Inside This Issue: HIV and viral hepatitis policy, treatment and care, global disease epidemics, and health communication.

HIV and Viral Hepatitis Policy

TIME SENSITIVE: Opportunity to Inform Development of Next National HIV/AIDS and Viral Hepatitis Strategies

The U.S. National HIV/AIDS Strategy (NHAS) and the National Viral Hepatitis Action Plan (NVHAP) are key national frameworks for coordinating the nation’s efforts to eliminate HIV, hepatitis B, and hepatitis C. The current versions of both national plans are set to expire in 2020.  In the coming days and weeks, the Department of Health and Human Services (HHS) Office of HIV/AIDS and Infectious Disease Policy (OHAIDP) will host both virtual and in-person listening sessions to allow interested parties to provide input into the development of updated NHAS and NVHAP.  The updated plans will establish HIV and viral hepatitis goals and policies for the years beyond 2020. 

In its upcoming listening sessions, OHAIDP is seeking input for a broad mix of stakeholders on a range of questions, including the following: 

• What changes do you recommend making to the HIV and viral hepatitis goals and strategies?
• What opportunities do you see to further improve the efficiency, effectiveness, accountability, and impact of the nation’s response to HIV and viral hepatitis?
• What actions could the federal government take to improve the efficiency and effectiveness of funding and delivery of HIV and viral hepatitis services?
• What monitoring and evaluation methods and tools would you recommend to further improve HIV and viral hepatitis efforts?

Although all interested parties are invited to participate in the listening sessions, registration is required. The virtual listening session will be held on Tuesday, January 29, between 1:00 and 3:00 pm Eastern Time (ET).  Click here to register now. 

The in-person listening session will be held on Friday, February 22, from 11:00 am to 1:00 p.m. ET in Room 800 of the Hubert H. Humphrey Building, 200 Independence Avenue, S.W., Washington, DC 20201.  Those wishing to attend the session are asked to RSVP no later than February 14, by sending your name, title, and organization to HepHIVStrategies@hhs.gov. 

HIV Treatment and Care

NIAID Emphasizes Message that Undetectable Equals Untransmittable

In a recent viewpoint article published in JAMA, National Institute of Allergy and Infectious Disease (NIAID) researchers discussed the overwhelming body of evidence and underlying scientific principles confirming the “Undetectable Equals Untransmittable” (U = U) concept.  “U = U means that people living with HIV who achieve and maintain an undetectable viral load – the amount of HIV in the blood – by taking and adhering to antiretroviral therapy (ART) as prescribed cannot sexually transmit the virus to others,” the researchers note.

The article presents the following key principles regarding U = U:

• For ART to provide maximum benefit, taking medication as prescribed is essential.
• Achieving an undetectable viral load can take up to 6 months of ART. Once achieved, continued adherence to treatment is required.
• According to HHS guidelines, viral load testing should be performed every 3 to 4 months after the plasma HIV-1 RNA level reaches an undetectable level (defined as less than 200 copies/milliliter). If a person maintains viral suppression and a stable immunologic status for more than 2 years, viral load testing can be extended to every 6 months thereafter.
• Stopping therapy negates the validity of assuming that U = U.

The NIAID researchers conclude, “The U = U concept provides incentives for individuals with HIV to seek, initiate, and adhere to ART. In addition, it adds incentives to efforts to control and ultimately end the HIV/AIDS pandemic because treatment as prevention is a critical tool in preventing the spread of HIV infection.”

Taking Prescribed Opioids Raises Risk of Community-Acquired Pneumonia

People who take prescribed opioids have an increased risk of community-acquired pneumonia, and the risk is even greater among those living with HIV, according to a recent study in JAMA Internal Medicine.  Opioids are often prescribed to individuals for pain, including persons living with HIV. However, there is evidence that some opioids – including codeine, fentanyl, and morphine – suppress the immune system and limit the body’s ability to fight bacterial infections, such as pneumonia.

To investigate the link between prescribed opioids and pneumonia, Yale University researchers and their colleagues analyzed data from more than 25,000 patients enrolled in the Veterans Aging Cohort Study, a national study of individuals who receive care through the Veterans Health Administration. The case-control study included both patients living with and without HIV. The researchers matched patients hospitalized for pneumonia with similar patients who did not have pneumonia. For their analysis, the researchers looked at the length of time patients were taking opioids, as well as dosages and whether the medications had known immunosuppressive properties or not.

The researchers found that patients prescribed medium or high doses of opioid painkillers were at greater risk for pneumonia than those not taking the medications. The risk was compounded if the opioids contained immunosuppressive properties. In addition, they found that persons living with HIV tended to be more likely to develop pneumonia even when receiving low doses of opioids and especially when they received immunosuppressive opioids.

“We saw that prescription opioids were independently associated with pneumonia requiring hospitalization,” according to E. Jennifer Edelman, lead author of the study. Prescription opioids can impact the body’s defenses against pneumonia in different ways, including by suppressing cough, respiration, and mucus secretion. The study “lends credence to the hypothesis that opioids have effects on the immune system that are clinically relevant,” Edelman noted.

NASTAD Publishes Trauma-Informed Approaches Toolkit

NASTAD has developed a new toolkit that is designed to help health departments become trauma-informed. “Applying a trauma-informed lens is a critical tool to address the HIV epidemic in the United States,” according to NASTAD. The Substance Abuse and Mental Health Services Administration has reported that 70% of persons living with HIV (PLWH) have experienced trauma, and that PLWH are 20 times more likely to have experienced trauma than the general population.

The 20-page toolkit covers the basics of trauma, provides an overview of the impact of trauma in PLWH, describes trauma-informed approaches and strategies, and provides practical steps for Ryan White HIV/AIDS Program Part B and AIDS Drug Assistance Programs (ADAPs), AIDS services organizations, and HIV clinics to develop and operationalize a plan for delivering trauma-informed prevention and care services to PLWH. “A trauma-informed approach is not simply another intervention or activity for a health department or HIV services organization to conduct; it is a necessary strategy to our everyday work in HIV care and prevention,” the toolkit authors note. “By realizing, recognizing, and responding to the impacts of trauma, and actively working to reduce traumatization of both PLWH and HIV providers, we will move closer to our vision of a world free of HIV.”

Global HIV Epidemic

Global Fund Announces $14 Billion Target to Step Up the Fight Against AIDS, TB, and Malaria

Earlier this month, The Global Fund announced a $14-billion funding goal for its next three-year cycle from 2020 through 2022. The Fund projects that, if this target is reached, it will help save 16 million lives; cut the mortality rate from HIV, TB, and malaria in half; and build stronger health systems by 2023. “We now face a decisive moment. Do we step up the fight, or do we allow ourselves to slip back?” stated Peter Sands, Fund executive director, in making the case for the $14-billion target. This amount represents an increase of $1.8 billion, or 15% over the $12.2 billion raised during the prior cycle. The Fund describes the rationale and projected benefits of its new funding target in the 15-page document, Step Up the Fight: Investment Case Summary.

Another organization, Friends of the Global Fight  (FGF), recently published an issue brief, Backing Civil Society to End the AIDS, Tuberculosis, and Malaria Epidemics, which also focuses on the global response to these three infectious diseases.  The issue brief “highlights the pivotal role in the fight against HIV/AIDS, TB, and malaria played by civil society – all those stakeholders who are neither government bodies nor private sector enterprises, such as NGOs [non-governmental organizations], advocacy groups and faith- based organizations,” according to FGF.  Further, the brief argues that engagement of civil society in the ongoing fight against HIV/AIDS, TB, and malaria helps ensure:

• accountability for government funding and program commitments;
• aid reaches the populations most in need;
• voices of the most vulnerable and stigmatized populations are included in policy-making decisions; and
• the path of a country’s transition from aid is viable.

Hepatitis C

HepVu: Nine States Make Up More Than 50% of Hep C Infections

The HepVu project recently launched new interactive maps that present U.S. state-level estimates of people living with hepatitis C infection.  The maps highlight that hepatitis C infections are concentrated in some of the states most heavily impacted by the opioid epidemic. A summary of the HepVu data analysis indicates that an estimated 2.3 million people were living with hepatitis C infection in the U.S. between 2013 and 2016, with a particularly high burden in the West and in some Appalachian states. Nine states – California, Texas, Florida, New York, Pennsylvania, Ohio, Michigan, Tennessee, and North Carolina – account for more than half (51.9%) of the total number of persons living with hepatitis C in the U.S.

“We still have more than 2 million people living with hepatitis C at a time when ending this epidemic is possible,” noted Patrick Sullivan, principal scientist for HepVu. “Hundreds of thousands of Americans have been cured of hepatitis C with newly available treatments, yet new hepatitis C infections have nearly tripled in recent years as a consequence of increasing injection drug use associated with the opioid epidemic. At the same time, many older Americans, who have been living with Hepatitis C for decades, still remain undiagnosed and untreated. Halting the Hepatitis C epidemic requires a commitment across the nation to diagnose and cure people living with the virus and stop new infections before they erode our significant progress.”

Three-fourths of Americans living with hepatitis C are Baby Boomers (persons born between 1945 and 1965). However, the largest increases in hepatitis C infections over the last decade have been among persons under 40 years old and particularly among those who inject drugs.

Health Communication

Upcoming UCHAPS Programs to Focus on Health Messaging for Priority Populations

During February, the Urban Coalition for HIV/AIDS Prevention Services (UCHAPS) will offer a three-part Facebook Live series, “How National Campaigns Can Improve Public Health Messaging Using Modern Technology,” which will focus on approaches for reaching priority populations. The series will include sessions on effective messaging for Black women (February 6), the lesbian, gay, bisexual, transgender, and questioning (LGBTQ) community (February 13), and youth (February 20). For more information and to register for the series, please visit this UCHAPS events page. 

UCHAPS will also hold the following free, half-day workshop in Washington, D.C., on February 12: “Message Received: Strategies for Effective Health Communication.” Participants in the workshop will learn to:

• define the essential components of effective communication for a diverse range of communities;
• identify the messaging and design elements that facilitate understanding and engagement;
• explain the importance of the use of person first language when disseminating health messaging;
• describe the importance of community engagement in creating effective communication products and health resources; and
• choose appropriate strategies to check for understanding with populations of interest when communicating health information.

For more information and to register for the workshop, please visit this UCHAPS page.