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In Brief: August 3, 2021

Inside This Issue: CDC COVID-19 recommendations for vaccinated persons, $120 million funding for EHE initiative, new STI guidelines, global HIV funding update, and conference news. 

COVID-19 Prevention

CDC Updates Guidance for Fully Vaccinated Persons as COVID-19 Cases Surge

On July 27, the U.S. Centers for Disease Control and Prevention (CDC) updated its COVID-19 guidance to recommend that even fully vaccinated persons wear a mask indoors in public if they live or work in an area of substantial or high transmission. The agency issued this updated guidance in response to a recent surge in U.S. COVID-19 cases, particularly in areas where vaccination rates have been low. 

The 7-day moving average of new U.S. COVID-19 cases has nearly quintupled from a low of about 11,500 cases/day on June 19 to nearly 57,000 cases/day on July 26. During the week of July 19-25, nearly half (46%) of U.S. counties had high levels of COVID-19 community transmission, defined as at least 100 new cases/100,000 persons in the past 7 days.  An additional 17% of counties had substantial levels, defined as 50 to 99.99 cases/100,000 persons. (CDC tracks and maps countywide COVID-19 data here.)

“Wearing a mask is most important if you have a weakened immune system or if, because of your age or an underlying medical condition, you are at increased risk for severe disease, or if someone in your household has a weakened immune system, is at increased risk for severe disease, or is unvaccinated,” according to CDC. “If this applies to you or your household, you might choose to wear a mask regardless of the level of transmission in your area.” The agency also advises fully vaccinated persons to continue to wear a mask where required by laws, rules, regulations, or local guidance.

U.S. HIV Funding

Nearly $120 Million Awarded Under the EHE Initiative

As part of the federal Ending the HIV Epidemic in the U.S. (EHE) initiative, CDC recently awarded $117 million to state and local health departments to help rebuild and expand HIV prevention and treatment efforts as the U.S. recovers from COVID-19. This round of funding builds on initial investments awarded to health departments in 57 priority areas to expand and tailor key HIV prevention strategies to community needs. CDC noted that the available funding was distributed based on the severity of the epidemic and the number of focus counties within each state.

The EHE funds will be used to reduce health disparities as well as to support the following strategies for ending the U.S. HIV epidemic:

  • diagnosing all people with HIV soon after infection;
  • treating people with HIV rapidly and effectively to reach sustained viral suppression;
  • preventing new HIV transmissions through proven interventions, including pre-exposure prophylaxis and syringe services programs; and
  • responding quickly to potential HIV outbreaks with needed prevention and treatment services.

“Innovative, community-driven solutions are at the heart of EHE – and are already showing what is possible with expanded investment, collaboration, and locally tailored strategies,” noted Dr. Demetre Daskalakis, director of CDC’s Division of HIV/AIDS Prevention in a July 27 Dear Colleague letter. “With continued investment and innovation, we have a once-in-a-generation opportunity to end the HIV epidemic . . . By expanding and sustaining the EHE initiative, in combination with a comprehensive, whole-person approach to care that places the person ahead of their HIV status, we can bring the HIV epidemic in the U.S. to an end once and for all.” 

Sexually Transmitted Infections

Updated STI Treatment Guidelines from CDC

CDC has just published Sexually Transmitted Infections Treatment Guidelines, 2021. The guidelines provide current evidence-based diagnostic, management, and treatment recommendations, and are designed to serve as a source of clinical guidance for managing sexually transmitted infections (STIs). An estimated 26 million new cases of STIs occur in the U.S. each year and are responsible for nearly $16 billion in associated medical costs, according to CDC.

The new guidelines include many significant updates to the previous 2015 guidance, including the following:

  • updated treatment recommendations for chlamydia, trichomoniasis, and pelvic inflammatory disease;
  • updated treatment recommendations for uncomplicated gonorrhea in neonates, children, and other specific clinical situations (such as proctitis, epididymitis, and sexual assault);
  • information about FDA-cleared diagnostic tests for Mycoplasma genitalium and rectal and pharyngeal chlamydia and gonorrhea;
  • an expanded list of risk factors for syphilis testing among pregnant patients;
  • recommendations concerning two-step serologic testing for diagnosing genital herpes simplex virus;
  • harmonized recommendations for human papillomavirus vaccination with the Advisory Committee on Immunization Practices; and
  • recommendations concerning universal hepatitis C testing in alignment with CDC’s 2020 hepatitis C testing recommendations.  

CDC has developed new online and print resources reflecting the updated STI guidelines. These include a wall chart and pocket guide, as well as a PDF version of the full STI guidelines. The agency expects to release a new 2021 STI Treatment (TX) Guide mobile app soon.

Global HIV Epidemic

KFF Reports Examine HIV Funding in Low- and Middle-Income Nations

The Kaiser Family Foundation (KFF) recently issued two reports summarizing trends in funding to support the global HIV response. Donor Government Funding for HIV in Low- and Middle-Income Countries in 2020 tracks funding levels of donor governments that collectively provide the bulk of international assistance for AIDS through bilateral programs and contributions to multilateral organizations. The report includes data on disbursements to low- and middle-income countries and contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria as well as UNITAID and UNAIDS. In 2020, total donor funding for HIV to these nations increased about 5% ($377 million) to $8.2 billion.  This rise was driven almost entirely by a temporary increase in U.S. contributions to the Global Fund, according to KFF.

In the second report, Funding for Key HIV Commodities in PEPFAR Countries, KFF analyzes funding for key commodities to diagnose, treat, and prevent HIV in 34 low- and middle-income countries that receive funds from the President’s Emergency Plan for AIDS Relief (PEPFAR). Funding for HIV commodities in these countries was estimated to total about $3.05 billion, of which $1.95 billion (64%) was for antiretroviral drugs, followed by lab and diagnostic products ($779 million, 26%), other drugs ($177 million, 6%), condoms and lubricants ($59 million, 2%), and voluntary medical male circumcision ($42 million, 1%).


NIH Continues Funding to Support International HIV Database Centers

The National Institutes of Health (NIH) has renewed grants to seven regional centers that compose the International epidemiology Databases to Evaluate AIDS (IeDEA). The 15-year-old IeDEA program “efficiently advances knowledge about HIV by pooling and analyzing de-identified health data from more than two million people with HIV on five continents to answer research questions that individual studies cannot address,” according to NIH. The agency’s first-year funding for renewed IeDEA grants is $20.8 million – part of an expected five-year total of about $100 million. “The new funding will enable the program to add a Sentinel Research Network to prospectively collect cardiovascular, cancer, lung, metabolic, substance use and mental health data to characterize the sizeable impact of non-communicable diseases on people with HIV today,” NIH noted. “The new funding also will enable IeDEA to do in-depth assessments of tuberculosis in close collaboration with the Regional Prospective Observational Research in Tuberculosis International consortium, addressing cutting-edge questions in tuberculosis clinical care and pathogenesis.”

Health Disparities

HHS Launches Challenge to Reduce HIV-Related Stigma and Disparities

Late last month, the U.S. Department of Health and Human Services (HHS) announced the launch of The HIV Challenge, a national competition designed to engage communities in efforts to reduce HIV-related stigma and increase prevention and treatment among racial and ethnic minority people.

Through this competition, HHS is seeking innovative and effective approaches to increase the use of PrEP medication among people who are at increased risk for HIV, and the use of antiretroviral therapy among people already living with HIV. The HIV Challenge is open to the public. HHS will award a total of $760,000 to 15 winners over three phases ending in July 2022.  These are: Phase 1 – Design of Concept; Phase 2 – Development of Approach; and Phase 3 – Refinement of Approach and Small-Scale Testing.

In Phase 1, participants will develop concepts for community engagement strategies to reduce stigma related to HIV prevention and treatment within a specific population. In this phase, up to 15 submissions may be selected to each receive a prize of up to $20,000. Proposals for phase 1 must be submitted by September 23, 2021.

Participants selected to receive a Phase 1 prize will be eligible to submit proposals for Phase 2, which involves the creation of “well-developed approaches for community engagement strategies to reduce stigma related to HIV prevention and treatment,” according to HHS. Participants selected to receive a Phase 2 prize will be eligible to submit proposals for Phase 3, which will involve testing the dissemination and uptake of their approaches at a small scale/community level.

Conference News

Online Resources for the 11th IAS Conference on HIV Science

The 2021 International AIDS Society Conference on HIV Science (IAS Conference) was held virtually with a local partner hub in Berlin, Germany, between July 18 and 21. IAS has limited access to full conference materials to registered conference participants until mid-September, after which time they will be freely available to the public. An IAS Conference press release summarizes several important studies on HIV and COVID-19-related illnesses; improved strategies to treat highly drug-resistant TB; HIV drug resistance among PrEP rollout participants who acquire HIV; adherence to oral PrEP and the dapivirine vaginal ring; and sexual violence and HIV exposure during Uganda’s COVID-19 lockdown. Extensive coverage of IAS Conference news is available at the following websites: NAM/AIDSmap, NATAP, TheBodyPro, and Poz.

Free NEAETC Webinar to Summarize Highlights of the 2021 IAS Conference

The New England AIDS Education and Training Center (NEAETC) will hold a 90-minute webinar on August 11 summarizing highlights of the 2021 IAS Conference.  Physicians Kenneth Mayer, Rajesh Gandhi, and Rebecca Zash will cover a variety topics, including:

  • behavioral HIV prevention;
  • PrEP;
  • U=U/treatment as prevention;
  • antiretroviral (ARV) treatment for adults and adolescents;
  • ARV treatment adherence, including viral load suppression; and
  • hepatitis C

For more information and to register for this free webinar, please click on this hyperlink.

Registration Now Open for 2021 Hybrid RWHAP Clinical Conference

The 2021 Ryan White HIV/AIDS Program (RWHAP) Clinical Conference will be held from October 3 through 6 this year.  Organizers are planning a hybrid conference, with a limited in-person component and a virtual component for persons who are unable to travel. The conference, which is being coordinated through the AIDS Education and Training Centers, will include a mix of lectures, case-based interactive presentations, and small-group workshop breakout sessions. It will provide the latest updates on research, care, and treatment issues in the medical management of HIV infection.

The in-person component of the RWHAP Clinical Conference will be held at the Hyatt Regency San Francisco Embarcadero Hotel in California. In-person attendance will be limited to 300 HIV physicians, nurse practitioners, and physician assistants in RWHAP-funded clinics and programs. For additional information, including registration, please click on these hyperlinks for the in-person and virtual conference.

Other COVID-19 News

Recent Research Reports

CDC’s Morbidity and Mortality Weekly Report (MMWR) is providing continuing coverage of COVID-19-related research. CDC is archiving the MMWR reports on a page devoted to studies about COVID-19. For your convenience, we have compiled links to recent MMWR papers below:

COVID-19 Vaccine Safety in Adolescents Aged 12-17 Years – United States, December 14, 2020-July 16, 2021

Outbreak of SARS-CoV-2 Infections, Including COVID-19 Vaccine Breakthrough Infections, Associated with Large Public Gatherings – Barnstable County, Massachusetts, July 2021

Disparities in COVID-19 Vaccination Coverage Among Health Care Personnel Working in Long-Term Care Facilities, by Job Category, National Healthcare Safety Network – United States, March 2021

Guidance for Implementing COVID-19 Prevention Strategies in the Context of Varying Community Transmission Levels and Vaccination Coverage

SARS-CoV-2 Infection in Public School District Employees Following a District-Wide Vaccination Program – Philadelphia County, Pennsylvania, March 21-April 23, 2021

Changes in Influenza and Other Respiratory Viral Activity During the COVID-19 Pandemic – United States, 2020-2021

COVID-19 Vaccination Coverage Among Insured Persons Aged ≥16 Years, by Race/Ethnicity and Other Selected Characteristics – Eight Integrated Health Care Organizations, United States, December 14, 2020-May 15, 2021

COVID-19 Vaccine Administration, by Race and Ethnicity – North Carolina, December 14, 2020-April 6, 2021

Acceptability of Adolescent COVID-19 Vaccination Among Adolescents and Parents of Adolescents – United States, April 15-23, 2021

SARS-CoV-2 B.1.617.2 (Delta) Variant COVID-19 Outbreak Associated with a Gymnastics Facility – Oklahoma, April-May 2021