CDCs HIV Testing Efforts to Support the National HIV/AIDS Strategy - PowerPoint PPT Presentation

CDC’s HIV Testing Efforts to Support the National HIV/AIDS Strategy M. Christine Cagle, Ph.D. Associate Director for Policy, Planning and Communications Erica Dunbar, MPH Program Leader, Health Department Initiatives Prevention Program Branch Division of HIV/AIDS Prevention National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention

Outline of Presentation • State of the HIV epidemic in the U.S. • Importance of HIV testing, linkage to and retention in care • CDC HIV testing policies • CDC HIV testing programs and activities • HIV continuum of care • Strategies to improve reach and impact

Magnitude of the epidemic • 1.2 million people living with HIV • Each year about • 50,000 new infections • 17,000 deaths among people with AIDS • Net increase of 33,000 people with HIV • People who start ART are expected to live at least an additional 35 years CDC surveillance reports; ART Cohort Collaboration Lancet 2008 3

HIV Prevalence and Incidence 1,200,000 New HIV Infections Prevalence 1,000,000 800,000 600,000 400,000 200,000 0 1980 1983 1986 1989 1992 1995 1998 2001 2004 2007 2010  Denotes incidence estimates using BED assay Number of people living with HIV has grown because incidence is relatively stable and survival has increased Hall JAMA 2008; PreJean PloS One 2011 ; MMWR 2011

Faster action saves lives and resources later 6 New HIV Infections x 100,000 5 Stable Incidence 4 25% reduction in 10 years 3 25% reduction in 5 years 2 1 0 1 2 3 4 5 6 7 8 9 10 Years • Reducing incidence by 25% • In 10 years would save 62,000 infections and save $23 billion • In 5 years would prevent 109,000 infections and save $42 billion Adapted using methods from Hall , et al. JAIDS 2010 5

CDC HIV TESTING POLICIES

HIV Testing Policies • HIV Testing Recommendations for Adults, Adolescents, and Pregnant Women in Health Care Settings (2006) – Promote routine, opt-out testing for all persons ages 13-64, not risk-based – Repeat HIV screening of persons with known risk at least annually – Include HIV consent with general consent for care; separate signed informed consent not recommended – Prevention counseling in conjunction with HIV screening not required – 46 states and DC have implemented laws that support recommendations

State Testing Laws • National testing recommendations influence state laws, but HIV testing laws under state jurisdiction • Many state testing laws present barriers to implementation • State laws should conform or, at a minimum, not conflict • To date, only 4 states have incompatible laws – New York – Massachusetts – Nebraska – Rhode Island JAMA, May 4 (17), 2011

State Testing Laws Legislative changes toward compatibility of state laws regarding HIV consent and counseling (2006 CDC Recommendations) JAMA, May 4 (17), 2011

HIV Testing Policies • Guidelines for Testing in Non-clinical Settings • Emphasis on targeting, recruitment, and linkage to care in addition to testing • Recommendation for retesting • Forthcoming (2012) • Guidelines for Supplemental Testing • New diagnostic algorithm • Alternative to Western blot • Detecting Acute HIV Infection • Forthcoming (2012)

National HIV Behavioral Surveillance System: Infected/Unaware MSM Time since most recent HIV test among MSM who were unaware they were HIV-infected. 21 Cities MMWR (60), 2011

Revised Testing Recommendations for MSM  HIV testing recommended at least annually for persons with ongoing risks for exposure to HIV infection  Recent data suggest more frequent testing for MSM  NHBS (2008)  19% of sexually active MSM were infected with HIV, but 44% were unaware  Among MSM with undiagnosed HIV infection, 45% had been tested within the previous 12 months, 29% within the previous 6 months  Prevalence of undiagnosed HIV among MSM who reported high-risk behaviors (7%) was similar to that among those who did not (8%)  Sexually active MSM might benefit from more frequent HIV testing  STD Treatment Guidelines - MMWR , December 2010 (59)

CDC HIV TESTING PROGRAMS AND ACTIVITIES

Expanded HIV testing activities  Expanded Testing Initiative  2.8 million tests conducted in first 3 years  18,000 people newly diagnosed with HIV; 70% African American; 12% Latino  Cost-saving for healthcare system  Provides evidence that large-scale HIV testing programs are cost-saving and effective  Newly diagnosed infection rate (0.7%)  Averted an estimated 3,381 HIV infections  Achieved a return of $1.97 for every dollar invested

PS10-10138 Expanded HIV Testing for Disproportionately Affected Populations  Purpose:  To sustain progress made under announcement PS07-768  To expand routine testing services to new clinical venues to reach a broader array of at-risk populations.  Target Population:  African American and Hispanic men and women  MSM and IDUs, regardless of race or ethnicity  Grantees:  Expanded to 30 state, territorial and local health departments

PS10-10138 Funded City and State Health Departments

Number of HIV Tests, Positive Tests, and Positive Test Rates October 2007 – September 2010 Total Clinical Settings Non-Clinical Settings Tests Done 2,786,739 2,519,917 (90%) 266,822 (10%) Confirmed HIV+ 29,503 23,546 (80%) 5,957 (20%) New HIV+ 18,432 15,478 (84%) 2,954 (16%) Previous HIV+ 11,071 8,068 (73%) 3,003 (27%) New HIV+ Rate 0.7 0.6 1.1 Data Source: APR Year 1 – 3

Venues Funded under PS10-10138 Oct 2010 – Mar 2011 30% 20% 10% 0% Emergency STD Clinics Correctional Substance Community Non Other * Departments Facility Abuse Health Healthcare Clinics Treatment Centers Settings and Facilities CBO * (n = 1,022 venues) Includes urgent care clinics, inpatient units, other primary care clinics, pharmacy-based clinics, TB clinics, other public health clinics, dental clinics, and other healthcare settings

PS11-1113: HIV Prevention for YMSM of color and YTG persons of color  Purpose:  Support the development and implementation of effective community-based HIV prevention programs.  Increase the number of YMSM of color and YTG persons of color who are are aware of their HIV status and linked to care, treatment, and prevention services.  Build the capacity of CDC-funded CBOs delivering structural interventions, behavioral interventions, and outreach or enhanced HIV testing.  Ensure provision of HIV prevention and care services.  Promote collaboration and coordination of HIV prevention efforts among CBOs, health departments, and private agencies.

YMSM FOA HIV Testing Objectives  $10 million per year FOA for Young MSM and Transgender of Color • Requirement for testing and maintain 4% new diagnoses • Linkage to care and prevention services for positives and negatives

YMSM FOA HIV Testing Objectives  All funded CBOs are required to implement HIV testing with Personalized Cognitive Counseling (PCC).  HIV testing objectives: • 600-1000 YMSM of color • 75-150 YTG persons of color  Approximate number of HIV tests to be conducted: • 90,000 YMSM of color and YTG persons of color- over thee 5 year project period  Approximate number of new HIV diagnoses and individuals linked to care and other support services: • 3,500 YMSM of color and YTG persons of color- over the 5 year project period

Health Department FOA and ECHPP  Health Department FOA  Funding distribution determined by number of people diagnosed and reported to be living with HIV  Focuses on interventions and strategies that will have greatest impact on epidemic while allowing flexibility  Base minimum floor level  Changes in funding distribution implemented over 5 years  Incorporates Expanded Testing Program  Supports innovative programs by Health Departments  Enhanced Comprehensive HIV Prevention Planning Project (ECHPP)  12 jurisdictions with 44% of epidemic  Planning for maximizing impact

Health Department FOA Categories The following categories are included in the new Health Department FOA: Category A: HIV Prevention Programs for Health Departments (core funding) Required Core Program Components: HIV Testing , Comprehensive Prevention with Positives, Condom Distribution, and Policy Initiatives Required Programmatic Activities: Jurisdictional HIV Prevention Planning, Capacity Building and Technical Assistance, and Program Planning, Monitoring and Evaluation, and Quality Assurance Recommended Program Components: Evidence-based HIV Prevention Interventions, Social Marketing, Media, and Mobilization, and PrEP and nPEP Category B: Expanded HIV Testing for Disproportionately Affected Populations (limited eligibility and optional) Required: HIV Testing in Healthcare Settings Optional: HIV Testing in Non-healthcare Settings Optional: Service Integration Category C: Demonstration Projects to implement and evaluate innovative, high impact HIV prevention activities (competitive and optional) Focus areas include 1) structural, biomedical, and behavioral interventions (or any combination thereof), 2) innovative HIV testing activities, 3) enhanced linkages to and retention in care, 4) advanced use of technology, and 5) use of CD4, viral load and other surveillance data to assess and reduce HIV transmission risk.