Inside This Issue: New 5-year global AIDS strategy, guidance on COVID-19 and HIV, expanding services through the RWHAP, updates from PACHA meeting, HIV resources on women and Native Americans, viral hepatitis response during the COVID-19 pandemic, and other COVID-19 news.
The Global HIV Epidemic
UNAIDS Board Adopts New Global AIDS Strategy for 2021-2026
On March 25, the UNAIDS Program Coordinating Board adopted a new Global AIDS Strategy 2021-2026: End Inequalities. End AIDS, which is designed to get every country and every community on track to end AIDS as a public health threat worldwide by 2030. The strategy “uses an inequalities lens to close the gaps preventing progress to end AIDS, and sets out bold new targets and polices to be reached by 2025 to propel new energy and commitment to ending AIDS,” according to UNAIDS. It incorporates the following strategic priorities: 1) maximize equitable and equal access to comprehensive people-centered HIV services; 2) break down legal and societal barriers to achieving HIV outcomes; and 3) fully resource and sustain HIV responses and integrate them into systems for health, social protection, and humanitarian settings.
The UNAIDS Strategy establishes the following 2025 HIV targets for increased coverage of services:
- at least 95% of people at risk for HIV infection use combination prevention;
- at least 95% of people living with HIV know their status through testing, at least 95% of diagnosed persons receive HIV treatment, and at least 95% of those on treatment achieve viral suppression;
- at least 95% of women have access to sexual and reproductive health services;
- at least 95% coverage of services for eliminating mother-to-child transmission of HIV;
- at least 90% of people living with HIV receive preventive treatment for tuberculosis; and
- at least 90% of people living with HIV and people at risk are linked to other integrated health services.
The strategy also includes the following targets for reducing stigma, discrimination, and inequalities:
- less than 10% of people living with HIV and key populations experience stigma and discrimination;
- less than 10% of people living with HIV, women and girls, and key populations experience gender-based inequalities and gender-based violence; and
- less than 10% of countries have punitive HIV laws and policies.
“This year marks 40 years since the first cases of AIDS were reported and 25 years since the establishment of UNAIDS. We are at a critical moment in our historic effort to end AIDS,” noted Winnie Byanyima, Executive Director of UNAIDS. “Like HIV before it, COVID-19 has shown that inequality kills. COVID-19 has widened existing inequalities that block progress to ending AIDS. That’s why I’m proud that our new strategy places tackling inequalities at its heart. We must seize this moment to ensure health equality for all in order to beat COVID-19 and end AIDS.”
HIV and COVID-19
HHS Issues Updated Guidance on COVID-19 and HIV
The U.S. Department of Health and Human Services (HHS) recently released updated Guidance for COVID-19 and Persons with HIV. The update incorporates information from several observational cohort studies that have provided new insights into the risk of severe COVID-19 in persons with HIV. The guidance was prepared by working groups from five expert panels responsible for developing HHS guidelines on the management of HIV disease and opportunistic infections in adults, adolescents, and children.
HHS now recommends that people with HIV should receive SARS-CoV-2 vaccines regardless of their CD4 count or HIV viral load, because the available evidence indicates that the potential benefits of vaccination outweigh the potential risks.
The guidance summarizes recent information on several drugs currently used to treat COVID-19, including drugs that have received FDA approval (remdesivir), are commonly used (dexamethasone), or are available through FDA emergency use authorization (EUA). The latter group includes anti-SARS-CoV-2 monoclonal antibodies, the janus kinase inhibitor baricitinib, and convalescent plasma. The indications for using these drugs should be the same for people with HIV as for the general population, according to the updated guidance.
The guidance also includes updated information on the current understanding of the clinical course of COVID-19 in pregnancy, and stresses the importance of continuing antiretroviral therapy in pregnant women with HIV who are hospitalized for COVID-19.
In addition, the guidance summarizes current knowledge about COVID-19 in pediatric patients, including a discussion of multisystem inflammatory syndrome in children (MIS-C), which has been reported in more than 2,600 U.S. children since the start of the pandemic. The guidance stresses the importance of following the recommendations of the HHS Pediatric Antiretroviral Guidelines for managing children with HIV during the pandemic.
Ending the HIV Epidemic
HRSA: Progress in Expanding Access to HIV Care and Services in RWHAP
During the past year, HRSA has funded Ryan White HIV/AIDS Program (RWHAP) Parts A and B jurisdictions to implement innovative activities to link people with HIV to essential HIV care, treatment, and support services. These efforts – which focus on people who are either newly diagnosed with HIV or previously diagnosed but currently not in care – are designed to help more people with HIV access care and treatment in order reach HIV viral suppression and reduce HIV transmission.
In a recent blog item on HIV.gov, Antigone Dempsey of HRSA’s HIV/AIDS Bureau shared early results of these efforts, which are funded as part of the federal Ending the HIV Epidemic (EHE) initiative. In the first six months, nearly 10,000 people were served, of which 6,300 were new to RWHAP and 3,600 were re-engaged in HIV care and treatment services funded through the EHE initiative. An important year one goal of these efforts is to engage or re-engage a total of 18,000 people in HIV care and treatment.
Despite the challenges presented by COVID-19, the EHE funding recipients “made significant progress toward implementing their EHE work plans,” according to Dempsey. “This progress included developing administrative and service delivery infrastructure, engaging with community members and new partners, and delivering services to clients.” The innovative activities implemented by RWHAP Part A and B jurisdictions include:
- leveraging new technologies, such as telehealth and mobile apps;
- developing and implementing new service delivery models and programs, such as rapid initiation of antiretroviral therapy, community health workers/peer navigators, differentiated service delivery, and mobile care/outreach; and
- supporting new infrastructure development, conducting data-to-care projects, and building relationships with new partners.
Updates from the 70th Meeting of PACHA
The 70th meeting of the Presidential Advisory Council on HIV/AIDS (PACHA), which took place virtually on March 8 and 9, featured a federal panel on the Ending the HIV Epidemic initiative and the HIV National Strategic Plan. A variety of presentation materials from the meeting are available on the PACHA website. These include video recordings of Part 1 and Part 2 sessions on March 8, and Part 3 and Part 4 sessions on March 9. Slide sets are also available for the following presentations:
- Update on the Ending the HIV Epidemic Initiative and HIV National Strategic Plan
- HRSA’s HIV/AIDS Bureau Role in the Ending the HIV Epidemic Initiative
- CDC’s Efforts to End the HIV Epidemic & Reduce Disparities
- HIV and COVID-19: Getting to Zero Through Greater Health Equity
During the meeting, PACHA members unanimously passed a resolution that makes a series of recommendations to President Joseph Biden for ensuring equity and justice in ending the HIV epidemic in the United States.
New AIDSVu Resources Highlight HIV Among Women and Among American Indians/Alaska Natives
In commemoration of National Women and Girls HIV/AIDS Awareness Day on March 10 and National Native HIV/AIDS Awareness Day on March 20, AIDSVu published several blog items and updated infographics highlighting new HIV diagnoses and trends in these two demographic groups. The resources focusing on women and HIV include an overview of HIV among women in the U.S., an interview with Dázon Dixon Diallo (founder and president of SisterLove), and the following series of updated infographics:
- Women Accounted for One-Fifth of All New HIV Diagnoses in 2019
- New HIV Diagnoses Among Women Decreased in Nearly All Age Groups from 2016 to 2019
- Disproportionate Impact of HIV on Black Women
- Most HIV Diagnoses Among Women Are Attributed to Heterosexual Contact
- HIV Prevalence Among Transgender Women by Race
- HIV Care Continuum Among Women
- Low PrEP Usage Rates Among Women
- States with the Lowest PrEP-to-Need Ratios Among Women
- Association Between Poverty and HIV Diagnoses Among Women
- Association Between Health Insurance Coverage and HIV Diagnoses Among Women
The new AIDSVu resources highlighting HIV among American Indian/Alaska Native (AI/AN) people include an overview article and an interview with Richard Haverkate (national HIV/HCV program coordinator for the Indian Health Service), focusing on injection drug use and hepatitis C trends among AI/AN people. AIDSVu has also produced the following series of updated infographics on HIV among AI/AN people:
- Increase in HIV Diagnoses Among AI/AN People from 2018 to 2019
- New HIV Diagnoses Among AI/AN Gay and Bisexual Men & AI/AN Women
- Among AI/AN People, Young Adults Aged 25 to 34 Accounted for Nearly One-Third of All New HIV Diagnoses
- Increases in New HIV Diagnoses Among AI/AN People by Gender
- HIV Care Continuum Among AI/AN People
- Five States with the Most New HIV Diagnoses Among AI/AN People
NACCHO Highlights Key Issues in U.S. Viral Hepatitis Response During the COVID-19 Pandemic
“The [COVID-19] pandemic has exacerbated existing challenges in the nation’s public health care system, further exposing decades, if not centuries, of health inequities and its impact on social determinants of health,” according to HHS’s recently released Viral Hepatitis National Strategic Plan for the United States. The National Association of County and City Health Officials (NACCHO) has published a 2-page fact sheet that summarizes communities’ efforts to respond to COVID-19 and the ways the pandemic has impacted hepatitis services, including vaccination, syringe services, surveillance, testing, and treatment. The fact sheet also identifies five populations at risk for viral hepatitis who are disproportionally impacted by the pandemic – racial/ethnic minorities, persons who use drugs, incarcerated persons, homeless persons, and those without access to routine medical care – as well as five things communities need to respond effectively to viral hepatitis during the pandemic.
NASTAD Launches Center for Innovation and Engagement Site
The National Alliance of State and Territorial AIDS Directors (NASTAD) recently launched its Center for Innovation and Engagement (CIE) website. The resource is designed to equip HIV providers “with evidence-informed approaches to better engage and retain people living with HIV in care,” according to NASTAD’s health equity director Rosy Galván. CIE is the result of a collaboration between NASTAD, Northwestern University, Howard Brown Health Center, and Impact Marketing + Communications. The CIE site currently has detailed information about 14 interventions that focus on HIV testing, linkage to care, and retention in care. CIE’s Innovation Lab also has tips on working with particular communities and implementing programs, a calculator to help people determine the costs of replicating interventions, and special concerns during the COVID-19 pandemic.
Other COVID-19 News
Recent COVID-19 Reports from MMWR
CDC’s Morbidity and Mortality Weekly Report (MMWR) is continuing to provide extensive coverage of COVID-19-related research. CDC has aggregated the MMWR reports on a page devoted to studies about COVID-19 and has summarized recent research in a weekly podcast. For your convenience, we have compiled links to recent MMWR papers below:
- County-Level COVID-19 Vaccination Coverage and Social Vulnerability – United States, December 14, 2020-March 1, 2021
- COVID-19 Vaccine Second-Dose Completion and Interval Between First and Second Doses Among Vaccinated Persons – United States, December 14, 2020-February 14, 2021
- Effectiveness of the Pfizer-BioNTech COVID-19 Vaccine Among Residents of Two Skilled Nursing Facilities Experiencing COVID-19 Outbreaks – Connecticut, December 2020-February 2021
COVID-19 Racial and Ethnic Disparities
- Racial and Ethnic Disparities in COVID-19 Incidence by Age, Sex, and Period Among Persons Aged <25 Years – 16 U.S. Jurisdictions, January 1-December 31, 2020
- Counties with High COVID-19 Incidence and Relatively Large Racial and Ethnic Minority Populations – United States, April 1-December 22, 2020
COVID-19 and Schools
- COVID-19 in Primary and Secondary School Settings During the First Semester of School Reopening – Florida, August-December 2020
- Low SARS-CoV-2 Transmission in Elementary Schools – Salt Lake County, Utah, December 3, 2020-January 31, 2021
- Pilot Investigation of SARS-CoV-2 Secondary Transmission in Kindergarten Through Grade 12 Schools Implementing Mitigation Strategies – St. Louis County and City of Springfield, Missouri, December 2020
- Association of Children’s Mode of School Instruction with Child and Parent Experiences and Well-Being During the COVID-19 Pandemic – COVID Experiences Survey, United States, October 8-November 13, 2020
- Minimal SARS-CoV-2 Transmission After Implementation of a Comprehensive Mitigation Strategy at a School – New Jersey, August 20-November 27, 2020
- First Identified Cases of SARS-CoV-2 Variant P.1 in the United States – Minnesota, January 2021
- Travel from the United Kingdom to the United States by a Symptomatic Patient Infected with the SARS-CoV-2 B.1.1.7 Variant – Texas, January 2021
COVID-19 Direct and Indirect Health Impacts
- Rapid Scale-Up of an Antiretroviral Therapy Program Before and During the COVID-19 Pandemic – Nine States, Nigeria, March 31, 2019-September 30, 2020
- Symptoms of Anxiety or Depressive Disorder and Use of Mental Health Care Among Adults During the COVID-19 Pandemic – United States, August 2020-February 2021
- Association of State-Issued Mask Mandates and Allowing On-Premises Restaurant Dining with County-Level COVID-19 Case and Death Growth Rates – United States, March 1-December 31, 2020
- Body Mass Index and Risk for COVID-19–Related Hospitalization, Intensive Care Unit Admission, Invasive Mechanical Ventilation, and Death – United States, March-December 2020
- Notes from the Field: Opioid Overdose Deaths Before, During, and After an 11-Week COVID-19 Stay-at-Home Order – Cook County, Illinois, January 1, 2018-October 6, 2020