National HIV Prevention Conference – Highlights of Day 3
Focus on Improving Access to Care
Tuesday’s plenary session addressed the National HIV/AIDS Strategy (NHAS) goal of improving access to care, focusing on three important approaches that can help us reach that goal: adopting universal HIV testing, measuring community viral load, and implementing test and treat programs. My colleague Dr. Deborah Parham Hopson, Associate Administrator, HIV/AIDS Bureau at the Health Resources and Services Administration, moderated the session, which was structured as a series of brief, spirited debates between physicians examining the pros and cons of each of these approaches.
- Universal HIV Testing – Among the persuasive reasons presented in favor of this tool is that it is proven to be a cost-effective public health intervention; more widespread HIV testing can help us diagnose more infections earlier—improving health and saving medical costs; and routinizing HIV testing will help to decrease stigma.
- Community Viral Load (CVL) – This discussion brought up several challenges we face when attempting to measure CVL. It is not a perfect measure –since it does not include undiagnosed persons with HIV or those who are not in care. But it can provide a “snapshot” that reflects whether persons are diagnosed in a timely manner and whether they are being retained in care. Comparing CVL across different population groups or by geographic locale of services can pinpoint disparities requiring program interventions to improve timeliness of HIV diagnosis and/or enhanced efforts to retain clients in care.
- Test and Treat – The final discussion was over the merits of the idea that if we increase the number of people who get tested for HIV and get those who are infected on treatment as soon as possible, we may decrease the overall HIV transmission rate in the larger population. Given the proven life-saving benefits of antiretroviral treatment and the recent findings of Dr. Myron Cohen’s study (HPTN 052Exit Disclaimer) (PDF) showing that early initiation of antiretroviral therapy reduces rates of sexual transmission of HIV, there was broad support for the usefulness of “Test and Treat”. However, panelists cautioned that to be successful we must ensure prompt access to antiretroviral therapy, which means addressing waiting lists for the AIDS Drug Assistance Program (ADAP).
Other Strategy-Related Highlights from the Day
The conference agenda was packed with dozens of informative sessions. Highlights of some of the sessions my team and I participated in include the following.Bringing HIV Prevention Programs to College-Age Minority Students: The Minority-Serving Institutions HIV Prevention Sustainability Demonstration—This session provided highlights from the first year of a three-year demonstration project, supported by the Secretary’s Minority AIDS Initiative Fund, designed to build capacity for and sustain HIV prevention and sexual health programs on the campuses of minority-serving institutions of higher education. Representatives from three of the participating institutions—Dine College (a Tribal College), Florida International University (a Hispanic-Serving Institution), and North Carolina Central University (a Historically Black University)—shared insights about the lessons, opportunities and barriers they have encountered. Among the lessons were the importance of strategies to secure the buy-in and support of the institution’s leadership and the importance of ensuring that the interventions selected—from use of peer educators to social marketing campaigns—are culturally competent and that the messages are culturally relevant.
African American Gay and Bisexual Men—In another of yesterday’s sessions, CDC’s HIV prevention communications team discussed their efforts to develop an HIV testing campaign for Black gay and bisexual men. Later in the day, the campaign was launched at an event attended by many who advised during the campaign’s development. The new campaign, “Testing Makes Us Stronger,” is the result of extensive formative research that included a panel of community advisors and an in-depth concept and message development process that involved input from more than 400 Black men in five U.S. cities. Members of the target audience were consulted on their recommendations about the best placements for the resulting online and print materials. The campaign will roll out nationally and in selected cities beginning in September. Watch Act Against AIDS for details. The urgent need for this targeted campaign was brought into even sharper focus by the new estimates of annual HIV infections in the U.S. released by the CDC earlier this month.
Asian Americans, Native Hawaiians, and Pacific Islanders and the National HIV/AIDS Strategy—This session highlighted the importance of improved data collection and HIV surveillance data within the Asian American, Native Hawaiian and Pacific Islander (AA&NHPI) communities. Local jurisdictions use the race and ethnicity categories for AA&NHPI in different ways, which impacts the availability of HIV prevention resources for these communities. Presenters recommended that all jurisdictions use the new HHS draft standards for collecting and reporting data on race, ethnicity, sex, primary language and disability status. Panelists also expressed concern that the lack of data distinguishing foreign-born versus U.S.-born AA&NHPIs makes it difficult to appropriately tailor prevention and treatment interventions. Strengthening the quality of data about these populations will enable us to address existing disparities in HIV testing rates and linkage to care.
The Strategy and Hispanic/Latino Communities—Another session explored “Why NHAS Matters for the Hispanic/Latino Communities.” Panelists observed that HIV has a disproportionate impact on the fastest-growing ethnic minority group in the U.S.; a disparity that is exacerbated by factors including the lack of access to health care, language barriers, and immigration status. However, Mr. James Albino of the White House Office of National AIDS Policy, and other panelists noted that the Strategy holds significant promise for addressing these disparities and even more promise when coupled with the implementation of the Affordable Care Act which will expand insurance coverage for uninsured and underinsured populations in the country. The panelists noted that the community will need to work to leverage these opportunities and that this will include efforts to engage the business community and other allies to support the Strategy’s goals.
HHS Listening Session About Implementation of the National HIV/AIDS Strategy—Yesterday afternoon I participated in a U.S. Department of Health and Human Services (HHS) listening session about the NHAS. During this session, senior HHS leadership heard from more than 30 conference participants who shared their ideas, suggestions, and requests for more information about progress in implementing the NHAS. Joining me at this listening session were: Mr. Jeffrey Crowley, Director of the White House Office of National AIDS Policy; Mr. Chris Collins of the Coalition for a National AIDS Strategy and Vice President for Public Policy at amfAR; Ms. Marlene McNeese, Chief of Houston’s Bureau of HIV/STD Prevention; Mr. Christopher Bates, Deputy Director of the HHS Office of HIV/AIDS Policy (OHAP); Dr. Kevin Fenton, Director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention; Dr. Deborah Parham Hopson, Associate Administrator, HIV/AIDS Bureau, Health Resources and Services Administration; and Dr. Gretchen Stiers, HIV/AIDS Policy Lead at the Substance Abuse and Mental Health Services Administration. Among the comments that we heard were:
- Recommendations about specific opportunities for enhanced coordination across federal agencies—especially in terms of reporting requirements;
- Concerns about the impact of the ADAP waiting lists on our ability to achieve NHAS goals;
- A need for more and better communication about the progress being made by the various federal departments and agencies involved in implementing the Strategy;
- Calls to ensure that the Strategy serves specific populations including women, transgendered persons, and older Americans as well as those in rural communities; and
- A request for information and assistance regarding the implications that the implementation of the Affordable Care Act (ACA) will have for HIV care and how the Ryan White Care Program will change when the ACA is fully implemented.
We appreciated the important comments shared, as they demonstrate the passion and energy of the many partners who truly want to achieve the vision of the NHAS.
Elsewhere at the Conference
Elsewhere at the conference on Tuesday, the HIV.gov team continued its collaboration with CDC to provide technical assistance in the conference’s social media lab. In addition to providing one-on-one technical assistance, CDC and HIV.gov team members offered special workshops on usability, accessibility, and developing a new media strategy. Based on their three days of technical assistance at the conference, the team compiled a list of many of the questions they received and their responses.
Dr. Andrew Forsyth, Senior Science Advisor and the newest member of the OHAP staff, presented on a panel where he previewed HHS’ plans to develop a streamlined set of HIV/AIDS metrics that will be used across HHS HIV/AIDS programs.
Tune in tomorrow for our final daily conference wrap.