HIV Prevention Practices and Non-Federal Funding Among U.S. States and Non-State Regions: A Survey of HIV/AIDS Directors
Abstract
We surveyed U.S. HIV/AIDS directors or designees in states and non-state regions, regarding factors influencing HIV viral suppression: (1) non-federal prevention funding; (2) contacting newly reported patients and providers, for care linkage and partner services; (3) follow-up of non-received viral load reports, to identify untreated patients; and (4) genotype/phenotype surveillance, to monitor drug resistance. The survey was conducted April–July 2015; 50 (87.7%) participated. Eighty percent of jurisdictions contacted all newly reported patients; 60% contacted all providers. HIV resistance tests were reportable in 38% 66% contacted providers and/or patients about missed viral loads. Non-federal funding was significantly associated with annual diagnoses (p = .0001) and population (p = .0002), but not with other factors studied. Many jurisdictions lacked non-federal funding (28%), or experienced unrestored reductions since 2008 (33%). Jurisdictions’ funding and preventive practices varied greatly. HIV viral suppression could be enhanced by restoring (or establishing) non-federal prevention funding, and by more standardized surveillance/outreach practices.
REFERENCES
- 2013, November 21). Dear colleague. [Letter]. Retrieved March 11, 2017, from https://www.cdc.gov/hiv/pdf/policies/dcl.pdf Google Scholar (
Centers for Disease Control and Prevention . (2008). Recommendations for partner services programs for HIV infection, syphilis, gonorrhea, and chlamydial infection. Morbidity and Mortality Weekly Report, 57(RR09), 1–63. Medline, Google ScholarCenters for Disease Control and Prevention . (2012a). CDC's new high-impact approach to HIV prevention funding for health departments. Retrieved March 15, 2017, from https://www.cdc.gov/nchhstp/newsroom/docs/hdawardsmediafactsheet-508c.pdf Google ScholarCenters for Disease Control and Prevention . (2012b). HIV prevention funding allocations at CDC-funded state and local health departments, 2010 report. Retrieved March 11, 2017, from https://www.cdc.gov/hiv/pdf/research/testing_prevention_funding.pdf Google ScholarCenters for Disease Control and Prevention . (2013a). Awards by state: FY2012. Retrieved October 1, 2016, from https://www.cdc.gov/hiv/pdf/policies_funding_awards2012.pdf Google ScholarCenters for Disease Control and Prevention . (2013b). CDC's new approach to surveillance funding activities: Advancing the National HIV/AIDS Strategy. Retrieved March 11, 2017, from https://www.cdc.gov/hiv/pdf/funding/announcements/ps13-1302/cdc-hiv-ps13-1302-factsheet.pdf Google ScholarCenters for Disease Control and Prevention . (2014). PS12-1201: Comprehensive HIV prevention programs for health departments: Program overview. Retrieved January 22, 2019, from https://www.cbaproviders.org/documents/orientationpresentations/CATA-PS12-1201_FINAL.pdf Google ScholarCenters for Disease Control and Prevention . (2015a). Centers for Disease Control and Prevention Fiscal Year 2015 grants summary profile report for Republic of Palau. Retrieved March 23, 2017, from https://wwwn.cdc.gov/fundingprofiles/Report_Docs/PDFDocs/Rpt2015/Republic-of-Palau-2015-CDC-Grants-Profile-Report.pdf Google ScholarCenters for Disease Control and Prevention . (2015b). HIV/AIDS; State laboratory reporting laws: Viral load and CD4 requirements. Retrieved June 15, 2015, from http://www.cdc.gov/hiv/policies/law/states/reporting.html Google ScholarCenters for Disease Control and Prevention . (2015c). HIV surveillance report, 2014; vol. 26. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2014-vol-26.pdf Google ScholarCenters for Disease Control and Prevention . (2016). Funding opportunity announcement: PS15-1506: Health department demonstration projects to reduce HIV infections and improve engagement in HIV medical care among men who have sex with men (MSM) and transgender persons. Retrieved March 29, 2017, from https://www.cdc.gov/hiv/funding/announcements/ps15-1506/ Google ScholarCenters for Disease Control and Prevention . (2017). Data to Care program guidance: Using HIV surveillance data to support the HIV care continuum. Retrieved October 10, 2017, from https://effectiveinterventions.cdc.gov/docs/default-source/data-to-care-d2c/datatocareprogramguidance.pdf Google ScholarCenters for Disease Control and Prevention . (2018). Understanding the HIV care continuum. Retrieved October 1, 2018, from https://www.cdc.gov/hiv/pdf/library/fact-sheets/cdc-hiv-care-continuum.pdf Google ScholarHPTN 052 Study Team . (2011). Prevention of HIV-1 infection with early antiretroviral therapy. New England Journal of Medicine, 365, 493–505. https://doi.org/https://doi.org/10.1056/NEJMoa1105243 Crossref Medline, Google Scholar , …- 2014). The status of the National HIV Surveillance System, United States, 2013. Public Health Reports, 129(4), 335–341. https://doi.org/https://doi.org/10.1177/003335491412900408. Crossref Medline, Google Scholar (
- 2015, January 3). 2014 State population: Rise of south and west continues. Newgeography website. Retrieved January 28, 2018, from http://www.newgeography.com/content/004818-2014-state-population-rise-south-and-west-continues Google Scholar (
Department of Health and Human Services , (2016a). HIV Care Continuum. Retrieved June 27, 2017, from https://www.hiv.gov/federal-response/policies-issues/hiv-aids-care-continuum Google ScholarDepartment of Health and Human Services . (2016b). Human subject regulations decision charts. Retrieved June 7, 2018, from https://www.hhs.gov/ohrp/regulations-and-policy/decision-charts/index.html Google ScholarDepartment of Health and Human Services . (2017). Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Retrieved November 15, 2017, from https://aidsinfo.nih.gov/contentfiles/lvguidelines/adultand-adolescentgl.pdf Google Scholar- 2011). The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clinical Infectious Diseases, 52, 793–800. https://doi.org/https://doi.org/10.1093/cid/ciq243. Crossref Medline, Google Scholar (
- 2009). Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: A mathematical model. Lancet, 373, 48–57. https://doi.org/https://doi.org/10.1016/S0140-6736(08)61697-9 Crossref Medline, Google Scholar (
- 2016). Antiretroviral treatment of adult HIV infection: 2016 recommendations of the International Antiviral Society–USA Panel. Journal of American Medical Association, 316, 191–210. https://doi.org/https://doi.org/10.1001/jama.2016.8900 Crossref, Google Scholar (
- 1996, March 15). Using medication to reduce the infectiousness of HIV: An underutilized prevention strategy. Beyond AIDS. Retrieved March 11, 2017, from http://beyondaids.org/articles/treatment.html Google Scholar (
- 2013). Elimination of HIV in South Africa through expanded access to antiretroviral therapy: A model comparison study. PLoS Medicine, 10, e1001534. https://doi.org/https://doi.org/10.1371/journal.pmed.1001534 Crossref Medline, Google Scholar (
Human Resources and Services Administration . (2017). Ryan White and Global HIV/AIDS Programs, SPNS initiative: Systems linkages and access to care initiative, 2011–2016. Retrieved March 29, 2017, from http://hab.hrsa.gov/abouthab/special/systemslinkages.html Google ScholarINSIGHT START Study Group . (2015). Initiation of early antiretroviral therapy in early asymptomatic HIV infection. New England Journal of Medicine, 373, 795–807. https://doi.org/https://doi.org/10.1056/NEJMoa1506816. Crossref Medline, Google Scholar- 2014). Most states funding schools less than before the recession, Retrieved August 26, 2015, from http://www.cbpp.org/research/most-states-funding-schools-less-than-before-the-recession Legal Dictionary. (n.d.). Territories of the United States. Retrieved March 23, 2017, from http://legal-dictionary.thefreedictionary.com/U.S.+territories Google Scholar (
- 2013). Estimating the impact of state budget cuts and redirection of prevention resources on the HIV epidemic in 59 California local health departments. PLoS One, 8, e55713. https://doi.org/https://doi.org/10.1371/journal.pone.0055713 Crossref Medline, Google Scholar (
National Alliance of County and City Health Officials . (2014). Research brief, April 2014; Local health department budget cuts and job losses: Findings from the 2014 Forces of Change Survey. Retrieved March 31, 2017, from http://www.naccho.org/topics/research/forcesofchange/upload/budget-cuts.pdf Google ScholarNational Alliance of State & Territorial AIDS Directors . (2009). National HIV Prevention Inventory, July 2009. Retrieved August 1, 2015, from https://www.nastad.org/sites/default/files/02406_National-HIV-Prevention-Inventory-July-2009-FINAL.pdf Google ScholarNational Alliance of State & Territorial AIDS Directors . (2012–2013). National HIV prevention inventory (NHPI), Modules 1, 2, and 3. Retrieved March 11, 2017, from https://www.nastad.org/resource/national-hiv-prevention-inventory-project-nhpi-module-1-module-2-and-module-3 Google ScholarNational Alliance of State & Territorial AIDS Directors . (2015). Membership directory, Washington: NASTAD. Retrieved April 1, 2015, from http://www.nastad.org/membership-directory Google Scholar- 2015). Human immunodeficiency virus transmission at each stage of the care continuum in the United States. JAMA Internal Medicine, 175, 588–596. https://doi.org/https://doi.org/10.1001/jamainternmed.2014.8180. Crossref Medline, Google Scholar (
- 2014, January 3). State budgets to aid U.S. growth amid federal cuts: Economy. Bloomberg News. Retrieved January 10, 2016, from http://www.bloomberg.com/news/articles/2014-01-03/state-spending-to-boost-us-growth-amid-federal-cuts-economy Google Scholar (
U.S. Census, International Programs . (2017). International Data Base. Retrieved January 28, 2018, from https://www.census.gov/data-tools/demo/idb/informationGateway.php Google ScholarThe White House, Office of National AIDS Policy . (2013). Executive order: HIV care continuum initiative. Retrieved March 11, 2017, from https://obamawhitehouse.archives.gov/the-press-office/2013/07/15/executive-order-hiv-care-continuum-initiative. Google Scholar