Inside This Issue: PEPFAR reduces all-cause mortality; COVID-19 vaccine saves nearly 40,000 lives of seniors; U.S. moves toward authorizing more COVID-19 boosters; PrEP awareness and use among Hispanic/Latino persons; and more.
PEPFAR Associated with 20% Reduction in All-Cause Mortality in Funded Countries
Since its inception in 2003, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has invested over $85 billion in the global HIV/AIDS response, saving more than 20 million lives, preventing millions of HIV infections, and accelerating progress in controlling the global HIV/AIDS epidemic. To assess the program’s broader impacts on health outcomes, researchers from the Kaiser Family Foundation (KFF) recently analyzed changes in the mortality rate in 90 PEPFAR-recipient countries between 2004 and 2018 compared to similar low- and middle-income countries during that period.
They found that PEPFAR funding was associated with large, significant declines in mortality, including the following:
- Overall, the all-cause mortality rate in the 90 countries receiving PEPFAR funding was 20% lower than what would have been expected without PEPFAR support.
- Compared to non-PEPFAR countries, PEPFAR-recipient countries with the highest per capita PEPFAR spending had the greatest reduction in all-cause mortality (27%), while those with the lowest level of PEPFAR investments had more modest reductions in mortality (16%).
- The decline in the mortality rate has continued over the course of the program, including in all three major five-year PEPFAR program phases. The largest reductions in mortality occurred in the first two phases, with a more modest, but significant, drop thereafter.
“These findings provide strong evidence that PEPFAR continues to have a significant and positive impact on health outcomes in the countries in which it works and that future investments would be expected to yield additional reductions in mortality,” the report noted. “They also suggest that PEPFAR has had positive spillover effects beyond HIV.”
HHS: Vaccination Helped Prevent Nearly 40,000 Deaths Among Seniors Earlier This Year
A new study conducted by researchers with HHS’s Office of the Assistant Secretary for Planning and Evaluation (ASPE) indicates that COVID-19 vaccinations helped prevent an estimated 265,000 COVID-19 infections, 107,000 hospitalizations, and 39,000 deaths among Medicare beneficiaries between January and May 2021. The ASPE analysis, which is based on individual-level health data and county-level vaccination rates, also found that reductions in cumulative weekly deaths occurred for all racial and ethnic groups, and across all 48 states included in their sample. During the study period, when vaccination rates increased from 1% to 47% among adults 18 to 64 and from 1% to 80% among seniors, there was an 11% to 12% decrease in weekly COVID-19 hospitalizations and deaths among Medicare beneficiaries for every 10% increase in county vaccination rates.
American Indian and Alaska Native Medicare beneficiaries saw the largest vaccination-related percentage decrease in infections, hospitalizations, and deaths. The study also found that COVID-19 vaccination was linked to a reduction of about 5,600 deaths among nursing home Medicare beneficiaries, a group that was disproportionately impacted by the pandemic.
“The difference in vaccination rates for those age 65 and older between the lowest (34%) and highest (85%) states by the end of May highlights the continued opportunity to leverage COVID-19 vaccinations to prevent unnecessary hospitalizations and premature deaths,” the report concludes.
U.S. Moves Toward Authorizing Additional COVID-19 Vaccine Boosters
During the past week, the U.S. Food and Drug Administration (FDA) vaccine advisory panel recommended that some persons who have been vaccinated with Moderna and Johnson & Johnson (J&J) vaccines be eligible to receive booster doses to preserve and enhance their protection against COVID-19. On October 14, the panel voted unanimously in favor of authorizing booster shots of the Moderna COVID-19 vaccine for certain groups of people who have already been fully vaccinated with the Moderna vaccine. These groups are: people age 65 and older; people 18 to 64 years old with risk factors for severe COVID-19; and people, such as health care workers, whose jobs place them at high risk for serious complications of COVID-19.
On the following day, the FDA vaccine panel unanimously recommended that all J&J vaccine recipients 18 years and older be eligible to receive a J&J booster as early as two months after the first dose. It is important to note that the vaccine advisory committee’s recommendations for the Moderna and J&J boosters most still be reviewed and endorsed by FDA and CDC before the boosters are officially authorized for use. We expect to include an update on COVID-19 vaccine boosters in the next issue of this newsletter.
HIV Pre-Exposure Prophylaxis
CDC Examines PrEP Awareness and Referrals Among Hispanic/Latino Persons
Awareness and use of HIV pre-exposure prophylaxis (PrEP) have increased rapidly in the U.S. during recent years. However, PrEP knowledge and use vary significantly by race/ethnicity, age, gender, and region. To examine PrEP awareness and referral to providers among Hispanic/Latino persons, CDC researchers analyzed National HIV Prevention Program Monitoring and Evaluation data for approximately 311,000 persons tested for HIV at CDC-funded sites during 2019.
They found that about one-quarter (27.4%) of the Hispanic/Latino persons tested were aware of PrEP, and 22.0% of those who received a negative HIV test result and were eligible for referral were referred to PrEP providers. PrEP awareness and referrals among Hispanic persons were slightly higher than among Black persons (26.2% aware of PrEP, and 20.8% referrals). However, these PrEP measures were significantly lower among Hispanic persons compared with non-Hispanic White persons (31.4% aware of PrEP, and 25.9% referrals) and persons in other racial/ethnic groups (42.1% aware of PrEP, and 25.8% referrals).
“Broader implementation of PrEP services among Hispanic persons at risk for HIV infection is an essential strategy of the EHE [Ending the HIV Epidemic] initiative,” according to CDC. “HIV prevention programs can help achieve the goals of the EHE initiative by addressing individual, social, and structural barriers to receipt of PrEP services, collaborating with health care and other providers, expanding health care coverage, and implementing culturally and linguistically relevant strategies for Hispanic persons.”
Funding Awards and Opportunity
HHS Awarded $2.21 Billion in Ryan White Program Grants During FY2021
During Fiscal Year (FY) 2021, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), awarded a total of about $2.21 billion in Ryan White HIV/AIDS Program (RWHAP) grants. These grants went to a wide variety of recipients, including states, counties, cities, and local community-based organizations. “This funding supports a comprehensive system of HIV primary medical care, medication, and essential support services critical to improving the health outcomes of nearly 560,000 people with HIV in the United States,” according to HHS. Here is a brief summary of the FY2021 awards made under the different parts of the RWHAP:
Part A: Fifty-two metropolitan areas received grants totaling about $621.4 million to provide core medical and support services for people with HIV. These grants were awarded to highly impacted urban areas that had the highest number of people with HIV and AIDS. A list of Part A recipients and their awards is available here.
Part B: A total of about $1.3 billion was awarded to 59 states and territories to improve the quality, availability, and organization of HIV health care and support services and to fund the AIDS Drug Assistance Program (ADAP). In addition, 16 states received Emerging Community grants based on the number of AIDS cases reported during the most recent five-year period. Twenty-nine states and territories were also awarded about $10.2 million in Part B Minority AIDS Initiative grants. A list of Part B recipients and their awards is available here.
Part C: Nearly 350 local, community-based organizations received a total of $179.8 million in Early Intervention Services (EIS) awards to provide core medical and support services to people with HIV. In addition, 30 organizations were awarded about $4.4 million in Capacity Development grants. Separate lists of Part C recipients and their awards are available for EIS and capacity development activities.
Part D: A total of about $67.2 million was awarded to 114 local community-based organizations to provide family-centered comprehensive HIV care and treatment for women, infants, children, and youth with HIV. A list of Part D recipients and their awards is available here.
Part F: A total of about $67.6 million was awarded to support clinical training, oral health services, quality improvement, and the development of innovative models of care through several different programs. These awards included: $12.4 million for dental programs; $30.3 million in support for the AIDS Education and Training Centers (AETC) Program; and $9.9 million to support the RWHAP Special Projects of National Significance (SPNS) Program. Separate lists of Part F recipients and their awards are available for dental, AETC, and SPNS programs.
“For more than three decades, HHS has driven federal efforts to end the HIV epidemic in our country and improve health outcomes for people with HIV,” noted HHS Secretary Xavier Becerra. “These funds support viral suppression that saves lives, reduces health disparities, and slows the spread of HIV. We will continue to support the Administration’s goal of ending the HIV epidemic in the United States.”
Funding Opportunity: Enhanced Surveillance of Persons with Early and Late HIV Diagnosis
The CDC has issued a notice of funding opportunity (NOFO) CDC-RFA-PS22-2202 for strategies and activities that support enhanced surveillance among persons with early or late HIV diagnoses. These will inform understanding of the individual- and systems-level barriers that prevent people from fully realizing the benefits of current prevention and testing interventions. The strategies and activities covered in this NOFO include identifying, contacting, and recruiting people who received an early or late HIV diagnosis in the past year to participate in behavioral interviews to be conducted by a CDC contractor.
Recipients of this funding will also engage local community partners to ensure that appropriate approaches are used to recruit participants and to disseminate findings to the community. Eligible applicants for this NOFO include all U.S. state health departments, the six local health departments with independent HIV surveillance programs, the District of Columbia Department of Health, and territorial health departments. CDC expects to make 20 awards totaling $8 million. The application deadline is December 17.
HIV Dashboard Now Includes Data on Social Determinants of Health
HHS recently added data on social determinants of health (SDOH) to America’s HIV Epidemic Analysis Dashboard (AHEAD). The addition of these data is expected to help stakeholders in the Ending the HIV Epidemic (EHE) initiative develop more comprehensive and data-driven plans of action to meet the diverse needs of their jurisdictions. “Data on SDOH help provide context to understand the drivers of health inequities and disparities,” notes Oskian Kouzouian, deputy director of HHS’s HIV.gov website. “Incorporating SDOH data into EHE planning and implementation allows community prevention planners to identify and address factors that may be significantly contributing to HIV morbidity and mortality in their communities.”
AHEAD now displays data on seven SDOH: 1) HIV stigma among persons living with HIV, 2) homelessness among persons living with HIV, 3) poverty levels, 4) Gini coefficient of income inequality, 5) educational attainment, 6) health insurance coverage, and 7) unemployment.
According to HHS, EHE stakeholders may use the SDOH data to:
- conduct analyses with HIV-related data to get an in-depth picture of the intersection of SDOH and HIV in communities;
- develop new, and enhance existing, programmatic and policy efforts to directly address SDOH relative to ending the HIV epidemic;
- assess possible changes to the implementation and delivery of HIV prevention and care and treatment services that would address identified barriers (such as transportation challenges); and
- monitor and better understand current and emerging trends in HIV outcomes.
CDC Letter and New AIDSVu Resources Focus on HIV Among Hispanic/Latinx Persons
Shortly before National Latinx AIDS Awareness Day, top HIV CDC officials Dr. Demetre Daskalakis and Dr. Jonathan Mermin distributed a Dear Colleagues letter highlighting HIV diagnoses and trends among Hispanic/Latinx persons. They also describe how social and structural factors, such as limited income and health care access, housing instability, discrimination, homophobia, transphobia, and?systemic racism have a significant influence on the overall health of some Hispanic/Latinx persons and can be barriers?to HIV testing, prevention, and treatment?services.
The AIDSVu website recently posted a blog item highlighting the impacts of HIV on Hispanic/Latinx persons, plus a new set of infographics about HIV in this population group. These infographics include:
- Number of Hispanic/Latinx Persons Ever Tested for HIV
- New HIV Diagnoses Among Hispanic/Latinx Persons by State During 2019
- Trends in HIV Diagnoses Among Hispanic/Latinx Females and Males from 2008 Through 2019
- Social Determinants of Health Among Hispanic/Latinx Persons
- Trends in HIV Infections Among Hispanic/Latinx Gay and Bisexual Men by Age
- HIV/AIDS Deaths Among Hispanic/Latinx Persons During 2019
- Late HIV Diagnoses by Race/Ethnicity During 2019
- HIV Care Continuum Among Hispanic/Latinx Persons
In the same blog item, AIDSVu has also published downloadable, Spanish-language versions of most of the infographics listed above.