Policy Points
A blog for people who love data, health care, and policy as we do

Tuesday, April 16th, 2019

Mississippi Highlighted in the Plan to Eradicate HIV/AIDs

By Zach Smith

In the Trump administration’s most recent fiscal year (FY) 2020 budget approximately $291 million dollars has been allocated to defeat the HIV/AIDs epidemic in America.  With the advancements in HIV antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) medications, individuals with HIV can live long, healthy lives and the risk of infecting others is dramatically reduced. Additionally, the CDC has been able to identify the most at-risk geographic and demographic areas with the greatest need of additional resources. In light of these advancements in medication and the knowledge of specific states and counties are in need of federal assistance, HHS has developed a targeted three pillar approach to eradicate HIV/AIDS: 1) increase investments in geographic hotspots through existing, effective programs, such as the Ryan White HIV/AIDS Program, as well as new programs through community health centers that will provide medicine to protect persons at highest risk from getting HIV; 2) use data to identify where HIV is spreading most rapidly and guide decision-making to address prevention, care and treatment needs at the local level; 3) provide funds for the creation of a local HIV HealthForce in the targeted areas to expand HIV prevention and treatment.

More than half of new HIV diagnoses in the United States during 2016 to 2017 were reported in only 48 counties and seven states, mostly in the rural south.  Funding will be directed to the Department of Health and Human Services to focus on these hotspots.

*48 high burden counties, Washington, D.C., San Juan P.R., and 7 states with a substantial rural burden. Retrieved from https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview

The Department of Health and Human Services (HHS) has set a goal to reduce the incidence of infections in the United States by 75% within 5 years, and by 90% within 10 years. To accomplish this goal HHS will be calling on the CDC, HRSA, and NIH to coordinate their programs, resources, and infrastructure and work collaboratively toward these goals. CDC will amplify its existing programs and its current work with state and local health authorities to bring HIV testing to all who need it, to diagnose infections as early as possible, to conduct epidemiological investigations of new HIV clusters, and to promote rapid linkage to comprehensive care in the Ryan White HIV/AIDS Program (RWHAP) in partnership with the Health Resources and Services Administration (HRSA).  The National Institute of Health (NIH) will inform HHS partners on best practices, based on biomedical research, and by collecting and disseminating data on the effectiveness of the approaches used.  A key component of the initiative to end HIV/AIDS will be partnerships with cities, counties, and state public health departments, local and regional clinics and health care facilities, clinicians, and providers of medication-assisted treatment (MAT) for opioid use disorder.

The United States spends more than $20 billion annually in direct health expenditures for HIV prevention and care. National intervention has driven down the incidence of new HIV infections to approximately 40,000 per year. The CDC estimated the cost to Mississippi for lifetime treatment of newly diagnosed HIV infections was approximately $205 million in 2009. Recent research has shown that individuals with HIV who receive antiretroviral therapy (ART), and achieve and maintain an undetectable viral load, do not sexually transmit HIV to others. Medications have advanced in such a way that those who do not have HIV but are at-risk of getting it can take treatment that has been proven to be highly effective at preventing infection. Collectively, these advances suggest that the HIV epidemic could be ended by expanding access to treatment for all persons with HIV and those at high risk for contracting the virus.

As clear a path as this initiative seems to create to eliminating HIV/AIDS, the path is not quite that easy. Several significant issues impact HIV/AIDs treatment including the overall cost to treat patients, the need to ensure patients sustain long-term viral suppression, and the social issues underlying disparities in treatment and access to treatment.  As of 2010, the CDC estimated the lifetime cost to treat an HIV infection to be $379,668 while PrEP therapy can cost as much as $2,000 per month.  Subsequent recent cost-effectiveness analyses suggest that treatments like PrEP have the potential to be a cost-effective addition to HIV prevention programs, but research also shows that high-risk populations report financial factors as a major barrier to PrEP.  Of the individuals in the US living with HIV in 2015, 63% received some HIV medical care and 51% achieved viral suppression.  The demographic impact of HIV shows another area of needed focus: in 2017, African Americans made up 13% of the US population and accounted for 43% of new HIV diagnoses, Latinos made up 18% of the population and accounted for 26% of new HIV diagnoses.  Several social factors contribute to these disparities, including economic instability, institutionalized discrimination, and mass incarceration.

The proposed initiative by the Trump administration has the theoretical potential to end the HIV epidemic but additional research and data on how the initiative functions once implemented and how much the program is costing will be needed to determine effectiveness and whether the initiative is sustainable with the currently allocated funding.