HHS Reviews Progress Towards National HIV/AIDS Strategy Goals

Dr. Ronald Valdiserri.

Last week, representatives of Operating Divisions and Staff Offices from across the U.S. Department of Health and Human Services (HHS) gathered to review major accomplishments of our collective efforts to implement the National HIV/AIDS Strategy (NHAS) over the past year. More than two-dozen representatives joined in the discussion during which we shared highlights about progress, forecasted key activities for the coming year, and identified opportunities for new or continuing cross-agency collaborations. Dr. Howard Koh, Assistant Secretary for Health, opened the meeting by thanking the participants for the extraordinary efforts that their agencies and offices have put forth over the past year in pursuit of the Strategy's goals. Mr. Jeffrey Crowley, Director of the White House's Office of National HIV/AIDS Policy (ONAP), echoed Dr. Koh's gratitude and observed that, while there remains significant work to be done to achieve the Strategy's 2015 goals, participants should be proud of HHS's accomplishments during the first year of implementation.

In the discussion that followed, colleagues from across the department underscored many examples of positive movement, including:

• Centers for Disease Control and Prevention (CDC) published a new funding announcement for health department HIV prevention activities that embodied many of the changes called for in the NHAS including intensifying HIV prevention efforts in the communities where HIV is most heavily concentrated. The new FOA also promotes the scale-up of those activities most effective at reducing HIV incidence.
• National Institutes of Health (NIH) described several studies examining the use of antiretroviral therapy (ART) as prevention (CAPRISA 004, iPrEx, and HPTN 052).
• NIH also highlighted ongoing efforts to determine the best combinations of behavioral and biomedical prevention activities, as well as continued studies investigating possible routes to achieving an eventual cure for HIV infection.
• Health Resources and Services Administration (HRSA) observed that its efforts in support of the Strategy's goals span the agency to include all of its bureaus, not just the HIV/AIDS Bureau (HAB) which administers the Ryan White Care Program that delivers HIV care services to more than 500,000 people living with HIV. For example, HRSA's Bureau of Primary Health Care (BPHC) issued two Program Assistance Letters to more than 1,200 community health center organizations across the nation on HIV testing and HIV care and treatment. BPHC has also partnered with HAB to enhance project officer training, and increased technical assistance offerings on HIV/AIDS prevention, testing and care and treatment.
• Substance Abuse and Mental Health Services Administration (SAMHSA) reported on efforts to better integrate HIV prevention, care and treatment into activities supported by the agency's new unified substance abuse prevention and treatment and mental health block grants to states, including the integration of new HIV testing measures into that grant.
• SAMHSA also made a determination that states which were eligible in any of the past three years to use the 5% block grant set-aside for early HIV intervention services may continue to do so, ending a challenging annual variability that hindered some state from providing these services, which include HIV testing, referrals for treatment, and testing for other infectious diseases (such as Hepatitis C).
• As part of their efforts to increase access to HIV care and improve outcomes, the Indian Health Service's pharmacist-run clinics demonstrated success in their efforts to partner with patients on adherence to antiretroviral therapy (ART). Employing local pharmacists contributed to increased rates of reported ART adherence among patients.
• With support from the Secretary's Minority AIDS Initiative Fund, the Office of Adolescent Health (OAH) funded a National Resource Center for HIV/AIDS Prevention Among Adolescents. The resource center, which will be operated by the University of Medicine and Dentistry of New Jersey, begins operation this month and will provide information, resources and technical assistance.
• The Office of Minority Health (OMH) reported on several demonstration programs designed to increase access to HIV care and improve health outcomes for vulnerable minority populations, including initiatives to support state and federal ex-offenders re-entering their communities in NY, FL and TX. Through the HIV/AIDS Health Improvement for Re-entering Ex-Offenders (HIRE) initiative, OMH supports networks of community-based, minority-serving organizations that work together to link HIV-infected ex-offenders to a continuum of care and help them make a more successful transition back into the community. The program has served approximately 15,000 participants.
• The Office of Population Affairs provides approximately $10 million in supplemental funding for HIV prevention integration to Title X Family Planning clinics to 78 grantees; this funding expands the availability of on-site HIV testing and related referral services. OPA reported that the number of HIV tests conducted at those sites continued to climb over the past year.

These and the many other activities discussed have established a strong foundation for continued progress as we commence the second year of aligning HHS's efforts to pursue the Strategy's goals in collaboration with our State, Tribal, local and community-based partners.

Our partners from across the department were also frank about some of the challenges encountered in the past year. Several of my HHS colleagues noted that the pace of Strategy-inspired change had been significant over the past year and while this was generally positive, it was not without its challenges within agencies and among grantees and partners. Other challenges cited included economic/budget concerns at the agency level as well as at the state and local levels. All agreed that budget constraints will certainly impact how we proceed with pursuing the Strategy's goals in the coming years. In addition, some participants cited challenges resulting from the need to navigate among competing priorities (i.e., Departmental vs. Agency vs. Strategy vs. Stakeholders).

Finally, I want to observe that through all of the presentations and discussions it was heartening to hear of so many examples of cross-agency and intra-departmental collaborations initiated or strengthened in the past year. Such partnerships demonstrate the Department-wide commitment to pursuing the Strategy's call for a more coordinated national response to the HIV epidemic. Though these collaborative activities are not without their own challenges–since they are often resource intensive–they will serve us well and, more importantly, our partners, and people at risk of or living with HIV.

We all agreed that there is much to celebrate in this first year of implementation of the NHAS, but achieving the Strategy's 2015 goals will require continued effort, perseverance, and a willingness to consider new ways of planning, implementing, and evaluating our shared efforts.

Ronald Valdiserri, M.D., M.P.H. is deputy assistant secretary for health, infectious diseases, and director of the Office of HIV/AIDS Policy, U.S. Department of Health and Human Services.