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In-Brief: February 12nd, 2018

In Brief is NEAETC's news service covering the latest developments and educational resources about HIV, hepatitis, health disparities, and related topics. To subscribe, please click HERE.

HIV Continuum of Care

CDC Study Examines Racial/Ethnic Disparities in Viral Suppression and HIV Transmission Risk

Although Non-Hispanic Blacks/African Americans (Blacks) represent 12% of the U.S. population, they accounted for an estimated 43% of persons living with HIV infection during 2014, and about 44% of all new HIV diagnoses in 2016. In a recent report analyzing data from the National HIV Surveillance System, CDC researchers found that only 41% of Blacks living with diagnosed HIV infection in 38 jurisdictions had sustained viral suppression in 2014. This viral suppression rate is substantially lower than that seen among Hispanics (50%) and Whites (56%). Among persons in care, Blacks experienced a longer period with a viral load greater than 1,500 copies/mL, “a circumstance that can adversely affect their health outcomes and increase their risk of transmitting HIV to others,” according to CDC.  Although prescription rates for antiretroviral treatment (ART) increased among Blacks who received HIV clinical care from 2009 to 2013, fewer Blacks received ART prescriptions (93%) than did Hispanics and Whites (95%). The CDC researchers conclude that, “Collaboration among health care providers, community-based organizations, and state and local health departments to strengthen programs that address barriers to HIV care, antiretroviral therapy prescription, medication adherence, and sustained viral suppression among Blacks, especially Blacks aged 13–24 years, could be beneficial in eliminating racial/ethnic disparities.”

Dramatic Improvements in Viral Suppression Among Black RWHAP Participants

Despite having low incomes and little to no health coverage, persons who get their HIV/AIDS care from the Ryan White HIV/AIDS Program (RWHAP) have relatively high rates of viral suppression and retention in care.  According to a recent TARGET Center blog posting for National Black HIV/AIDS Awareness Day, the rates of viral suppression among Blacks/African Americans (Blacks) who receive care from RWHAP improved dramatically from 63.3% in 2010 to 81.3% in 2016.  Black RWHAP clients also had high rates of retention in care during 2016 (80.8%) – with higher rates seen among women (83.1%) than among men (79.5%).  

In the blog, the TARGET Center highlighted several Ryan White initiatives focusing on Blacks:

His Health: Engaging Black MSM in HIV Care, which offers a compendium of care models, training modules, and resources for enhanced linkage, retention, and engagement strategies targeting Black MSM.

Well Versed, which is described as “a conversation-starting resource for healthcare providers and Black MSM”;

In It Together, a National Health Literacy Project for Black MSM; and 

Enhancing Access to and Retention in Quality HIV Care for Women of Color 

Pregnancy and HIV

New NIH Study Compares HIV Regimens for Pregnant Women

The National Institutes of Health (NIH) recently launched a large international study to compare the safety and effectiveness of three ART regimens for pregnant women living with HIV and the safety of these regimens for their infants.  The study will evaluate the current preferred first-line regimen for pregnant women recommended by the World Health Organization (WHO) and two regimens that contain new antiretroviral drugs (ARVs) that have become more widely used. WHO currently recommends a regimen of three ARVs – efavirenz (EFV), lamivudine (3TC) or emtricitabine (FTC), and tenofovir disoproxil fumarate (TDF) – for pregnant women living with HIV in resource-limited settings. However, this regimen is not well-tolerated by or otherwise appropriate for all women, according to NIH. The new study, called IMPAACT 2010, will compare maternal EFV/FTC/TDF with regimens containing a newer drug, dolutegravir (DTG), and either tenofovir alafenamide (TAF – an alternative formulation of tenofovir) or TDF. Researchers plan to enroll about 640 women who are 14 to 28 weeks pregnant, living with HIV, and not currently on ART. The women will be randomly assigned to treatment with EFV/FTC/TDF, DTG/FTC/TAF or DTG/FTC/TDF. Their infants will also be enrolled in the study and will receive local standard-of-care interventions to prevent HIV transmission after birth. “Therapies for pregnant women and new mothers should be based on the best available evidence, always keeping in mind the health of the woman, her developing fetus, and her newborn,” notes Nahida Chakhtoura of the Maternal and Pediatric Infectious Disease Branch at the National Institute of Child Health and Human Development. “The results of this study will help inform optimal treatment of pregnant women living with HIV in both resource-limited and well-resourced settings.”


Harm Reduction

NASTAD Sees Key Role for Supervised Injection Facilities in Response to HIV, Hepatitis, and Opioid Epidemics

Supervised Injection Facilities (SIFs) – legally sanctioned facilities where people who use intravenous drugs can inject pre-obtained drugs under medical supervision – should be an important element in a comprehensive strategy to end the intersecting epidemics of HIV, viral hepatitis, and opioid use, according to a recent issue brief from NASTAD.  “SIFs have been shown to reduce HCV/HIV transmission risks and link participants to testing, infectious disease treatment, medication-assisted treatment, and physical and behavioral health services. Studies of SIFs have shown that they do not lead to increases in drug use, frequency of injection, or levels of drug-related crime while effectively reducing overdose death and occurrence.”  The two-page brief includes a series of recommendations to guide health departments, policymakers, and community-based organizations in educating and engaging stakeholder groups about the potential benefits of SIFs. These include reducing the risk of HIV and hepatitis C transmission, and linking participants to testing, infectious disease treatment, medication-assisted treatment, and physical and behavioral health services.

AIDS United Announces $2.4 million in Grants Supporting Syringe Access

On February 1, representatives for AIDS United’s Syringe Access Fund (SAF) announced that the Fund was providing a total of nearly $2.4 million in grants to 62 organizations that work to prevent HIV and viral hepatitis by providing sterile injection equipment, health education and messaging, and local and regional advocacy.  “Access to sterile syringes is a proven public health tool to prevent the transmission of HIV and HCV,” said Jesse Milan Jr., president and CEO of AIDS United. “With the opioid epidemic raging, the SAF is needed now more than ever.”  Monique Tula, executive director of the Harm Reduction Coalition, a Fund grantee, noted that, “It's been a long hard push, combatting misconceptions and moral objections to services for people who use drugs, but we have seen some promising policy movement across the country.” She added, “As we continue our work, promoting sound, evidence-based strategies for protecting the health of people who inject drugs, we are thrilled to have the support of the Fund.”  For a full list of grant recipients, see AIDS United’s SAF Grantees page.

Program Highlight: PEPFAR

NEJM Article Spotlights 15-Year Achievements of PEPFAR

Launched in 2003, the President’s Emergency Plan for AIDS Relief (PEPFAR) has achieved remarkable success in providing HIV services in parts of the world hardest hit by the pandemic, according to a recent perspectives article in the New England Journal of Medicine.  Researchers Anthony Fauci and Robert Eisinger of the National Institute of Allergy and Infectious Diseases note that, by September 2017, PEPFAR-funded programs had:

• provided 13.3 million HIV-infected men, women, and children with antiretroviral therapy; 

• supported 15.2 million voluntary medical male circumcisions in eastern and southern African countries to reduce the risk of HIV transmission; 

• averted nearly 2.2 million perinatal HIV infections; and 

• provided care for more than 6.4 million orphans and vulnerable children.

“Over the past 15 years, PEPFAR has demonstrated the transforming results that can be realized by strong government leadership in the global health arena.  It is entirely possible to bring the HIV/AIDS pandemic to an end, and PEPFAR will undoubtedly play an essential role in this endeavor,” according to Fauci and Eisinger. “However, it is vital that support for this transformative program continue both to meet the immediate challenge of HIV/AIDS and to serve as the model for the control and elimination of other globally devastating infectious diseases.”

Educational Resources

NASHP Toolkit Focuses on Strategies to Improve HIV Health Outcomes

The National Academy for State Health Policy (NASHP) has developed a toolkit – State Strategies to Improve Health Outcomes for People Living with HIV. This new resource offers state officials guidance on sharing and using data, collaborating with stakeholders, and making policy and program changes to improve the overall health of people living with HIV. Last year, NASHP worked with 19 states to help them identify and implement policy and program changes to improve viral suppression rates among Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries living with HIV. Through this work, NASHP determined that state officials needed additional resources on a range of topics, such as data sharing and quality improvement. The state strategies toolkit, which was supported through a cooperative agreement between NASHP and the Health Resources and Services Administration, is one response to this need.  It currently includes more than 30 issue briefs, webinars, and presentations. NASHP plans to add new items to the toolkit on a regular basis, “providing state officials with up-to-date information and timely policy resources.”

Free Continued Education Activity on Delayed HIV Diagnosis

The Centers for Disease Control and Prevention (CDC) and Medscape recently announced a new free continuing education activity: Vital Signs: Human Immunodeficiency Virus Testing and Diagnosis Delays – United States.  (Note: Registration is required to access this activity.) According to CDC, after completing this learning activity, clinicians will be able to:

• describe diagnosis delay among persons infected with HIV, based on an analysis of data from the CDC’s National HIV Surveillance System, and missed opportunities for HIV testing, based on CDC’s National HIV Behavioral Surveillance;

• identify the proportions of persons in various high-risk populations who tested for HIV in the past 12 months; and

• determine the clinical and public health implications of these findings regarding HIV testing, missed opportunities for testing, and diagnosis delay among persons infected with HIV.

New Pediatric HIV Surveillance Slides from CDC

CDC has recently uploaded a new HIV surveillance slide set that contains 14 slides with charts, maps, and timelines summarizing HIV infection among children under 13 years old in the U.S., as well as perinatal HIV infection.  The slides include information about: pediatric HIV diagnoses, with breakdowns by age and race/ethnicity; trends in perinatal infection from 1985 to 2015; and the number of persons living with perinatally acquired HIV infection, with breakdowns by state.