CDC, Division of HIV/AIDS Prevention (DHAP)

Update to the Federal AIDS Policy Partnership

Eugene McCray, MDDirector, DHAP

NCHHSTP, Office for Infectious Diseases, CDC

March 4, 2015

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Division of HIV/AIDS Prevention

DHAP – Mission and Key Areas

Supporting Prevention Programs

Tracking the HIV Epidemic

Supporting Prevention Research

Raising Awareness

Mission: To promote health and quality of life by preventing HIV infection and reducing HIV-related

illness and death in the U.S.

DHAP Budget (2014)

89%

11%

Extramural Intramural

Funding for Maximum Impact

72%

15%

8%

3% 2%

Prevention Programs

Surveillance

Technical Assistance

Operational Research

Program Evaluation

DHAP projects by mission category, total $665.99 Million (2014)*

Priorities Reducing New Infections

Expanded HIV testing in clinical and non-clinical settings “Prevention for Negatives” “Treatment as Prevention”

Improving Surveillance and use of data Strengthen surveillance systems by improving data quality and

data use to target and evaluate prevention efforts

Expanding HIP Activities Transition CBOs to HIP prevention approach

Prioritizing interventions that are…

Scientifically proven

Cost-effective

Scalable

… targeted to the right populations in the right geographic areas

... to achieve the greatest potential impact on the epidemic

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Advancing High-

Impact Prevention

(HIP)

FY16 President’s Budget Request

President’s FY 2016 funding request for NCHHSTP was $44.14M higher than 2014 enacted

The request was $12.65M higher than 2014 enacted funding levels for HIV prevention activities, including $6.4M to improve program effectiveness and $6.3M for HIV-prevention education in schools

HIV and AIDS prevention investments will continue to align activities with the NHAS and promote high-impact prevention that focuses resources on effective, scalable, and sustainable prevention strategies

High-Impact Prevention Progress Update for Health Department Program (12-1201)

Expanded prevention and care services and coordination

HD efforts in MSAs w highest burden of disease

Jurisdictions meeting FOA routine HIV testing objectives and increasing potential for retention in care

Increased routine testing in healthcare settings

Meet current FOA requirements

New biomedical strategies

Information and resources for MSM & providers

Increase utilization of surveillance data

New approaches to planning

More diverse engagement of non-traditional partners

Healthcare system transformation*

Social issues – stigma

Social determinants of health

Healthcare system transformation*

Human capital/capacity

Successes OpportunitiesChallenges

Supporting LGBT Work & Mitigating Poor Health Outcomes for MSM

Funding targeted towards communities experiencing heaviest disparities.

Organization Leadership & Inclusion• DHAP as coordinating office for domestic HIV, MSM

activities through CDC

Surveillance• Monitor trends in HIV incidence, prevalence, risk behaviors

Research• Increase understanding of drivers of HIV transmission

• Develop interventions and messaging in MSM in close partnership with communities

In addition to funding…

Programs• MSM testing initiative

• YMSM of color & transgender youth

• Training and capacity building; support for organizations serving MSM

Prevention Efforts in Transgender Community

Surveillance reporting 80% of jurisdictions reported that they collect transgender-specific data Although, issues exist with collecting and reporting transgender surveillance

data Technical assistance guidance Funding (YMSM, Transgender FOA -- PS11-1113)

$55M over five years to provide effective HIV prevention services Commitment to renew for FY 2017

New research Life Skills (for young transgender women aged 16-24) Girlfriends (for adult transgender women)

Public HIV campaigns Let’s Stop HIV Together Testing Makes Us Stronger

ACA: Essential Health Benefits

Covers a range of drugs across a broad distribution of therapeutic categories and classes and recommended drug treatment regimens treating all disease states without discouraging enrollment by any group of enrollees

Requires issuers’ formularies to provide appropriate access to drugs included in broadly accepted treatment guidelines/best practices

Changes should improve access to optimal preventative and treatment regimens for HIV and related comorbidities

“If an issuer places most or all drugs that treat a specific condition on the highest cost tiers, we believe that such plan

designs effectively discriminate against, or discourage enrollment by, individuals who have those chronic conditions.” - Notice of Benefit and Payment Parameters for 2016 Rule, CMS

Testing Reimbursement DHAP is supporting grantee efforts to address

these challenges by: Redirecting funds to support billing related activities Supporting a network of capacity building assistance providers

who can offer billing related technical assistance grantees; and Redesigning the NACCHO billing toolkit

DHAP recognizes payment models are rapidly evolving, and we need to prepare for both the present and future by: Positioning key public health partners, as recognized providers of

valued health services Actively partnering with key payers and policy innovators to

develop and test new models for delivering and paying for care

Infrastructure & System Implications Variation exists within and across states making it

difficult to provide universal guidance DHAP initiated program changes and demonstration

projects: will integrate HIV into larger healthcare delivery system when complete Example: Partnerships for Care (P4C) aims to identify and develop

effective models for partnership between Federally Qualified Health Centers (FQHCs) and health departments (HDs) to support HIV prevention and care.

Also, actively supporting transformation efforts through many of our core FOAs (CBOs, CBAs, etc.)

HIV Criminalization DOJ – leads government’s response

to laws that criminalize HIV exposure

CDC – provides information that policy makers use in drafting/revising criminalization laws

Current HIV exposure laws

Evidence about the risks of transmission

Source: Lehman JS, Carr, MH, Nichol AJ, et al. Prevalence and public health implications of state laws that criminalize potential HIV exposure in the United States. AIDS Behav 2014.

“Given that HIV-specific criminal laws may have wide-ranging social implications, states are

encouraged to utilize the findings of this paper as a basis to re-examine those laws, assess the

laws’ alignment with current evidence regarding HIV transmission risk, and consider whether current laws are the best vehicle to

achieve their intended purposes.”

DHAP

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Division of HIV/AIDS Prevention

Publications and Resources

Available by visiting the DHAP website:

www.cdc.gov/hiv/dhap/about.html

Or by calling:1-800-CDC-INFO

Division of HIV Prevention Centers for Disease Control and

Prevention Corporate Square, Atlanta GA

MS D-21

Q&A / DISCUSSION

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