President Biden’s Fiscal Year 2022 Budget Request Includes $670 Million for the Ending the HIV Epidemic Initiative
On May 28, 2021, the White House published President Biden’s Budget of the United States Government for Fiscal Year 2022 (October 1, 2021-September 30, 2022). A section on investing in public health infrastructure highlights the funding request for the Ending the HIV Epidemic in the U.S. (EHE) initiative:
- Commits to Ending the HIV/AIDS Epidemic. To help accelerate and strengthen efforts to end the HIV/AIDS epidemic in the United States, the Budget includes $670 million within HHS to help aggressively reduce new HIV cases while increasing access to treatment, expanding the use of pre-exposure prophylaxis, also known as PrEP, and ensuring equitable access to services and supports.
Details of the $670 million proposed for the EHE initiative are provided in the FY2022 Budget in Brief for the U.S. Department of Health and Human Services, which was also published on May 28, 2021. EHE is highlighted in the budget overview discussion early in the document:
“The budget provides $670 million across HHS to continue efforts to end the HIV epidemic in the United States by working closely with communities where HIV transmission occurs most frequently to implement effective prevention, diagnosis, and treatment strategies, and to address the disproportionate impact of HIV and Hepatitis C infections in Tribal communities. HHS programs have already made major progress in combating this epidemic. HRSA ensures equitable access to services and supports for low-income people with HIV through Health Centers as well as the Ryan White HIV/AIDS Program. In 2019, 88.1 percent of Ryan White HIV/AIDS Program clients were virally suppressed, a record level that exceeds the national average of 64.7 percent. HHS will build on this work to end the epidemic once and for all.”
The budget proposes the following amounts (in millions) by HHS agency for EHE in FY22:
|CDC-support to 57 focus jurisdictions||$275.00|
|HRSA-Ryan White HIV/AIDS Program||$190.00|
Congress will now consider the request as part of its responsibility to complete the annual federal appropriations and budget process.
Fiscal Year 2021 HHS Budget Resources for the Ending the HIV Epidemic Initiative
In December 2020, Congress passed and the President signed the fiscal year 2021 (FY21) federal budget, which included $404.5 million for implementation of the EHE initiative:
- $175 million for the Centers for Disease Control and Prevention (CDC) to reduce new HIV infections.
- $208.5 million for the Health Resources and Services Administration (HRSA), allocated as $105 million to deliver HIV care through the Ryan White HIV/AIDS Program (RWHAP); $102 million to provide HIV testing, linkage to care, and prescription of pre-exposure prophylaxis (PrEP) and associated medical costs through the Health Centers program; and $1.5 million for rural HIV technical assistance through Bureau of Primary Health Care-funded Primary Care Associations.
- $5 million to the Indian Health Service (IHS) for an initiative to treat or reduce the transmission of HIV and HCV.
- $16 million for the National Institutes of Health (NIH) for evaluation activities to identify effective interventions to treat and prevent HIV.
To date, the following FY21 funding opportunity announcements and awards have been made:
- HRSA awarded nearly $99 million to 61 RWHAP recipients to link people with HIV to essential HIV care and treatment and support services, as well as to provide workforce training and technical assistance. This included more than $87 million to 39 metropolitan areas and eight states, which are Ryan White HIV/AIDS Program Parts A and B jurisdictions, to enable recipients to implement strategies, interventions, approaches, and core medical and support services to reduce new HIV infections in the U.S. HRSA also awarded $3 million to 12 Ryan White HIV/AIDS Program Part F AIDS Education and Training Centers Program recipients to provide workforce capacity development and technical assistance to the identified jurisdictions. In addition, HRSA awarded $8 million to two organizations to continue providing technical assistance and systems coordination services to the 47 Ryan White HIV/AIDS Program Parts A and B jurisdictions. The awards were made in March 2021. View a list of the fiscal year 2021 Ryan White HIV/AIDS Program Ending the HIV Epidemic award recipients.
- HRSA announced the availability of funding to expand the number of health centers delivering HIV services in EHE jurisdictions with the FY21 Ending the HIV Epidemic – Primary Care HIV Prevention Notice of Funding Opportunity in December 2020. HRSA’s expansion of this funding in FY21 will support up to 175 additional health centers located in the 57 geographic locations prioritized by the EHE initiative. Like those funded in FY20 and continuing their work in FY21, the newly funded centers will expand HIV prevention services that decrease the risk of HIV transmission, focusing HIV testing, supporting access to and use of pre-exposure prophylaxis (PrEP), and linkage to HIV care and treatment. Award notices are anticipated in the summer of 2021. (Read about the initial outcomes of the health centers funded in FY20.)
- CDC announced the award of $117 million to state and local health departments in the 57 EHE jurisdictions to continue advancing innovation and health equity in the federal initiative to end HIV. The awards build on initial investments made in CDC’s FY20 Integrated HIV Programs for Health Departments to Support Ending the HIV Epidemic in the United States cooperative agreements (see below) and will be used to reduce health disparities related to the four EHE strategies: Prevent, Diagnose, Treat and Respond. The second year of funding will help rebuild and expand HIV prevention and treatment efforts as the U.S. recovers from COVID-19. The awards included $11 million for 19 communities to scale up quality HIV prevention services in sexually transmitted disease clinics. Read more about these awards.
Fiscal Year 2020 Budget Allocated Additional Resources for Ending the HIV Epidemic
In December 2019, Congress passed, and the President signed into law, a $1.4 trillion spending package for Fiscal Year (FY) 2020. The legislation appropriated $267 million for EHE activities, including:
- $140 million in new funding for the CDC’s Division of HIV/AIDS Prevention to expand the use of PrEP, develop approaches to better detect and respond to clusters of HIV cases, and invest in core HIV prevention programs at State and local health departments to provide the foundational infrastructure for the initiative.
- $70 million in additional funding for HRSA’s RWHAP to expand access to HIV treatment and antiretroviral therapy for those newly diagnosed with HIV.
- $50 million in continued funding for HRSA's Bureau of Primary Health Care to support outreach, testing, care coordination, and HIV prevention services, including the use of PrEP through community health centers.
- $1 million for HRSA to support technical assistance in rural states as part of the EHE.
- $6 million for NIH for targeted HIV research that includes continuing and expanding EHE-focused implementation research and disseminating best practices.
These increases are in addition to core CDC and HRSA appropriations for HIV prevention, care, treatment, and research programs that received full funding. NIH also received an additional $25 million to support its existing HIV/AIDS research portfolio, which is not specific to the initiative, but supports the highest priority areas of scientific research necessary to end HIV and improve health outcomes for persons affected.
However, $25 million requested for the Indian Health Service EHE activities was not appropriated.
To date, the following FY20 funding opportunity announcements and awards have been made:
- Integrated HIV Programs for Health Departments to Support Ending the HIV Epidemic in the United States: In July 2020, CDC awarded $109 million to state and local health departments to support the EHE Phase I jurisdictions in implementing the comprehensive Ending the HIV Epidemic plans that each one developed, informed by consultations with diverse stakeholders and community-level input. The funding awards are part of a five-year funding program, which will help state, local, and territorial health departments scale up four strategies that can end the epidemic: diagnosing all people with HIV as early as possible; treating people with HIV rapidly and effectively to reach sustained viral suppression; preventing new HIV transmissions with proven interventions, including PrEP and syringe services programs; and responding quickly to potential outbreaks to get needed prevention and treatment services to people who need them. As part of this effort, CDC also awarded a total of $3 million to seven state and local health departments to scale up quality HIV prevention services in STD clinics. View the table of awards by jurisdiction (PDF, 161 KB). Read more about the funding.
- HRSA awarded approximately $63 million to 60 Ryan White HIV/AIDS Program recipients to link people with HIV to essential HIV care and treatment and support services, as well as to provide workforce training and technical assistance: In February 2020, HRSA announced awards that included more than $55 million to 39 metropolitan areas and eight states, which are RWHAP Parts A and B jurisdictions, to enable recipients to implement strategies, interventions, approaches, and core medical and support services to reduce new HIV infections in the U.S. In addition, HRSA awarded approximately $3 million to 11 RWHAP Part F AIDS Education and Training Centers Program recipients to provide workforce capacity development and technical assistance to the identified jurisdictions. HRSA also awarded $5 million to two organizations to provide technical assistance and systems coordination services to the 47 Parts A and B jurisdictions. The funding announcements were issued in summer 2019.
- HRSA awarded nearly $54 million to 195 health centers with service delivery sites in geographic locations identified by the EHE initiative: Also in February 2020, HRSA announced this first-of-its-kind program that emphasizes outreach, HIV testing, partnerships, and workforce expansion to increase access to and use of PrEP, as well as linking individuals who test positive for HIV to treatment. HRSA’s Primary Care HIV Prevention (PCHP) funding opportunity was released in the fall of 2019 with applications due from eligible health centers in late December. Supporting both the Diagnose and Prevent pillars of EHE, health centers will use the funding to expand HIV prevention services that decrease the risk of HIV transmission, focusing on supporting access to and use of PrEP, as well expanding HIV testing in primary care settings and linking those who test positive to HIV care and treatment.
- NIH awarded $10 million to support implementation science research to advance the goals of EHE. In September 2020, NIH announced that it had awarded approximately $10 million in supplemental funds to 17 of its Centers for AIDS Research (CFARs) and AIDS Research Centers (ARCs), that are collaborating with partners in local communities on research to determine how best to leverage existing, highly effective tools to diagnose, prevent and treat HIV. Read more about this funding and view a list of the awards.
FY19 Resources Supported Preliminary Activities
HHS allocated some FY2019 resources, including $33 million from the Minority HIV/AIDS Fund (MHAF), to activities that supported jurisdictions and other stakeholders in initiating some preliminary EHE activities. This helped galvanize key stakeholders and community members following the initiative’s announcement, resulting in new ideas and collaborations focused on the goal of ending the HIV epidemic. The activities to which these FY2019 resources were allocated include:
- Launch of Ready, Set, PrEP: On December 3, 2019, HHS launched Ready, Set, PrEP, a national program that makes medications for PrEP, taken daily to prevent HIV, available at no cost to people without prescription drug insurance coverage. To qualify for the program, participants must test negative for HIV, receive a valid prescription from a healthcare provider, and not have prescription drug coverage. PrEP is a critical component of the Prevent pillar of EHE. FY2019 resources were awarded to support the process of patient verification, enrollment, distribution of the prescriptions, and a consumer and provider awareness campaign.
- Pilot Site Activities: HHS allocated MHAF resources to support four “jumpstart sites.” The Assistant Secretary for Health announced in July the allocation of resources to three jurisdictions to jumpstart activities under EHE. The funds—$1.5 million each to Baltimore City, Md.; DeKalb County, Ga.; and East Baton Rouge Parish, La.—are supporting the jurisdictions’ health departments to move swiftly to implement key parts of the initiative, including providing treatment for those living with HIV, increasing HIV testing, and expanding preventative services, including PrEP. Read about East Baton Rouge’s innovative efforts to expand HIV diagnosis, treatment, and prevention. In addition, IHS awarded $1.5 million of MHAF resources to the Cherokee Nation Health Service to launch an HIV pilot project to begin implementing and evaluating some key foundational activities to help accelerate progress toward ending the HIV epidemic in Indian Country.
- Rapid Planning Processes in 57 Phase I Jurisdictions: In June, CDC announced a Notice of Funding Opportunity, PS19-1906: Strategic Partnerships and Planning to Support Ending the HIV Epidemic in the United States, to support eligible state and local health departments to conduct a rapid planning process that engages the community, HIV planning bodies, HIV prevention and care providers, and other partners in aligning resources and activities to develop jurisdictional plans to end the HIV epidemic in the 57 jurisdictions prioritized in Phase I of the initiative. Then, in September 2019, HHS announced that $12 million of the Minority HIV/AIDS Fund was awarded to 32 CDC-funded state and local health departments to develop those comprehensive EHE plans that are tailored by and for each of the 57 jurisdictions prioritized in Phase I of the initiative. In addition, CDC awarded $1.5 million to NASTAD to provide technical assistance to the jurisdictions in developing and implementing those plans. Draft plans from each jurisdiction were submitted at the end of December 2019. Feedback on the plans was shared with jurisdictions by the end of March 2020.
- Efforts to End HIV in Ryan White Part A Jurisdictions: In June, HRSA awarded approximately $1 million to 10 metropolitan areas that are designated Part A jurisdictions under the RWHAP to support technical assistance that enhances efforts to end the HIV epidemic. Eight of those 10 jurisdictions are Phase I priority jurisdictions. Based on the awarded jurisdictions’ needs, activities under this initiative include community engagement, enhancing core medical and support services, infrastructure support, and information dissemination efforts.
- Targeted Implementation Research Projects: In September, NIH awarded approximately $11.3 million to 17 NIH-funded Centers for AIDS Research (CFARs) and six AIDS Research Centers (ARCs) funded by the National Institute of Mental Health (NIMH) to identify and design targeted implementation science research projects that address at least one of the key pillars of the initiative and support local initiative plans. As part of this effort, the CFARs and ARCs will build on existing relationships with local health authorities, community-based groups, and other HHS agencies involved in EHE. A total of 65 awards were made, funding research in 36 of the 48 counties and five of the seven states with a high rural burden, as well as in Washington, D.C., and Puerto Rico. The supplements were funded with NIH resources as well as $1.5 million in MHAF resources. View a list of awardees.
- Strengthening Capacity in Tribal Communities: IHS awarded $2.4 million to nine Tribal Epidemiology Centers to support American Indian and Alaska Native communities in reducing new HIV infections and relevant co-morbidities, specifically hepatitis C and sexually transmitted infections. Resources from the FY2019 MHAF supported these awards. The Tribal Epidemiology Centers will participate in regional- and national-level coordination, provide technical assistance and disease surveillance support to communities, and support the development of community plans to end the HIV epidemic throughout Indian Country. Read the announcement about the funding awards and view a list of the recipients.
- Deployment of PACE Officers: Teams of U.S. Public Health Service (USPHS) commissioned corps officers have been strategically deployed to HHS Regions 4, 6, and 9 to support the implementation of EHE in three HHS regions. The officers are deployed as part of the Prevention through Active Community Engagement (PACE) program of the Office of the Assistant Secretary for Health. This component of the larger PACE program is funded with resources from the MHAF. The two PACE officers in each region serve as public health educators about the initiative and its strategies, opportunities, and developments. They also engage with community stakeholders at various public forums to raise awareness of effective evidence-based HIV prevention, testing, and care interventions.
Read the announcement.