Dawn Fukuda, Director, Office of HIV/AIDS, Massachusetts Department of Public Health and NASTAD Chair

For perhaps the first time in history, the end of HIV/AIDS and hepatitis is within our reach. Recent notable achievements provide promise for success, among them the release of the National HIV/AIDS Strategy (NHAS) and the Viral Hepatitis Action Plan (VHAP) and the passage of the Affordable Care Act (ACA). Collectively, these achievements have catalyzed the beginning of a radical transformation in our healthcare systems for communities impacted by HIV and hepatitis. In particular, the ACA represents an opportunity for the country to expand access to HIV/AIDS and hepatitis prevention, medical care, and health promotion services in profound and impactful ways. The systems-level changes advanced in the legislation also require state health departments to reassess their role in the context of an evolving health care system and the other sources of financing that may become available to support what have historically been public health functions—this is particularly the case for HIV/AIDS and viral hepatitis prevention and care services.

Preparing Health Department Programs for Health Reform Implementation

Expanding access to critical HIV/AIDS and hepatitis services will require health departments to:

• Undertake an exhaustive inventory of direct care functions, services, and personnel we fund in medical and non-medical settings, and determine what components of the system might be covered under expanded health insurance coverage for our state residents.
• Determine the sufficiency of reimbursement for these services, where there will be limitations in coverage—both service gaps and populations that will remain ineligible for coverage—and how long it will take for the new system to be fully established.
• Become familiar with their state Medicaid program and the specific plans to enroll newly eligible clients, the scope of the state’s Essential Health Benefits package, and emerging opportunities for enhanced billing associated with HIV Health Homes.

Support for tailored, client-responsive, and intensive prevention and care services administered with resources from discretionary funding streams (notably the Center’s for Disease Control and Prevention [CDC] and the Health Resources and Services Administration [HRSA]) may vary among different health insurers (both public and private). Given this variability, health departments should consider enlisting the technical assistance of health insurance experts to:

• Determine what types of services will be reimbursed in the new health insurance landscape.
• Identify which provider types will be certified to bill third parties.
• Determine the extent to which reimbursement rates will cover the full cost of providing essential prevention and care services to impacted population groups and regions.

Health department staff that is responsible for HIV/AIDS and hepatitis prevention and response programs must become adept at describing the specific ways in which public health investments complete gaps in the evolving health care system. In addition, health departments must leverage the opportunities of third party billing to support core public health activities that are essential to successful care and treatment at the patient-level, such as laboratory services, screening and vaccination, disease surveillance, and partner services.

The Continued Need for Public Health Programs

Access to prevention, screening, and medical care services under ACA will undoubtedly improve the opportunities for health promotion and disease prevention in our states and jurisdictions at both the individual- and population-level; however, access alone will not be sufficient particularly for our most vulnerable residents who may experience profound socioeconomic and psychosocial challenges, or may remain categorically ineligible for health insurance coverage. It remains a governmental responsibility (federal, state, and local) to protect and advance public health, particularly in the case of communicable disease. The scientific lessons that have emerged in recent years are clear. Our best chance to make progress in reducing new HIV infections in the country is to ensure that people living with HIV learn their status in a timely manner, access care and treatment, reach viral suppression, and sustain viral suppression long term. This will require investments in new diagnostic technologies, disease surveillance systems, engagement and retention in care interventions, and more effective and tolerable treatments. At this early stage in our country’s transformation of the health care system, it will certainly require a combination of health care reform initiatives and strategic public health investments to accomplish the goals of the National HIV/AIDS Strategy and Viral Hepatitis Action Plan and ultimately achieve a world free of HIV and hepatitis.

We want to hear from you! How are your health department HIV and hepatitis programs preparing for health reform? What challenges are you facing? Share your experience by leaving a comment below.

Randy Mayer, Chief, Bureau of HIV, STD, and Hepatitis, Iowa Department of Public Health

As I began my tenure as NASTAD’s Chair in May 2012, state health department HIV and viral hepatitis programs were trying to understand and react to the impact of the funding redistributions brought about by the Centers for Disease Control and Preventions’ (CDC) HIV prevention funding opportunity announcement 12-1201. At the same time, we were just learning about the possibility of fiscal sequestration, set to begin in early 2013. NASTAD’s analysis pointed to the potential for an overall 8.2 percent cut to HIV/AIDS and viral hepatitis programs that would severely impact ADAP enrollment and critical prevention, surveillance and viral hepatitis programming. The cuts would be especially devastating at a time when ending HIV/AIDS and viral hepatitis is within our reach. The National HIV/AIDS Strategy (NHAS) and the Department of Health and Human Services’ Viral Hepatitis Action Plan provide roadmaps for reducing new infections and increasing access to care, but these cuts mean we may never be able to realize these goals.

Like many health departments, Iowa has already faced steep reductions in funding, particularly to our HIV prevention program. Sequestration will mean further reductions in core activities like condom distribution, partner services, and disease surveillance. There is no way to maintain current levels of health department infrastructure with these cuts.

In addition, the implementation of health reform confronts us with daunting challenges and uncertainties. Perhaps at no time since the first AIDS program directors banded together to create NASTAD have we faced such adversity.

Despite the very difficult times in which we find ourselves, I am proud to have served NASTAD as we advanced critically important policy and program initiatives. Efforts to address stigma, particularly to decriminalize HIV and address states’ harsh and unnecessary criminal statutes pertaining to HIV transmission, will be one of the keys to achieving an AIDS-free generation. Only by reducing the fear and stigma surrounding HIV/AIDS and viral hepatitis will we be able to achieve that goal.

Moreover, addressing the social determinants of health is essential for tackling the hugely disproportionate impact of HIV on gay men of all races and ethnicities, particularly young Black gay men, as well as people who use injection drugs. NASTAD’s work to develop state health department capacity to address the HIV and viral hepatitis epidemics among these populations and to provide best practices for other states to emulate is imperative.

As we forge ahead to achieve an AIDS- and hepatitis-free generation, NASTAD will continue to play a critical role in facilitating peer-to-peer exchange of information, strategies, best practices, and capacity building through its multi-faceted technical assistance program across prevention, viral hepatitis prevention and health care access programs in the U.S. and internationally.

We want to hear from you! What changes have your health department programs experienced over the last year? Tell us by leaving a comment below.

In addition to observing Hepatitis Awareness Month and Asian and Pacific Islander Heritage Month in May, this week we also recognize the second annual Hepatitis Testing Day. As I look at all these important events for the month, I am reminded about why I do the work that I do. I invest my time and energy and passion in combating viral hepatitis not only because I believe in public health, not only because I am an Asian American, but also because it affects people I know and love. 

The Face of the Hepatitis B Epidemic

Chronic hepatitis B is a major health burden that affects up to 2.2 million people in the U.S. We also know that the majority of those living with chronic hepatitis B in the U.S. are from regions of the world where hepatitis B is highly endemic, especially Asia and the Pacific Islands. Even though Asians and Pacific Islanders (API) make up less than 5% of the general U.S. population, APIs account for more than 50% of Americans living with chronic hepatitis B. Most of these APIs (approximately two-thirds) currently living with hepatitis B are unaware of their status. We know that hepatitis B is the greatest health disparity among API and that we therefore should be addressing it within the API communities.

Drivers of Hepatitis B Infection

There are many social, economic, cultural, and linguistic challenges to ensuring appropriate, evidence-based education, prevention interventions, testing and comprehensive care are available to all API communities. Addressing these barriers in a culturally sensitive and linguistically appropriate way must be an ongoing priority, especially in the context of achieving the goals of the U.S. Department of Health and Human Services’ (HHS) Viral Hepatitis Action Plan and advancing culturally and linguistically appropriate services in health and health care.

For me, as a public health official and as a community member, it all comes back to ‘ohana (family). I think of my relatives who passed away from liver cancer because they were too poor, too unaware, or too ashamed to address their hepatitis B. Unfortunately, my situation is not an uncommon one, especially in Hawaii.

In Hawaii, more than half of our communities identify as Asian or Pacific Islander, and almost 1 out of 5 people are foreign-born. We are a state that is proud of our cultural diversity, and we recognize the need to keep all of our diverse communities healthy. When people in our state think about hepatitis B, they are not thinking about percentages or numbers. Instead, they are visualizing friends and coworkers, friends and family, aunties and uncles: people they know and love.

Responding to Hepatitis B in API Communities

In addressing hepatitis B, we have had to tailor our interactions for each API community so as to make meaningful and sustainable impacts on the community. We engage communities in Talking Circles that allow them to create their own “intra-ventions” on how they would like to address health issues within their own culture. Across these various intraventions, there are some consistent messages that have been developed around hepatitis B among all the cultures:

• Learn about it
• Get tested
• Get vaccinated
• Talk to your doctor

These are simple messages, but they are messages that can save lives and keep families healthy. Ultimately, public health “work” in hepatitis B (as well as hepatitis C) goes beyond medical models and numbers. We, as public health officials, are empowering diverse communities to stay healthy and take care of each other. In the same way, I hope that we, as public health officials, can continue to work together to support communities to combat viral hepatitis to the benefit of our communities, our families, and ourselves.

Learn more about hepatitis and Hepatitis Test Day resources and events in your area here.

We want to hear from you! Tell us how your state is responding to hepatitis B by leaving a comment below.

Oscar Mairena, Manager, Viral Hepatitis/Policy and Legislative Affairs, NASTAD

This month, Congresswomen Barbara Lee (D-CA) and Ileana Ros-Lehtinen (R-FL) introduced bipartisan legislation, HR1843, the Repeal Existing Policies that Encourage or Allow Legal (REPEAL) HIV Discrimination Act. The REPEAL Act calls for laws and policies that demonstrate a public-health oriented, evidence-based, medically-accurate and contemporary understanding of HIV transmission, risks of transmission based on means of exposure, current health implications of living with HIV and the benefits of treatment and comprehensive support services.

The REPEAL Act builds on the National HIV/AIDS Strategy’s (NHAS) recommendation that “state legislatures should consider reviewing HIV-specific criminal statutes to ensure that they are consistent with current knowledge of HIV transmission and support public health approaches to screening for, preventing and treating HIV.” The Presidential Advisory Council on HIV/AIDS (PACHA) provided similar guidance when it unanimously passed the Resolution on Ending Federal and State HIV-Specific Criminal Laws, Prosecutions, and Civil Commitments in February 2013. The PACHA resolution acknowledged that punishments imposed for non-disclosure, exposure or HIV transmission are out of proportion to the actual harm inflicted and reinforce fear and stigma associated with HIV. PACHA also resolved that “HIV criminalization is unjust, bad public health policy and is fueling the epidemic rather than reducing it.”

The Impact of Criminalization on Public Health

Given the role state HIV/AIDS programs play in implementing HIV related policies, laws and procedures, HIV criminal laws pose a professional and ethical conflict for health providers, public health officials and health departments who may be put in the position of having to choose between enforcing the law and protecting their patients—a conflict that can be detrimental to patient-provider relationships, identification of people living with HIV, linkage and retention to care, and treatment adherence. Because of this conflict, NASTAD released a Policy Statement on HIV Criminalization which committed our members to promote public education and understanding of the stigmatizing impact and negative public health consequences of criminalization statutes and prosecutions. NASTAD also issued five basic guidelines that identify current practices and procedures and provide a framework for evaluation, remedial measures and follow-up monitoring of HIV modernization efforts.

How the REPEAL Act will Benefit Public Health

The REPEAL Act calls for a joint-report between the Department of Health and Human Services, the Department of Justice and the Department of Defense which:

• Incorporates the input of state public health officials, nongovernmental health organizations and associations
• Involves state public health officials in the review of these laws and the creation of guidance to better address criminal statutes
• Determines whether these laws demonstrate a public-health oriented understanding of routes and risks of transmission of HIV
• Provides an analysis of the public health and legal implications of these laws on people living with and at-risk of HIV
• Includes a set of best practice recommendations directed to state governments, legislatures, attorneys general, public health officials and judicial officers

These specific recommendations will better equip state health departments and HIV/AIDS programs to tackle the criminalization of people living with HIV, modernize their policies so that they are in-sync with national directives and ensure the rights of their constituents without a professional and ethical conflict.

NASTAD commends Congresswomen Lee and Ros-Lehtinen for their work in ensuring the rights of people living with HIV and introducing the REPEAL Act. To learn more about NASTAD’s HIV Decriminalization efforts read our blog posts or visit our website.

We want to hear from you! How are criminal laws impacting HIV prevention and access to care in your state? Tell us how by leaving a comment below.

­­­­­As we begin to see the effects of the sequester on public health programs nationwide, it becomes increasingly clear that we must increase funding for HIV and viral hepatitis programs in FY2014 and onward in order to truly end these epidemics and improve the nation’s health. In light of this need, NASTAD has released fact sheets with recommendations for FY2014 health department HIV/AIDS and viral hepatitis program funding at the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA).

The across-the-board cut to federal programs in FY2013 known as the sequester means that CDC’s Divisions of HIV/AIDS Prevention (DHAP) and Viral Hepatitis (DVH) are cut by $40 million and $1 million, respectively, while HRSA’s Ryan White Program Part B and the AIDS Drug Assistance Program (ADAP) are cut by $22 million and $47 million, respectively. Additionally, because the continuing resolution (CR) that is currently funding FY2013 did not include the Emergency Relief Funding (ERF) for ADAPs that President Obama announced on World AIDS Day 2011, ADAPs are cut by an additional $35 million, on top of the sequester, unless the Administration acts to provide ERF once again.

The President’s Budget proposal for FY2014 would, however, undo the sequester, restore the cuts that happened in FY2013 and increase funding for HIV surveillance, viral hepatitis prevention and ADAPs, including continuation of the ERF. While NASTAD supports the President’s request, there continues to be a need for increased funding for health department HIV and viral hepatitis prevention and care programs in order to truly turn the page on these epidemics. Specifically, NASTAD recommends that, when compared to FY2012:

• “HIV Prevention by Health Departments” receive an increase of $75 million
• HIV surveillance cooperative agreements receive an increase of $35 million
• Viral hepatitis prevention receives an increase of $5.3 million for the Viral Hepatitis Prevention Coordinator Program (VHPC)
• Ryan White Part B receives an increase of $36 million
• ADAPs receive an increase of $133 million, including continuation of the ERF
• State and local health departments have the discretion to use federal funds to support cost-effective and scientifically proven, syringe services programs

These increases will better equip health departments to meet the goals of the National HIV/AIDS Strategy (NHAS), the HHS Viral Hepatitis Action Plan, CDC’s high-impact prevention model and will increase access, linkage to and retention in care and treatment.

Additionally, NASTAD is a part of the AIDS Budget and Appropriations Coalition and convenes the Hepatitis Appropriations Partnership, which continuously advocate for HIV and viral hepatitis funding for health departments, community based organizations, providers, research and others. To find out more about ABAC’s funding requests, please see their website.

Please view the fact sheets:

• HIV Prevention and Surveillance by Health Departments Funding
• Ryan White Program Part B and ADAP Funding
• Viral Hepatitis Prevention Funding
• The Impact of Sequester on Health Department HIV and Viral Hepatitis Programs

We want to hear from you! Tell us how budget cuts and the sequester are affecting HIV and viral hepatitis programs in your state by leaving a comment below.

NASTAD is working with the Botswana Ministry of Local Government and Rural Development (MLG) and the CDC Sustainable Management Development Program (SMDP) to develop the Applied Leadership Development Program for HIV and AIDS Coordination for District AIDS Coordinators (DACs). As we discussed in a previous blog post, in Botswana, DACs are critical to the management and coordination of the district-level response to HIV. This program is designed to develop the capacity of the Botswana government to equip AIDS Coordinators with the essential public health management competencies and confidence needed to effectively respond to the HIV/AIDS epidemic in their communities.

The Impact of Capacity Building in Botswana

To date, NASTAD and the government of Botswana have developed a curriculum framework and training modules, trained ten expert trainers selected from the public sector, and has piloted the training with eight AIDS Coordinators. The government of Botswana and NASTAD look forward to training all AIDS coordinators in the next year, and establishing the training program within the Botswana MLG as a permanent component of its Department of Primary Health Care Services (DPHCS).

The Official Launch will be performed by the Permanent Secretary of the Ministry of Local Government and Rural Development.

Ten Years of Partnerships in Botswana

At the same occasion, NASTAD will commemorate ten years of successful partnerships in building the HIV/AIDS response capacity in Botswana (2003-2013) by recognizing and honoring the contribution of its key partners including:

• The Centers for Disease Control and Prevention (CDC), represented by the Botswana CDC Director, Dr. Kathleen Toomey
• The National AIDS Coordinating Agency (NACA) represented by the NACA coordinator, Mr. Richard Matlhare
• The Ministry of Local Government and Rural Development (MLG) represented by the Permanent Secretary, Mr. Boipelo Khumomatlhare
• Family Health International represented by the Director, Dr. Alison Cooke

NASTAD has had a presence in Botswana since 2003, establishing strong relationships with the Botswana MLG and its Department of Primary Health Care Services (DPHCS), which provides oversight and strategic direction for the district level HIV/AIDS response. During the course of this relationship, NASTAD has worked to promote evidence-based planning (EBP) by districts, developing revised governance structures for District Multi-Sectoral AIDS Committees (DMSACs) and standardized national guidelines for evidence-based planning, and providing ongoing, one-on-one, on-site technical assistance and training to all districts.

In 2008, NASTAD expanded its support to districts by assisting them in implementing high priority HIV prevention activities identified in their comprehensive plans. NASTAD supported this through the provision of organizational, financial and technical assistance to district-level HIV prevention implementing partners in five districts.

NASTAD’s support for districts further expanded in 2010, when we began providing technical assistance to Ministry of Local Government and National AIDS Coordinating Agency (NACA) for strengthening the application of the Community Capacity Enhancement Program (CCEP), which is designed to build the capacity of Botswana Government Institutions, including Civil Society Organizations, to use Community Capacity Enhancement Strategies to enhance HIV prevention planning and interventions.

In 2011, NASTAD partnered with Family Health International (FHI 360) for the implementation of the Botswana Civil Society Strengthening Program (Maatla Project). With FHI’s team, NASTAD seeks to develop and implement a model to strengthen district level systems to provide and coordinate HIV/AIDS services in hard-to-reach areas.

To learn more about NASTAD’s work around the world, please visit www.NASTAD.org/global.

With federal and state funding for HIV/AIDS and viral hepatitis services increasingly constrained, it is essential that health departments explore alternative sources of support to ensure the sustainability of vital services. Full implementation of the Affordable Care Act (ACA) provides new opportunities for health departments and implementing partners to leverage resources made available through third-party reimbursement. Please visit NASTAD’s health reform website for resources on what the ACA means for HIV/AIDS and viral hepatitis programs and services, and how health departments are preparing for reform.

Assessing Health Departments’ Capacity for Third-Party Billing and Reimbursement

Until now, health departments have relied largely on grant funding to support comprehensive HIV/AIDS and viral hepatitis prevention and care programming. Because of this historical reliance, many health department HIV/AIDS and viral hepatitis programs have relatively limited knowledge of and experience with third-party billing and reimbursement. To inform plans for technical assistance to support health departments in increasing their third-party billing and reimbursement capacity (and that of their contracted providers), NASTAD assessed current health department practice regarding third-party billing and reimbursement as well as the legal and regulatory challenges faced by health departments in implementing third-party billing. The results of the assessment are contained in an Issue Brief: Health Departments and Capacity for Third-Party Billing and Reimbursement: A Status Report and Resources for Capacity Building.

NASTAD’s assessment made it clear that health department capacity for participating in third-party billing is currently limited. Survey findings indicated that only 11 of 29 health departments that provide services directly to clients are engaged in any sort of billing of third-party payers. An encouraging finding is that many of the agencies that health departments support to provide HIV/AIDS and viral hepatitis services, especially community health clinics and other providers of medical services, have the capacity to bill Medicaid and other insurers for health services. However, most health departments do not require their contractors and grantees to bill for those services which are reimbursable by third-party payers, such as HIV and HCV screening services.  

How Health Departments Can Build Capacity for Third-Party Billing and Reimbursement

There are several concrete steps that health departments can take now:

1. Assess the capacity of service providers in your jurisdiction to participate in third-party billing and reimbursement. A sample tool is available for download here.
2. Talk to your health immunization or family planning programs. These programs have likely already implemented third-party billing and can provide you with valuable information and lessons learned. You may also be able to leverage existing billing capacity within your health department.
3. Collaborate with your public health laboratory to implement billing for testing for HIV and viral hepatitis.
4. Require health department contractors and grantees that have the capacity to do so to seek third-party reimbursement for services which are reimbursable.
5. Consult with your state Medicaid program to ensure or negotiate coverage of vital preventive services.

To ensure sustainable services, health departments cannot afford to wait any longer to develop their capacity and that of local HIV/AIDS and viral hepatitis service providers to participate in third-party billing and reimbursement. Some resources that can help you get started are available here.

For additional information about this report or about NASTAD’s activities around billing and reimbursement, please contact Amy Killelea, Senior Manager, Health Care Access or Liisa Randall, NASTAD Consultant.

We want to hear from you! Is your health department implementing third-party billing? Tell us about your experience and share resources that have helped you by leaving a comment below.

On April 9^th, the Centers for Medicare and Medicaid Services (CMS) released a funding opportunity announcement (FOA) for eligible entities to serve as Patient Navigators in federally facilitated and partnership exchanges/marketplaces (state-run exchanges/marketplaces will be administering their own Patient Navigator programs). To access the funding opportunity announcement, visit: http://www.grants.gov, and search for CFDA #93.750. See the Kaiser Family Foundation map to the right to see which type of exchange/marketplace your state will have.

Upcoming Webinars on Patient Navigators

To learn more about the Patient Navigator FOA and what it takes to be a patient navigator, register for the webinars referenced below.

• CMS, Conference Call on Patient Navigator FOA, April 19, 2013 (3:30-5:00pm EST)
 Toll-free teleconference phone number: 877-267-1577; ID: 2917
• Enroll America, Webinar: So You Want to Be a Navigator? April 18, 2013 at 2:00pm EST. Register here.
  

What is the Patient Navigator Program?

The Patient Navigator program will fund eligible entities (including state health departments and community-based organizations) to conduct a range of outreach, education, and enrollment assistance activities to help people purchase insurance through the exchange/marketplace. Navigators must be able to serve both the individual exchange/marketplace as well as the Small Business Health Options Program (SHOP). However, applicants may identify the specific populations they will reach. For instance, an applicant could note expertise in serving underserved populations (such as low-income people living with HIV) or individuals with limited English proficiency.

Navigators are expected to:

• conduct public education activities about insurance coverage options available through the exchange/marketplace;
• provide information to applicants in a fair and impartial manner;
• be knowledgeable about other health programs, such as Medicaid;
• help applicants choose a Qualified Health Plan that meets their needs;
• refer applicants to relevant appeals bodies to resolve complaints, etc.; and
• provide information in a culturally and linguistically appropriate manner.

A proposed regulation currently out for comment provides additional information about the conflict-of-interest and training/certification requirements for all Patient Navigators (whether serving in a federally facilitated, partnership, or state exchange/marketplace). For example, Navigators must undergo thirty hours of training, receive a passing score on an approved certification examination, and participate in annual continuing education.

How Do I Apply to Become a Patient Navigator?

The funding opportunity provides up to $54 million in total funding to eligible entities. Applications are due by June 7, 2013 (applicants may submit an optional Letter of Intent by May 1, 2013). To access the funding opportunity announcement, visit: http://www.grants.gov, and search for CFDA #93.750. Applicants must have a Dun and Bradstreet Data Universal Numbering System (DUNS) number (any federal grantee will already have this number).

State HIV/AIDS programs and community-based organizations have the option of applying as a lead entity or applying as part of a consortium of applicants (with one designated lead entity). Smaller organizations may want to consider the consortium option and should identify and reach out to the other potential applicants in their areas.

Importantly, in addition to the Patient Navigator Program, there will be other outreach and enrollment resources and funding opportunities. Providers and state HIV/AIDS programs should monitor state Medicaid programs, departments of insurance, and exchange/marketplace websites for state training modules and other insurance assister opportunities.

Patient Navigator Resources

• CMS, Fact Sheet: New Funding Opportunity Announcement for Navigators in Federally-facilitated and State Partnership Marketplaces
• CMS, Proposed Rule Outlining standards for Navigators in Federally-facilitated and State Partnership Marketplaces.
  

We want to hear from you! Do you or your organization plan on applying to be a Patient Navigator? Tell us by leaving a comment below.

Today’s youth are the first generation to have never known life without HIV/AIDS. According to the U.S. Centers for Disease Control and Prevention (CDC), people ages 13-29 accounted for 39% of all new HIV infections as of 2009. More than 34,000 young people are living with HIV, and health departments remain committed to linking these individuals to care.

The National Alliance of State and Territorial AIDS Directors (NASTAD) has partnered with 13 other national and local organizations to establish the first-ever National Youth HIV/AIDS Awareness Day (NYHAAD), which is April 10, 2013. NYHAAD is a day to educate the public about the impact of HIV/AIDS on young people as well as highlight the amazing work young people are doing across the country to fight the epidemic.

In observance of NYHAAD, NASTAD is releasing a new video “Raising the Bar: Young People, HIV and Access to Healthcare.” The 10-minute clip features youth and health care professionals from across the United States discussing the barriers to effectively linking youth to HIV care, and the urgent need for a disease response that addresses the unique issues facing young people.

The video is a continuation of NASTAD’s efforts to raise awareness of issues facing youth living with HIV/AIDS, particularly youth disproportionately impacted by the disease.

NASTAD’s other work on youth and HIV includes:

• In January 2013, the article “Improving Engagement and Retention in Adult Care Settings for Lesbian, Gay, Bisexual, Transgender and Questioning (LGBTQ) Youth Living with HIV: Recommendations for Health Care Providers” was published in the Journal of Gay & Lesbian Mental Health; it was co-written by NASTAD staffer Michelle Batchelor and NASTAD consultant Rena Greifinger.

• In 2012, NASTAD released “Reaching Them Where They Are,” a guide for using online and social media to conduct sexual health outreach with youth.

NYHAAD will feature events across the country, including a Congressional briefing led by U.S. Rep. Barbara Lee (D-CA), who has long been a champion of strengthening the response to HIV/AIDS. A resource toolkit is available for any community stakeholders interested in commemorating National Youth HIV/AIDS Awareness Day, and NASTAD will continue to share information and resources as appropriate.

If you have any questions about NASTAD’s youth work or about NYHAAD, please contact Isaiah Webster III.

To learn more about National Youth HIV/AIDS Awareness Day and related events in your area, please visit www.AmplifyYourVoice.org/NYHAAD.

ADAP Enrolling and Serving More Clients than Ever Before; Future Funding Uncertain

Washington, DC – Today, the National Alliance of State and Territorial AIDS Directors (NASTAD) released the second and final module of its 2013 National ADAP Monitoring Project Annual Report. The National ADAP Monitoring Project is NASTAD’s long-standing effort to document new developments and challenges facing AIDS Drug Assistance Programs (ADAPs), assessing key trends over time and providing the latest available data on the status of ADAPs. For the last 18 years, NASTAD has provided comprehensive analysis about ADAPs through The Report.

This year, NASTAD released the report in two installments. Module Two, which is being released today, provides updated ADAP enrollment information and highlights ADAPs’ progress towards the implementation of health reform. Included in this Module is a tool for ADAPs to use in preparing for health reform. Action steps are identified to assist ADAPs in identifying state decision makers and assembling necessary program information and data to inform conversations and next steps. Despite a tough economic climate and shifting funding, ADAPs enrolled and served more clients that ever before during FY2012. ADAPs also continue to move forward with health reform implementation by engaging in conversations with Medicaid programs on expansion planning, working with Pre-Existing Condition Insurance Plans (PCIP) on ADAP client enrollment and transition planning for post-health reform implementation and programmatic changes.

Module One, released in January, includes detailed information related to ADAP budgets, client enrollment and utilization, client demographics, prescription distribution and payment methods, expenditures and prescriptions filled, insurance coordination, program eligibility, program management and administration, ADAP formulary coverage and hepatitis treatment coverage. These modules will be combined into a final, comprehensive report later this year.

ADAP continues to play a crucial role in ensuring and maintaining access to care for people living with HIV/AIDS (PLWHA), which is an important part of achieving the goals of the National HIV/AIDS Strategy and filling coverage gaps as implementation of the Affordable Care Act (ACA) moves forward. ADAP’s role in providing medications to PLWHA is also essential for optimizing outcomes and preventing new infections, as illustrated in the prevention to care continuum.

“While the data in this year’s Report paints a picture of a resilient and flexible national program, many states continue to experience increased stress as demand for services outpaces available funding resources,” noted Julie Scofield, NASTAD’s Executive Director. “ADAP remains a vital safety net program for those disproportionately impacted by the HIV epidemic, especially communities of color, and it is imperative that we continue pushing for the critical funding needed to eliminate waiting lists and continue providing access to life-saving care and treatment for clients.”

The House and Senate passed the Consolidated and Further Continuing Appropriations Act, 2013, a continuing resolution (CR) that will fund the federal government for the rest of FY2013. President Obama signed the bill on Tuesday, March 26, 2013. The bill does not affect the implementation of sequestration, which will result in automatic cuts of at least five percent to ADAPs and could result in an estimated 15,708 clients losing ADAP services.

Additionally, the $35 million for ADAP Emergency Relief Funding (ERF) that President Obama announced on World AIDS Day 2011 is not included in the bill. The ERF for Ryan White Part C is also not included. The Secretary of the Department of Health and Human Services (HHS) retains transfer authority and NASTAD is working with the administration to secure replacement of that loss of funding through that authority. If this anomaly is not corrected, this funding will not be available for states during FY2013 and could result in up to 8,000 individuals being disenrolled from ADAP. It is also then likely that funding levels for other ERF awards from previous years would shift greatly. In response, the HIV community is organizing a sign-on letter to the President urging him to restore the funding in order to ensure continuation of care and treatment for thousands of people living with HIV/AIDS.

The current fiscal challenges facing the nation pose threats to access to life-saving medications for PLWHA through ADAP. Work must continue through a three-pronged approach that includes securing additional resources for ADAPs from the federal government; maintaining, restoring, and increasing resources for ADAPs from state governments; and, continuing pricing agreements between ADAPs and pharmaceutical manufacturers to provide financial stability and augmenting existing agreements, when applicable.

Learn more about ADAP here.

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The National Alliance of State & Territorial AIDS Directors (NASTAD), founded in 1992, is a nonprofit national association of state and territorial health department HIV/AIDS program directors who have programmatic responsibility for administering HIV/AIDS, viral hepatitis and associated public health programs. NASTAD works to strengthen the role and promote the success of state and territorial public health programs in the U.S. and internationally. For more information, visit www.NASTAD.org.