Dr. Jonathan Mermin, Director of CDC’s National Center for HIV, Viral Hepatitis, STD and TB Prevention, discussed High Impact Prevention—the approach to reducing new HIV infections being implemented by CDC and its partners—and its future. High Impact Prevention involves using combinations of scientifically proven, cost-effective, and scalable interventions targeted to the right populations in the right geographic areas. The approach is consistent with the National HIV/AIDS Strategy’s call to focus on reaching the right people in the right places with the right practices. Dr. Mermin observed that implementing High Impact Prevention over the past several years has involved aligning resources to match the burden of the epidemic as well as carefully assessing the effectiveness of the interventions being utilized—and stopping some of what we were doing because it was “leading us down the wrong path.”
According to Jono, implementation of High Impact Prevention has resulted in important program shifts, including an increase in the proportion of CDC-supported activities focused on prioritized HIV interventions, a doubling of jurisdictions with integrated HIV prevention and care planning, and increased HIV prevention activities for people living with HIV and gay, bisexual, and other men who have sex with men (MSM), especially Black MSM.
Indications that High Impact Prevention is working include the following findings from recent HIV surveillance data:
- At 87%, the proportion of persons with HIV who know their status is the highest ever
- Viral suppression among persons receiving HIV care increased from 72% in 2009 to 80% in 2013
- Between 2010-2014, annual new HIV diagnoses decreased 9%
- Declining death rates associated with HIV between 2010-2013 were seen in all race/ethnic groups
Addressing HIV disparities will be a critical component of what Jono called “HIP 2.0,” or the next generation of High Impact Prevention, which will encompass the following:
- Improving the proportion of persons with HIV who are aware of their status and engaged in care since 9 in 10 new HIV infections in the U.S. are transmitted by individuals either unaware of their status or aware of their positive status but not in care.
- Making HIV prevention, including PrEP services, a part of routine health care, educating patients and providers, and ensuring reimbursement for services.
- Merging goals and practices of clinical medicine, community, and public health through strategies such as Data to Care, which uses CD4 count and viral load surveillance data to identify people living with HIV who are not engaged in care or not receiving optimal care and helping connect them to the care they need and deserve.
- Improving sexual health education for youth.
- Coordinating and integrating prevention, testing, treatment, and partner services for HIV with those for sexually transmitted infections, hepatitis B and C.
- Continuing to monitor national and state progress as CDC has been doing through their regular HIV prevention progress reports.
New National HIV Testing Campaign and Online HIV Risk Reduction Tool LaunchedDuring his presentation, Jono launched two new national HIV awareness and education initiatives that provide vital information to help people reduce their risk of infection:
- Doing It is a new national, bilingual HIV testing campaign that uses humor to spark conversation and encourage people to get tested. Testing is essential to ending the HIV epidemic—recent studies suggest that nearly one-third of new infections are transmitted by people who don’t know they are living with HIV.
- CDC’s HIV Risk Reduction Tool is an interactive tool that provides customized information on the most current HIV prevention strategies and houses a visual estimator that allows users to compare the risk of different sexual activities and explore how one or a combination of prevention methods can change the risk of infection.
Encouraging the conference participants to ”think bigger and act faster,” Jono concluded by observing that while we may have turned the corner on HIV, we are still far from achieving our ultimate goal. To get there, we’ll need to prioritize the tools and programs that have the greatest impact on preventing new infections and integrate HIV treatment, PrEP, and the use of data to improve programs. He reminded us that if we achieve the NHAS 2020 goals, 300,000 new HIV infections will be prevented and we will save $127 billion in healthcare spending starting in 2020.