The Director of the US Centers for Disease Control and Prevention (CDC), Dr. Robert Redfield, presented the findings of a new CDC report at the triennial National HIV Prevention Conference (NHPC), which showed that roughly 80% of new HIV infections in the United States occur among people who either do not know their HIV status or are not receiving antiretroviral therapy (ART) to suppress their viral load. The NHPC took place March 18-21, 2019, in Atlanta, Georgia.

Dr. Redfield also spoke about the Trump Administration’s new “Ending the HIV Epidemic” initiative that seeks to reduce new HIV infections in the United States by 90% by 2030. To reduce transmission, the CDC recommends that all adults get tested for HIV, that anyone who tests positive for HIV should be immediately initiated on ART, and that HIV at-risk individuals be prescribed PrEP. The CDC report further indicated that 43% of new HIV transmissions occur among the 23% of people living with HIV who are not on ART.

Many speakers stressed the importance of tackling the stigma that often acts as a barrier to those most in need accessing and utilizing HIV testing, treatment, and prevention services. Dr. Gail Wyatt, a Professor at the UCLA Semel Institute for Neuroscience and Human Behavior who also serves as the Associate Director of the UCLA AIDS Institute, highlighted the fact that African-American women represent 61% of women living with HIV, despite the fact that they comprise 13% of women in the United States.

Other speakers reported data demonstrating a link between localized outbreaks of new HIV infections and communities suffering from high rates of substance use. Kevin Cranston, who directs the Bureau of Infectious Disease for the Massachusetts Department of Public Health, said that clusters of new HIV infections were being observed among higher income areas of his state that are associated with higher numbers of people who inject drugs.

IAPAC was represented at the conference by Senior Director for Stakeholder Engagement, Ace Robinson. Since 2014, 23 municipalities across the United States have joined the global Fast-Track Cities network to achieve 90-90-90 – programmatic targets related to HIV testing, treatment, and viral suppression – as well as zero stigma.

 

 

 

Public Comments Delivered by
IAPAC President/CEO Dr. José M. Zuniga at the
63rd Presidential Advisory Council on HIV/AIDS Meeting 
March 15, 2019, Washington, DC

My name is Dr. José Zuniga, and I am the President/CEO of the International Association of Providers of AIDS Care, or IAPAC. In 2014, we partnered with UNAIDS and other institutions to launch the global Fast-Track Cities initiative. Last month, Columbia, South Carolina, became the 23^rd US municipality to become a Fast-Track City, joining more than 270 other cities and municipalities worldwide.

Fast-Track Cities functions under a catalytic, data-to-care model. We coalesce politicians, public health officials, clinical leadership, service providers, and community stakeholders around accelerated local AIDS responses. Progress is measured by programmatic and service delivery targets. The initiative prioritizes key populations, and our aim is to increase the numbers of people – particularly from key populations – who are aware of their status, linked to care, initiated on PrEP or ART, and achieving the preventative and therapeutic benefits that these biomedical interventions represent.

We support President Trump’s pledge to end the US HIV epidemic by 2030 because it is achievable. We believe that Fast-Track Cities is well aligned with and can support the new Ending the HIV Epidemic Plan because our US efforts are focused in cities and counties – for example, Birmingham and Jefferson County, San Antonio and Bexar County, and Atlanta and Fulton County. In this and other countries, we are also recruiting a critical mass of cities and municipalities to impact national HIV epidemics. We have seen such an impact in countries such as Brazil and the United Kingdom, and in PEPFAR-supported countries, including Kenya and Ukraine.

I commit that IAPAC will harmonize our Fast-Track Cities activities to support the new federal HIV strategy, including data generation and reporting, capacity-building, stigma elimination, and implementation science. And, I urge you to leverage the political will that we have engendered among Mayors, County Chairs and Judges, and even Governors across existing and prospective Fast-Track Cities. We share a belief in HIV responses that are community-centered, multi-stakeholder, data-informed, equity-based, and accountability-driven. These attributes all factor into the calculus for progress that we are witnessing across the Fast-Track Cities network.

As has already been said, we cannot rely solely on a biomedical approach. So long as HIV-related and intersectional stigma remain obstacles for people to seek HIV testing and other services, even the best intentions will achieve limited results. We have a duty to care for Americans who are marginalized by race, ethnicity, gender and gender identity, sexual orientation, mental health conditions, substance use disorders, poverty, and homelessness. De-stigmatizing an HIV diagnosis by promoting the U=U message is also critical.

Members of PACHA, the public health threat we face transcends politics. HIV affects us all. Only with that understanding, and by working together, can we make President Trump’s pledge and the Ending the HIV Epidemic Plan a reality. IAPAC, UNAIDS, and the Fast-Track Cities initiative stand ready to play our role.

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IAPAC Vice President for Programs, Dr. Christopher Duncombe, chaired a gathering of HIV researchers on March 3, 2019, to discuss the development of an urban AIDS-focused implementation science agenda. The expert advisory meeting preceded the annual Conference on Retroviruses and Opportunistic Infections (CROI), which is taking place March 4-7, 2019, in Seattle.

Dr. Duncombe discussed how the Fast-Track Cities initiative presents an opportunity for implementation science studies aimed at identifying and taking to scale promising new strategies to accelerate the attainment of the initiative’s 90-90-90 and getting to zero targets. IAPAC’s desired objective is to leverage the Fast-Track Cities network by funding clinician and community researchers to conduct implementation science studies that address barriers to optimized HIV prevention and care continua.

Implementation science is an evolving field of research that aims to enhance public health by promoting the adoption of effective interventions, policies, and strategies in diverse real-world settings. An expert in the field, Dr. Elvin Geng of the University of California, San Francisco, noted at the meeting that there remains no single definition for “implementation science” among the research community. However, he added that a number of common themes have emerged within the existing body of research. These themes include gap mapping, understanding and closing these gaps in care, and exploring the tension between generalizability and context. Dr. Geng noted that the field of implementation science places an emphasis on interdisciplinary approaches that encompass expertise in epidemiology, statistics, anthropology, sociology, health economics, political science, policy analysis, ethics, and other fields. The hallmarks of good implementation science, according to Dr. Geng, are a strong theoretical justification, design for external and internal validity, the pursuit of conceptualization and specification of implementation strategies, and attention to outcomes.

The meeting also included representatives from the Joint United Nations Programme on HIV/AIDS (UNAIDS), as well as the Office of AIDS Research and the National Institute of Mental Health, which operate under the National Institutes of Health in the United States, and researchers from other academic institutions. Also in attendance was Dr. Maggie Czarnogorski, Head of Innovation and Implementation Science at ViiV Healthcare, which is an HIV industry leader in supporting a growing community of researchers, policy makers, community organizations, and advocates interested in advancing an implementation science agenda. ViiV Healthcare is also an early supporter of and longtime partner with IAPAC in advancing myriad activities and programs across 40 Fast-Track Cities worldwide.

As previously noted, the meeting, titled “Leveraging Fast-Track Cities for Implementation Science,” took place ahead of the CROI 2019 Conference in Seattle. News emerged on the conference’s second day of a second patient in London whose HIV is reportedly in remission. While expressing “cautious optimism that this development may some day yield a cure for HIV,” IAPAC President/CEO Jose M. Zuniga stressed that “sustained investment in innovative research is as important as implementation science around the acceleration of uptake of new medicines, diagnostics, and technologies.”