In advance of World AIDS Day on December 1st, the O’Neill Institute for National and Global Health Law has released two new reports on emerging HIV issues in the United States, including policy ideas for states and local communities and for the Ryan White HIV/AIDS Program. The reports were written by two leading HIV/AIDS policy experts, Jeffrey S. Crowley, Distinguished Scholar and Director of Infectious Disease Initiatives at the O’Neill Institute, and Sean Bland, a Senior Associate at the O’Neill Institute.
The first of the two reports, State and Local ‘End the Epidemic’ Plans Can Drive HIV Progress, is focused on promoting state and local plans to ‘End the Epidemic.’ In this report, the authors note that several state and local jurisdictions have created and implemented such plans emphasized that other jurisdictions must develop their own plans to end the HIV epidemic in their communities.
“To reduce new HIV infections and support all people living with HIV to be in care and on antiretroviral therapy (ART) and achieve sustained viral suppression, it is important that states and local jurisdictions develop plans that are tailored to their communities and the specific characteristics of their epidemics,” says Jeffrey Crowley, the lead author of both reports. “While tailored approaches are needed in each jurisdiction, effective plans to ‘End the Epidemic’ share many common features,” adds Crowley.
The report identifies key elements of a plan to ‘End the Epidemic.’ One of the most significant elements of some emerging plans is to treat HIV earlier by offering same-day or rapid start of antiretroviral therapy (ART) when individuals receive an HIV diagnosis or are re-engaged in HIV care. Other significant elements include continued focus on monitoring engagement and actively intervening to address barriers to care and an emphasis on scaling up access to pre-exposure prophylaxis (PrEP) and ensuring appropriate access to post-exposure prophylaxis. The report also provides some leading examples of jurisdictions across the county that have developed plans. The jurisdictions highlighted in the report include New York State, New York City, Washington State, the District of Columbia, Houston, and Los Angeles.
The second of the two reports, Leveraging the Ryan White HIV/AIDS Program to Make Rapid Start of HIV Antiretroviral Therapy Standard Practice, examines the role of the Ryan White Program in making rapid start of ART a reality. Starting people with HIV on antiretroviral therapy (ART) on the same day that they are diagnosed has been shown to decrease the time to viral suppression and may also improve retention in care, yet there are numerous financial and other barriers to adoption of rapid start across the health system.
In the report, the authors outline the elements of a rapid start program and discuss common barriers to scaling up rapid start, ranging from clinician acceptance and patient readiness to insurance and AIDS Drugs Assistance Program (ADAP) eligibility. The challenge in adopting rapid start of ART is developing workable models of care that can be implemented across our diverse national health care landscape. The authors also discuss how the Ryan White HIV/AIDS Program can help overcome barriers to widespread adoption of rapid start.
“The Ryan White Program is a federal program that provides a comprehensive system of care for people living with HIV and is uniquely situated to work with clinicians, health departments, and community stakeholders to support efforts to adopt rapid start,” Bland says. “Now is the time to ask the Ryan White Program to help move this idea from leading clinics to standard practice across the health system.”
Crowley and Bland conclude that now is the time for more jurisdictions to make plans to ‘End the Epidemic’ and scale up rapid start of ART. By promoting state and local plans and using the Ryan White Program to make rapid start a standard practice, it is possible to keep providing better supports to people living with HIV and reduce new HIV infections.