This month the U.S. Department of Health and Human Services’ (HHS) Health Resources and Services Administration (HRSA) published a manuscript titled HRSA’s Ryan White HIV/AIDS Program’s (RWHAP) Response to the Opioid Epidemic in the October 2020 edition of the Journal of Infectious Diseases (JID). This manuscript was published as part of a thematic supplement titled “Infectious Diseases and Injection Drug Use: Public Health Burden and Response” hosted by JID and the U.S. Centers for Disease Control (CDC). This publication highlights articles on disease epidemiology and strategies that have affected injection drug use (IDU) associated conditions such as HIV.
The U.S. is in the midst of an opioid crisis, with increases in IDU-related HIV outbreaks, particularly in rural areas. This manuscript presents an analysis of the sociodemographic characteristics and substance use service utilization of RWHAP clients with HIV attributed to IDU nationwide compared to seven southern states with large rural epidemics identified through the Administration’s Ending the HIV Epidemic: A Plan for America initiative.
Each year, the RWHAP provides HIV care and support services to more than half a million people with HIV and is the largest federal government program focused on providing HIV care and treatment. Data from the 2017 RWHAP Services Report showed that 6.7 percent of RWHAP clients had HIV attributed to IDU. Nationwide, 17.5 percent of RWHAP providers delivered substance use services and 3.3 percent of RWHAP clients accessed these services (average 65 clients per provider). In the seven rural states, 6.5 percent of RWHAP clients accessed substance use services. When compared with RWHAP IDU clients nationally, IDU clients in the seven rural states were younger (aged <45 years), more likely to be White, and less likely to have Medicaid. Conversely, when compared with RWHAP clients who accessed substance use services nationally, clients in the seven rural states were more commonly Black/African American, had incomes above 100 percent of the federal poverty level and had stable housing, but were less likely to be covered by Medicaid.
Also presented in this manuscript are nine key themes from a HRSA-hosted technical expert panel where 13 RWHAP-funded recipients, HIV care providers, and opioid use disorder (OUD) experts convened to discuss the intersection of the RWHAP and the opioid epidemics. The panel emphasized the importance of a “whole person” approach to address the complexities of HIV and OUD care and treatment in the RWHAP. Panel findings and RWHAP data were used to develop implementation science projects that focus on addressing OUD and integrating behavioral health in primary care through initiatives such as those funded by the RWHAP Part F Special Projects of National Significance Program. In addition, other HRSA programs facilitate access to health care and substance use services in these areas through Health Centers, Rural Health Clinics, and remote care delivery via the AETC Telehealth Training Centers Program, Project ECHO initiatives, and Rural Health Information Hub.
HRSA’s RWHAP is uniquely positioned to integrate treatment for IDU-associated HIV infections with treatment for substance use disorder. In addition, HRSA has focused efforts to identify replicable, cost-effective, and adaptable interventions that meet the needs of people with HIV and OUD. By addressing the key themes identified by participants at HRSA’s technical expert panel and implementing effective evidence-informed projects in communities most affected by the HIV and opioid epidemics, the U.S. will be better equipped to end the HIV epidemic.