Inside This Issue: Updated ACA preventive care guidelines; clinical guidelines for pregnancy and perinatal HIV; new CDC guidance on masks and respirators; HHS mandates coverage of at-home COVID-19 testing; HIV discrimination and criminalization; and more.
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Women’s and Children’s Health
Updated ACA Preventive Care Guidelines Expand Care for Women and Children
On January 11, the Health Resources and Services Administration (HRSA) updated its comprehensive preventive care and screening guidelines to improve care women and for infants, children, and adolescents. The Affordable Care Act (ACA) requires certain group health plans and insurance issuers to provide coverage with no out-of-pocket cost for preventive health services within these comprehensive guidelines.
The latest guidelines for women include updates related to breastfeeding services and supplies, well-woman preventive care visits, access to contraceptives and contraceptive counseling, HIV screening, and counseling for sexually transmitted infections (STIs). “The resulting coverage without cost-sharing will help us achieve the goals of the STI National Strategic Plan and National HIV/AIDS Strategy for women,” according to HIV.gov. The updated guidelines for children include the addition of universal screening for suicide risk to the current Depression Screening category for adolescents and young adults ages 12 to 21, as well as new guidance for behavioral, social, and emotional screening.
The U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) has also issued an issue brief highlighting how the ACA has increased access to preventive care, including vaccinations, contraception, and cancer screening. According to the brief, more than 150 million people with private insurance, including 58 million women and 37 million children, are receiving preventive services with no cost-sharing, as required by the ACA.
HHS Expert Panel Revises Pregnancy and Perinatal HIV Clinical Guidelines
The HHS Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission recently updated several sections of the U.S. HIV clinical guidelines for pregnancy and the prevention of mother-to-child transmission. This most recent update includes revisions to the following guidelines sections:
- maternal HIV testing and identification of perinatal HIV exposure;
- pre-exposure prophylaxis (PrEP) to prevent HIV during periconception, antepartum, and postpartum periods;
- reproductive options for couples when one or both partners have HIV;
- recommendations for use of antiretroviral drugs during pregnancy;
- pregnant people with HIV who are currently receiving antiretroviral therapy
- acute HIV;
- perinatal HIV prevention for transgender and gender diverse people assigned female sex at birth; and
- antiretroviral management of newborns with perinatal HIV exposure or HIV infection.
COVID-19 Prevention and Testing
CDC Updates Guidance on Masks and Respirators
On January 14, the U.S. Centers for Disease Control and Prevention (CDC) updated its consumer webpage on face masks and respirators to emphasize protection, fit, and comfort. “To protect yourself and others from COVID-19, CDC continues to recommend that you wear the most protective mask you can that fits well and that you will wear consistently.” Recent changes to the guidance include clarification that:
- people can choose respirators such as N95s and KN95s for COVID-19 protection, without worrying about creating shortages of N95s;
- “surgical N95s” are a specific type of respirator that should be reserved for healthcare settings; and
- some types of masks and respirators provide more protection to the wearer than others.
“Masks and respirators (i.e., specialized filtering masks such as ‘N95s’) can provide different levels of protection depending on the type of mask and how they are used,” according to CDC’s mask and respirators page. “Loosely woven cloth products provide the least protection, layered finely woven products offer more protection, well-fitting disposable surgical masks and KN95s offer even more protection, and well-fitting NIOSH-approved respirators (including N95s) offer the highest level of protection. Whatever product you choose, it should provide a good fit (i.e., fitting closely on the face without any gaps along the edges or around the nose) and be comfortable enough when worn properly (covering your nose and mouth) so that you can keep it on when you need to.”
HHS Mandates That Health Insurers Cover Costs of At-Home COVID-19 Testing
Health insurance plans are now required to make at-home COVID-19 tests available, free of charge to the persons they insure, according to recent HHS guidance. “Over-the-counter test purchases will be covered in the commercial market without the need for a health care provider’s order or individualized clinical assessment, and without any cost-sharing requirements such as deductibles, co-payments or coinsurance, prior authorization, or other medical management requirements,” according to the HHS Centers for Medicare & Medicaid Services (CMS). “The new coverage requirement means that most consumers with private health coverage can go online or to a pharmacy or store, buy a test, and either get it paid for up front by their health plan, or get reimbursed for the cost by submitting a claim to their plan.” Insurers are allowed to limit the number of tests requested to eight per month. For additional details, see CMS’s fact sheet on free, at-home testing.
In related news, free at-home COVID-19 tests also became available from the federal government website COVIDtests.gov on January 19. Every home will be allowed to order four free tests with no shipping costs or need to provide a credit card number. The tests are expected to arrive about 7 to 12 days after they are ordered.
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HIV Discrimination and Criminalization
UNAIDS Finds That Punitive Laws Targeting Groups at High Risk for HIV Are “Alarmingly Common”
“Criminalization of same-sex sexual relations, sex work, drug possession and use, and HIV exposure, non-disclosure, and transmission have been shown to block HIV service access and increase HIV risk,” according to UNAIDS. In a recent analysis of data from its Laws and Policies Analytics data platform, UNAIDS found, “Countries that criminalize key populations saw less progress towards HIV testing and treatment targets over the past five years – with significantly lower percentages of people living with HIV knowing their HIV status and achieving viral suppression than in countries that avoided criminalization. Even greater gains were achieved in countries where laws have advanced human rights protections, particularly those that protected rights to non-discrimination and responded to gender-based violence. Despite this compelling evidence, discriminatory and punitive laws remain alarmingly common.”
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Educational Resources
New Report, Fact Sheet, and Slide Set from CDC
In recent weeks, CDC has published several new and updated resources on HIV. These include:
CDC-Funded HIV Testing in the United States, Puerto Rico, and U.S. Virgin Islands: 2020 Annual HIV Testing Report – This 23-page report describes the demographics of persons tested, persons with newly diagnosed HIV infection, and persons linked to HIV medical care in the U.S., Puerto Rico, and U.S. Virgin Islands in 2020. Information presented in this report include HIV test-level data reported to CDC through EvaluationWeb as of September 15, 2021 from 60 state and local health departments and 100 community-based organizations. According to the report, a total of about 1.34 million CDC-funded HIV tests were conducted in 2020. Of this number, 14,053 had a positive HIV test result, 6,458 were new HIV diagnoses (0.5% positivity), and 76% of persons with newly diagnosed HIV infection were linked to HIV medical care within 30 days.
HIV and African American Gay and Bisexual Men – This updated web resource and fact sheet summarizes HIV diagnoses among African American gay and bisexual men, with breakdowns and trends by age, as well as 2019 data on U.S. HIV prevalence and the HIV care continuum in these men. Information is also provided on challenges that place African American gay and bisexual men at higher risk for HIV and steps CDC is taking to address HIV in these men.
HIV Mortality 2019 – This 33-slide set provides an analysis of trends in rates and distributions of U.S. deaths for which HIV disease was the underlying cause. The slides are based on death certificate data compiled by the National Center for Health Statistics. CDC notes that, after rapidly increasing since the 1980s, the annual rate of death due to HIV disease peaked in 1994 or 1995 (depending on the demographic group), decreased rapidly through 1997, and continued to decrease much more slowly thereafter. Of HIV deaths in 2019, approximately three-quarters (74%) were among men, half (51%) were among Black/African American persons, 55% were among residents of the U.S. South, and 75% were among persons age 45 years or older. In addition, HIV remains among the leading cause of death for persons aged 25 to 44 years old, ranking 11th in 2019.
COVID-19 Videos Focus on Vaccination of Children
As part of the Greater Than COVID campaign, the Kaiser Family Foundation, the Black Coalition Against COVID, and UnidosUS have produced a video series in which doctors, nurses, researchers, and community health care workers provide facts and dispel misinformation about COVID-19 vaccines. The most recent videos, created in partnership with the American Academy of Pediatrics, discuss COVID-19 vaccines in children. There are about 40 videos in English and Spanish on this topic, including the following:
- Kids and COVID Vaccines: W. Kamau Bell Talks to Pediatricians About the COVID Vaccines (4 minutes)
- The Top 5 Things Parents Want to Know About the COVID-19 Vaccine for 5-11 Year Olds (4 minutes)
- Las 5 Cosas Principales que los Padres Quieren Saber Sobre la Vacuna Contra COVID-19 Para Niños 5-11 (3 minutes)
- How Do We Know the COVID-19 Vaccine Is Safe for Kids? (1 minute)
- What If I'm Not Sure About Getting My Kid a COVID-19 Vaccine? (1 minute)
- Get Vaccinated for COVID as a Family (1 minute)
Other COVID-19 News
Recent Data Summaries and Research Reports
CDC’s COVID Data Tracker Weekly Review highlights key data from its COVID Data Tracker, narrative interpretations of the data, and visualizations from the week. Themes of recent Weekly Review issues include keeping children safe from infection, and taking steps to avoid infection during the surge of the Omicron variant.
The Morbidity and Mortality Weekly Report (MMWR) is also providing continuing coverage of COVID-19-related research. CDC is archiving its MMWR reports on a page devoted to studies about COVID-19. For your convenience, we have compiled links to recent MMWR papers below.
COVID-19 Vaccine Safety in Children Aged 5-11 Years – United States, November 3-December 19, 2021
Investigation of a SARS-CoV-2 B.1.1.529 (Omicron) Variant Cluster – Nebraska, November-December 2021