Access Campaign, TransLatina Coalition, US PLHIV Caucus, and The Well Project.
COVID-19 Updates and Resources from NASTAD
NASTAD – the National Alliance of State and Territorial AIDS Directors – has compiled an extensive collection of articles and other resources on COVID-19, with particular emphasis on the overlap of COVID-19 and HIV or viral hepatitis. Materials are organized into five categories: national updates; program updates; policy updates; ensuring health equity; and other resources. Topics of particular relevance to HIV and viral hepatitis and at-risk communities include:
- antiretroviral (ARV) and direct acting antiviral (DAA) supply chains;
- evaluation of HIV treatments for COVID-19;
- health department staffing impact (and how this might affect HIV services);
- RWHAP considerations and resources;
- viral hepatitis program resources;
- syringe services programs (SSPs) and drug user health resources; and
- legislative and regulatory responses to COVID-19, including emergency appropriations for the Ryan White HIV/AIDS Program and Housing Opportunities for Persons with AIDS (HOPWA) Program.