Articles, Blog

DAY 1, Part 2: Ending the HIV Epidemic: A Plan for America

December 17, 2019


>>GREAT SO TAMMY I THINK WE
WILL KICK THIS OFF TO YOU TO INTRODUCE OUR FEDERAL LEADERS TO
TALK ABOUT THE PLAN SO PRESENTATION ON ENDING HIV
EPIDEMIC.>>THANK YOU VERY MUCH.
I AM TAMMY BECKHAM AND I’M DIRECTOR OF OFFICE OF HIV/AIDS
AND INFECTIOUS DISEASE POLICY AND I’M THRILLED TO BE HERE
TODAY AS WELL AND THANK YOU DR. MCCRAY FOR SETTING THE STAGE
FOR THE NEXT PRESENTATION THAT WE WILL HEAR.
I THINK YOU OUTLINES SEVERAL OF THE CHALLENGES AND HAVING THE
DATA BEFORE THE PRESENTATION WILL BE GREAT.
IT’S MY GREAT PLEASURE TODAY TO HAVE THE OPPORTUNITY TO
INTRODUCE OUR NEXT PANEL WHO ARE THE AGENCY LEADERSHIP AND WHO
HAVE SET THE VISION FOR THIS PLAN AND THEY’RE GOING TO SPEAK
TODAY ON ENDING THE HIV EPIDEMIC, A PLAN FOR AMERICA.
SO THEY’RE GOING TO PRECEPT TO US AND THEN WE WILL HAVE THE
OPPORTUNITY TO DISCUSS AND ASK QUESTIONS AND I WILL START BY
INTRODUCING OUR PANEL MEMBERS TODAY.
WE HAVE ADMIRAL BRETT GIROIR WHO YOU HEARD EARLIER, ASSISTANT
SECRETARY FOR HEALTH. DR. ROBERT REDFIELD, CENTERS OF
DISEASE CONTROL AND PREVENTION. DR. ANTHONY FAUCI, DIRECTOR NIH
WITH NIAID AND DR. GEORGE SIGOUIN, AS, HEALTH RESOURCES
AND SERVICES ADMINISTRATION AND DR. MICHAEL WEAHKEE ACTING
DIRECTOR INDIAN HEALTH SERVICE AND WE ALSO HAVE DR. ELINORE
Mc CANC KATZ,.>>THANK YOU FOR THAT.
I THINK THIS WILL BUILD ON THE CONCEPTS YOU JUST HEARD.
MANY OF YOU KNOW THIS INFORMATION BUT WE FEEL IT’S
IMPORTANT TO HEAR FROM THE PRINCIPALS AT THE AGENCY SO WE
HAVE THE SAME COMMON FOUNDATION. SO WE WILL GO THROUGH THE EARLY
PART OF THE PRESENTATION RELATIVELY QUICKLY BECAUSE IT
BUILDS ON THINGS YOU’VE HEARD, TALK ABOUT WHAT’S GOING TO
HAPPEN AND THE STATE REGULATOR STATUS OF THE PLAN MOVING
FORWARD FOR THE $291 MILLION IN RESOURCES AS WELL AS THE ONGOING
RESOURCES WE HAVE AND HAVE AN OPPORTUNITY FOR QUESTIONS AND
ANSWERS. GOOD, I CONTROL MY OWN SLIDE
DESTINY. THATYA REALLY GREAT.
YOU JUST SAW THIS SLIDE BUT IT IS A SLIDE SET THAT WE HAVE BEEN
USING FOR SEVERAL MONTHS TO SLIDE AND IT JUST SAYS WHAT IT
SAYS, 700,000 AMERICANS, 400,000 PEOPLE WILL LIKELY GET INFECTED
OVER THE NEXT TEN YEARS UNLESS WE MAKE AN IMPACT.
AND YOU’VE ALSO HEARD DESPITE THE PROGRESS IN 1980S TO THE
2000S WE HAVE REALLY HIT A PLATEAU.
SOMEWHERE IN THE NEIGHBORHOOD OF 40,000 CASES A YEAR THAT REALLY
UNDERSCORES THE REASON FOR THIS NEW INITIATIVE.
THAT A PLATEAU ACCEPTANCE OF 40,000 CASES A YEAR IS NOT
ACCEPTABLE. WE ALL HEARD THE PRESIDENT, WE
ARE PROUD OF THE MOMENT WHEN HE DID INDICATE HIS SUPPORT FOR
THAT INITIATIVE AND THAT MOVING FORWARD AND MUCH WORK WENT INTO
BEFORE THAT ANNOUNCEMENT WAS HAD AS YOU MIGHT IMAGINE BUT THE
WORK JUST REALLY JUST BEGENERATEDS.
SO THE MEAT OF THIS AND EACH OF MY COLLEAGUES WILL GO INTO EACH
OF THESE POINTS VERY SPECIFICALLY, BUT IT IS VERY
CLEAR THAT THE TIME IS NOW, IT HAS BEEN PREPARED FOR THE PAST
THREE DECADES TO GET TO THIS POINT, BUT THE TIME IS EXACTLY
NOW BECAUSE WE HAVE THE RIGHT DATA, WE HAVE THE RIGHT TOOLS
AND I WOULD ALSO SUGGEST THAT WE HAVE THE RIGHT LEADERSHIP TO GET
THIS DONE. EPIDEMIOLOGY CRITICAL,
DR. REDFIELD WILL TALK TO YOU ABOUT HOW HIV INFECTIONS OR ARE
CLUSTERED. BOTH HE AND ADMIRAL WEAHKEE WILL
TALK ABOUT HOW THEY’RE CLUSTERED GEOGRAPHICALLY.
THERE’S NO BETTER PERSON IN THE WORLD TO TALK ABOUT THE
EFFECTIVENESS AND THE OPPORTUNITIES OF THE
ANTIRETROVIRAL THERAPY AND PREP THAN DR. TONY FAUCI, PROVEN
MODELS OF CARE AND PREVENTION, RYAN WHITE AND A NEAR MIRACLE TO
THIS COUNTRY AND WHO IT HAS ACHIEVED AND IT’S CONTINUING
TO,A CHIEF AS WELL AS WITH HEALTH CENTERS COUPLED WITHEY
DETECT AND RESPOND STRATEGY AND WE WILL HEAR AT THE END HOW THIS
FITS TOGETHER, WHERE WE’RE GOING, MOVING FORWARD, AND
DR. KATZ IS COMMITTED TO THIS. SHE’S THE ASHES CYST ANT
SECRETARY AND DIRECTOR OF SAMHSA, BUT HAD BE AT A
WHITE HOUSE MEETING THAT WAS VERY IMPORTANT FOR HER TO DO BUT
SHE IS FULLY INVOLVED AND ENGAGED.
SO WITH THAT INTRODUCTION, LET ME TURN IT OVER TO DR. REDFIELD.
>>YOU’VE SEEN THIS MAP BEFORE BUT IT’S IMPORTANT, WHAT WE DID
HERE–FORMERLY TRAINED EPIDEMIOLOGY, YOU KNOW THE MAPS
WE’RE USING IS OCCURRENCE PER HUNDRED THOUSAND AND WHEN YOU
LOOK AT A MAP LIKE THAT IT’S PRETTY SPREAD BUT HERE’S WHAT WE
DID WAS THE PROGRAM MAPPED OUT EACH CASE WHERE IT OCCURRED,
WHAT JURISDICTION IT WAS IN AND THEN WE ARBITRARILY BUILDING ON
SOME OF THE EXPERIENCES THAT DR. FAUCI HAD WITH PEP FFAR AND
SOME OF YOU IN THIS ROOM, LET’S ELECTRIC AT WHERE 50% OF THE NEW
CASES ARE OCCURRING AND WHAT YOU SEE HERE ARE THE 48 COUNTY
JURISDICTIONS OUT OF MORE THAN 3000 COUNTIES IN THE UNITED
STATES THAT ACCOUNTS FOR MORE THAN 50% OF THE INFECTIONS, WITH
THE ADDITION OF WASHINGTON AND SAN JUAN PUERTO RICO.
THESE WERE ALL URBAN AREAS, FAIRLY POPUMENT THE URBAN AREAS
AND OBVIOUSLY AS HAS BEEN ALLUDED TO WE RECOGNIZE THE
CHALLENGES IS IN RURRAAL AREAS ALSO AND IN ADDITION TO THAT WE
LOOK AT THE UNITED STATES TO TRY TO DETERMINE WHERE THE HIGHEST
OCCURRENCE, INCIDENCE OR DIAGNOSE IN THIS TWO YEAR PERIOD
AS EUGENE ALLUDED TO, WHEREVER THE MOST RURAL INFECTIONS?
AND YOU SEE WHAT WE CAME UP WITH WAS ACTUALLY SEVEN STATES, SOUTH
CAROLINA, AND YOU CAN SEE THE STATES HERE.
SARK SARKS, KENTUCKY, ALABAMA, MISSOURI, ARKANSAS AND OKLAHOMA.
AND SO THE COMBINATION OF THAT AND I WILL TELL YOU THAT WHEN
DR. FAUCI AND I THINK SAW THAT MAP, WE LOOKED AT IT AND SAID,
WOW, THIS IS A REAL FOCUSED CHALLENGE AND IF YOU COULD JUST
TARGET RESOURCES INTO THOSE 50 JURISDICTIONS WE COULD REALLY
MAKE A MAJOR IMPACT AND I THINK WHAT THE ADMIRAL AND MYSELF AND
TONY HAVE SAID FOR YEARS WHICH MANY LOOKED AS AN ASPIRATIONAL
GOAL TO END THE AIDS EPIDEMIC ALREADY WHEN THIS MAP CAME UP
PEOPLE SAID, INCLUDING OUR SECRETARY, WAIT A MINUTE, THIS
IS DOABLE. OKAY, THIS IS DOABLE, PUT
TOGETHER A PLAN. HOW WILL WE DO IT?
SO VERY IMPORTANT. THAT’S THE POINT I WANT TO MAKE.
NEXT SLIDE. THE SECOND SLIDE IS SOMETHING
MANY OF YOU ARE VERY FAMILIAR WITH AND CDC CAME OUT WITH THE
WRECK MENDATIONS IN 2006 TO ENCOURAGE THE MEDICAL COMMUNITY
TO ROOTINIZE THE DIAGNOSIS OF HIV IN THE MEDICAL SETTINGS AND
AS THE NEW CDC DIRECTOR WHEN I SAW THIS, I COULDN’T BELIEVE
THIS WAS THE STATE OF AFFAIRS IN 2018.
BUT YOU CAN SEE THAT IN REALITY SEVEN OUT OF TEN PEOPLE WHO WERE
DIAGNOSED IN THAT PERIOD, 2018–YOU KNOW 16, AND 17, YOU
CAN SEE THAT SEVEN OUT OF TEN PEOPLE HAVE BEEN IN HEALTHCARE
FACILITY IN THE LAST 12 MONTHS BUT THEY WEREN’T DIAGNOSED.
MORE DIFFICULT FOR ME TO COMPREHENS IS THAT ONE IN FIVE
PRESENTED WITH AIDS. YOU REQUEST SEE ONE IN FOUR
BASED ON MODELING AND ONE IN TWO WERE INFECTED FOR MORE THAN
THREE YEARS AND THAT’S WHY EUGENE USE THAD TERM OF
DIAGNOSIS VERSUS INCIDENCE, WE’RE NOT MEASURING INCIDENCE
WE’RE MEASURING DIAGNOSIS. BUT THE SUBSTANTIAL NOW THE
DIAGNOSIS THAT WE’RE MAKING ARE IN PEOPLE THAT HAVE NOT BEEN
DIAGNOSED FOR MULTIPLE YEARS. I WAS SURPRISED.
THE OTHER ANALYSIS THAT’S BEEN DONE IS DETERMINED THAT
APPROXIMATELY 87% OF THE NEW INFECTIONS WERE SOMEHOW LINKED
TO PEOPLE THAT WERE NOT DIAGNOSED OR PEOPLE THAT WERE
DIAGNOSED THAT WEREN’T–THEY HAD NOT RETAINED IN CARE.
JUST UNDERSCORING THAT SO ONE OF THE BIG CHALLENGES WE ALL HAVE
TOGETHER WOULD BE INTERESTED IN MANY OF YOU THAT HAVE BEEN IN
THE FIELD IS THIS SORT OF DIAGNOSTIC COMPLACENCY THAT’S
SORT OF COME INTO MANY OF THE HEALTHCARE SYSTEMS IN OUR NATION
TODAY. AND THEN THE NEXT SLIDE.
I THINK THE OTHER THING THAT MADE IT AS THE ADMIRAL SAID
REALISTIC THAT THIS GOAL COULD BE ACCOMPLISHED WAS THIS IS NOT
JUST GEOGRAPHICALLY HIGHLY FOCUSED IT’S DEMO
PHOTOGRAPHICALLY VERY FOCUSED. LARGELY IN AFRICAN AMERICAN AND
WELL TIN O MEN WHO HAVE SEX WITH MEN AND BETWEEN THE AGES 25-34.
REALLY IMPORTANT AREA, THE OTHER THING TO HIGHLIGHT IN THIS AND
I’LL TURN IT OVER TO MY COLLEAGUES, IS THAT WE DO HAVE A
SUBSTANTIAL IMPACT OF THIS CURRENT OUTBREAK IN THE SOUTH.
I’M TKPHRAD WE INCLUDED SEVEN SOUTHERN STATES TO BE A FOCAL
POINTS TO SEE IF WE CAN MAKE SURE THAT THE STRATEGIES THAT
ARE DEVELOPED IN THE PRESIDENT’S INITIATIVE NOT ONLY WORK IN
URBAN CITIES, BUT ACTUALLY CAN WORK IN THE RURAL SOUTH,
INCLUDING THE TRIBAL AREAS.>>DR. REDFIELD, WE WANT TO DO A
DEEP DIVE INTO ONE OF THOSE DEMOGRAPHIC HOT SPOTS WHICH IS
THE AMERICAN INDIAN, ALASKA NATIVE.
AT THE INDEPIDEMIOLOGIC HEALTH SERVICE WE’RE VERY EXCITED TO BE
PART OF THIS ENDING THE HIV INITIATIVE, RESERVE A RELATIVELY
SMALL SUBSECTION OF THE U.S. POPULATION, AND WE WE’RE
GRATEFUL FOR THIS OPPORTUNITY TO ADDRESS HIV IN INDIAN COUNTRY.
THE PRESIDENT’S BUDGET FOR FISCAL YEAR 2020, WE’RE ASKING
THAT THERE BE AN INVESTMENT OF $25 MILLION IN THE CONTINUING
PARTNERSHIPS BETWEEN IHS AND NATIVE COMMUNITIES TO END THE
HIV EPIDEMIC AND INDIAN COUNTRY. THIS BUDGET PROPOSE ESTABLISHING
HEPATITIS C AND HIV/AIDS AND INDIAN COUNTRY INITIATIVE TO
PROVIDE TREATMENT AND CASE MANAGEMENT SERVICES TO PREVENT
INFECTION AND ENHANCE HIV TESTING AND LINKAGES TO CARE IN
SUPPORT OF THE ADMINISTRATION ENDING THE HIV EPIDEMIC.
AND AND BY OUR AGENCY BEST PRACTICE TO ASK THE COMMUNITIES
THAT WE’RE SERVING HOW WE SHOULD PUT THIS MONEY OUT AND HOW IT
CAN BEST BE USED SO WE’LL BE REACHING OUT TO THEM TO ASK HOW
BEST TO USE THESE NEW FOUND FUNDS TO SERVE OUR AMERICAN
INDIAN AND ALASKA NATIVE COMMUNITY.
I WANT TO,A NOUNS FOR EVERYBODY THAT NEXT WEEK IS NATIONAL
HIV/AIDS AWARENESS KAY ON WEDNESDAY MARCH 20th AND THIS
SERVES AS AN OPPORTUNITY TO INCREASE AWARENESS OF THE IMPACT
OF HIV/AIDS ON AMERICAN INDIANS AND ALASKA NATIVE AS WELL AS
HAWAIIANS. IT ALSO WELCOMES THE OPPORTUNITY
FOR PEOPLE TO CREATE A GREATER AWARENESS OF THE RISK OF
HIV/AIDS TO THEIR COMMUNITIES AND REMEMBER THOSE WHO HAVE
PASSED AND ACKNOWLEDGE THOSE THAT ARE EFFECTED BY HIV/AIDS,
MARCH 20th CAN BE USED AS A CALL TO ACTION ACROSS INDICAN
COUNTRY TO GET TESTED FOR HIV TO CREATE MORE ACCESS TO TREATMENT
AND CALL FOR INCREASED RESOURCES IN OUR TRIBAL COMMUNITIES.
OUR GOAL WITH THE IHS TO TO INSURE ACCESS TO QUALITY HEALTH
SERVICES AND THOSE LIVING WITH HIV AND THOSE WHO ARE AT RISK
FOR CONTRACTING HIV. EMPLOY DINNER RECOMMEND AND
WE’RE USING INNOVATIVE TOOLS SUCH AS TELEMEDICINE AND THE
EXTENSION FOR COMMITTEE HEALTHCARE OUTCOMES AND THE ECHO
MODEL TO EXPAND ACCESS TO HIV OR CARE AND CONSULTATION IN RURAL
AREAS WERE HEALTHCARE RESOURCES AND PERSONNEL IS SCARCE.
DID FOR OUR TRIBES AND TRIBAL ORGANIZATION TO IMPROVE ADOPTION
AND UTILIZE OF BEST PRACTICE AND MODELS OF CARE.
AND THESE STRATEGIES ARE ESSENTIAL TO REACH OUR PATIENTS
MOST IN NEED. THE PRESIDENT’S PLAN PLACES
FOCUS ON PROTECTING PEOPLE AT RISK FOR HIV IMPROVEMENT
INTERVENTIONS AND PREP AND OUR MISSION AT THE INDIAN HEALTH
SERVICE IS RAISE THE PHYSICAL, MENTAL, SOCIAL AND SPIRITUAL
HEALTH OF AMERICAN INDIANS AND ALASKA NATIVES SO IT’S A
WHOLISTIC APPROACH. PART OF THAT IS MAKING SURE THAT
OUR COMMUNITIES HAVE THE TOOLS AND INFORMATION THAT THEY NEED
TO HELP PROTECT THEMSELVES. ALSO AT THE IHS, I’M HAPPY TO
INTRODUCE RICK [INDISCERNIBLE] WHO’S CHAIR AT THE BACK OF THE
TABLE ARE PRIMARY ON HIV/AIDS PROGRAMMING.
WE’RE TRAINING CLINICIANS ON THE OPTIONS PRESENTED BY PREP AND WE
HAVE MEDICATIONS ON OUR FORMULARY TRAINING MATERIALS,
AND CLINICAL GUIDELINES FOR HIV PREVENTION INCLUDING PREP AND
TREATMENT. BY INSURING THAT EVERYBODY IS
AWARE OF THEIR STATUS AND RECEIVING TREATMENT THEY NEED WE
CAN SIGNIFICANTLY REDUCE NEW INFECTIONS, THIS IS THE LATE
1980S PROGRESS PROGRESS IS MADE IN THE FIGHT AGAINST HIV BUT
THERE’S MORE WORK TO BE DONE AS YOU ALL KNOW.
NATIONAL INTERVENTIONS HAVE DRIB THE NUMBER OF INFECTIONS DOWN TO
ABOUT 40,000 AS WE’VE HIGHLIGHTED A FEW TIMES THIS
MORNING ALREADY OR THIS AFTERNOON.
BUT IT’S NOT BENEFITING EVERYBODY EQUALLY AS WE HEARD
AND NEW INFECTIONS ARE HIGHLY CONCENTRATED IN BOTH AMERICAN
INDIAN AND ALASKA NATIVE POPULATIONS, AFRICAN AMERICAN
AND WE’VE SEEN HISPANIC LATINO POPULATIONS IN MEN HAVING SEX
WITH MEN AND THOSE WHO LIVE IN THE SOUTHERN STATES.
AND WE WANT TO ADDRESS SIGMA, STIGMA IS A HUGE ISSUE, MANY OF
US WHO DREW UP IN SMALL RURAL RESERVATION COMMUNITIES KNOW
THAT EVERYBODY KNOWS EVERYTHING ABOUT EVERYBODY AND WHEN YOU GET
YOUR CARE ASK TREATMENT FROM THE SAME PLACE THAT YOUR FAMILY
WORKS, IT’S HARD TO KEEP THINGS QUIET.
SO ADDRESSING STIGMA, ENGAGING ALL SECTORS OF THE COMMUNITY,
FAITH BASED ORGANIZATION, TRIBAL LEADERSHIP, ET CETERA, WE CAN
WORK TO ADDRESS THE ISSUE OF STIGMA.
AMERICAN INDIAN AND ALASKA NATIVE GAY AND BISEXUAL MEN MAY
FACE CULTURALLY BASED STIGMA AND CONFIDENTIALITY CONCERNS THAT
COULD LIMIT THEIR OPPORTUNITIES FOR EDUCATION AND HIV TESTING.
ESPECIALLY THOSE LIVING IN THE RURAL COMMUNITIES.
THIS WILL CREATE ENVIRONMENTS NO MATTER BACKGROUND OR RISK
PROFILE WILL FEEL WELCOME FOR PREVENTION SERVICES.
I WILL ASK THE ADMIRAL TO TURN TO THE NEXT SLIDE.
IT’S A PICTURE OF THE INDIAN HEALTH SERVICE AND WE HAVE A MAP
THAT DEPICTS WHERE WE’RE LOCATED–
>>HAVE YOU A DIFFERENT MAP IN THE HAND OUT THAN WHAT’S ON THE
SCREEN BUT YOU GET THE PICTURE? , WHICH IS A BETTER MAP, I
WANTED TO POINT TO A GEOGRAPHIC HOT SPOT, WHO ONE IS THE STATE
OF OKLAHOMA, CAN YOU SEE THE DOTS ON THE MAP, THERE ARE
SEVERAL OF THEM. WE HAVE MANY DIFFERENT TRIBES
AND HEALTH PROGRAMS LOCATED WITHIN THAT STATE AND ALSO FOR
MR. SAPERO, MARICOPA, ARIZONA WOULD BE ONE OF THOSE, THE
INDIAN HEALTH SERVICE HAS A LARGE FACILITY THERE, WHERE YOU
HAD THE PRIVILEGE TO BE THERE MOST RECENT CEO AND THERE AN HIV
CENTER OF EXCELLENCE IN THAT COUNTY.
THE MEDICAL CENTER STRIVES TO BE KNOWN AS A FACILITY WHERE
QUALITY HIV SERVICES ARE ACCESSIBLE, CONFIDENTIAL AND
CULTURALLY COMPETENT. THEY SERVE AS A SPECIALTY
REFERRAL CENTER FOR A FOUR-FIVE STATE REGIONAL AREA COVERING
EVERYWHERE FROM CALIFORNIA AND NEW MEXICO, NAVAHO NATION AND
AND PATIENTS GO TO MARICOPA COUNTY FOR HIV CARE AND
TREATMENT. THEN THE RESULTS IN 2017, PIMC’S
PATIENTS ADHERENCE TO CARE AND 92% VIRAL SUPPRESSION RATES.
THE PIMCHIV CENTER OF EXCELLENCE WORK HAS A SIGNIFICANT POSITIVE
IMPACT ON AMERICAN INDIAN AND ALASKA NATIVE PATIENTS NOT ONLY
STATEWIDE BUT REGIONALLY. OUR AMERICAN INDIAN ALASKA
NATIVE PEOPLE IN ARIZONA WHO ARE LIVING WITH HIV HAVE THE BEST
VIRAL SUPPRESS RATES OF ALL RACIAL GROUPS IN THE STATE
BECAUSE OF THE EFFORT OF THESE HIV CENTER OF EXCELLENCE.
SO THE PRESIDENT’S PLAN WILL ALLOW US TO EMULATE THIS CENTER
OF EXCELLENCE THROUGHOUT INDIAN COUNTRY, THE CENTER PROVIDES
ADHERENCE COUNSELING, CASE MANAGEMENT AND CARE NAVIGATION
SERVICES THAT ARE COMMONLY AVAILABLE IN HIV CARE AND
THEY’VE ALSO INCORPORATED TRADITIONAL INDIAN HEALTH
SERVICES THAT ARE AVAILABLE THROUGH THE CENTER.
SO WITH THE RESOURCES AND TOOLS WE HAVE AVAILABLE TODAY, WE HAVE
AN UNPRECEDENTED TAOUPT TO MAKERS AND A REAL DIFFERENCE IN
REDUCING HIV TRANSMISSION AND WE LOOK FORWARD TO WORKING CLOSELY
WITH OUR AMERICAN INDIAN ALASKA NATIVE PATIENTS, COMMUNITIES,
TRIBES AND URBAN INDIAN ORGANIZATIONS TO ENCOURAGE HIV
TESTING AND TREATMENT AND PROMOTE HIV PREVENTION AND
OPPORTUNITY.>>THANK YOU SO MUCH.
WE HEARD A LOT ABOUT ANTIRETROVIRAL THERAPY AND PREP,
THE RIGHT TOOLS AT THE RIGHT TIME AND NOW TO GIVE THE LINE ON
THAT DR. FAUCI.>>COULD I HAVE THE NEXT SLIDE.
HAVE YOU IT. OKAY.
OKAY.>>WE’RE IN GOOD SHAPE.
>>OKAY, SO TALKING ABOUT THE TWO, THIS IS REALLY ONE OF THE
FOUNDATIONS FOR THE PLAN. I AM LOOKING AROUND THE ROOM I
KNOW THAT SOME OF MY COLLEAGUES WERE THERE FROM THE BEGINNING
AND IF YOU LOOK AT THE EVOLUTION OF THE TOOLS SO WHEN I STARTED
TAKING CARE OF PEOPLE WHO DIDN’T KNOW IT WAS HIV IN 1981, THE
FIRST PATIENT WAS IN THE FALL OF 1981, THE DISEASE DOESN’T HAVE A
NAME IT WAS CALLED GRID, IT DOESN’T HAVE AN ETIOLOGY, WE
HAVE IT YET AND IT DIDN’T HAVE ANY DRUGS AND THEN IN 86, 87 WE
HAD THE FIRST DRUG WHICH STARTED TO GIVE US A CLUE, WE DROPPED
THE VIRAL LOAD SLIGHTLY AND NOT CURABLY BY 1991, WE HAD THE
SECOND DRUG AND THEN BETWEEN 1991 AND 1996 WE HAD A
COMBINATION OF TWO DRUGS, AND THEN WE LET THINGS LOOK PRETTY
GOOD TO BE ABLE TO DROP THE VIRAL LOAD, NEVER TO BELOW BUT
RARELY BELOW DETECTABLE, AND THEN THINGS CHANGED IN 1986 WITH
THE INVENTION OF THE PROTEASE INHIBITOR WHICH GAVE US TRIP
WILL COMBINATION BECAUSE IT DROPPED THE VIRUS BELOW
DETECTABLE LEVEL AND CRITICALLY. SO WE HAD A TREMENDOUS
TRANSFORMATION OF THE LIVES OF HIV INFECTED INDIVIDUALS.
THE DOWN SIDE AS YOU SEE ON THE LEFT-HAND SIDE OF THE SLIDE IS
THAT SOMETIME ITS WAS AS MANY AS 20-25-MILE PILLS TO BE TAKEN AT
MULTIPLE TIMES, WITH MEALS, WITHOUT MEALS, WITH WATER,
WITHOUT WATER, IT WAS DIFFICULT AND THERE WERE TOXICITIES BUT AS
THE YEARS WENT BY, THE REGIMENS BECAME LESS TOXIC AND MORE
EFFECTIVE SO AT THIS POINT WITH THIS SLIDE, WE CAN SAVE PEOPLE’S
LIVES. NEXT SLIDE.
THEN WE FOUND OUT SOMETHING THAT WAS THE GAME CHANGER AS FAR AS
WE’RE CONCERNED ABOUT THE PLAN. IT BECAME CLEAR THAT IF YOU
TREATED A PERSON WHO IS HIV INFECTED AND BROUGHT DOWN THE
VIRAL LOAD TO BELOW DETECTABLE LEVEL THAT NOT ONLY WOULD YOU
SAVE THE LIFE OF THE PERSON BUT YOU WOULD MAKE IT ESSENTIA WILY
IMPOSSIBLE FOR THAT PERSON TO TRANSMIT THE VIRUS TO ANYONE
ELSE. THEN YOU GO TO THAT POINT ON THE
RIGHT HAND SLIDE WHICH ALLOWED US TO SAY NOW WITH THE GOOD
SCIENTIFIC BASIS THAT UNDETECTABLE REALLY DOES MEAN
UNTRANSMITTABLE. GO TO THE NEXT SLIDE AND THEN
SOMETHING ELSE CAME ABOUT. PREEXPOSEURE PROPHYLAXIS, A
SINGLE PILL OF TREVADA FOR SOMEONE AT RISK FOR INFECTION
WOULD DECREASE THE LIKELIHOOD THAT THEY WOULD ACQUIRE HIV
INFECTION BETWEEN 95-97%. SO JUST AS WHEN BOB SAID WE
LOOKED AT THE MAP AND WE SAID OH MY GOODNESS, WE HAVE A COMPLETE
CONCENTRATION HERE THAT WE COULD ADDRESS WHEN WE LOOK AT THE DATA
WE SAID OH MY GOODNESS IF YOU CAN ACTUALLY SUPPRESS THE VIRUS
IN PEOPLE AND PREVENT THEM FROM TRANSMITTING AND GIVE PREP TO
PEOPLE AND PREVENT THEM FROM ACQUIRING, THEORETICALLY, IF YOU
ACCESSED EVERYBODY OR MOST PEOPLE WHO WERE HIV INFECTED,
PUT THEM ON THERAPY, GET THEM TO UNDETECTABLE AND THEN GIVE PREP
TO THOSE WHO ARE UNINFECTED BUT AT RISK THEORETICALLY YOU COULD
END THE EPIDEMIC NOW AND THAT’S WHEN THE REALISTIC THOUGHTS OF
TRULY ENDING THE EPIDEMIC BUT WE’RE REALISTS AND WE’RE TALKING
ABOUT THE IDEALISTIC ISSUE OF DOING IT AND WHAT WE’RE DOING
NOW AND DISCUSSING AND DOING IS TO BRIDGE THE GAP BETWEEN THE
IDEALISTIC WORLD OF WE CAN DO IT TO THE REALISTIC WORLD OF WE
ACTUALLY DONE IT. AND THAT’S REALLY WHAT THE PLAN
IS ALL ABOUT.>>THANK YOU DR. FAUCI, BUT
MEDICATIONS DON’T OCCUR IN A VACUUM THERE HAVE ABOUT KNOW
SYSTEMS OF CARE AND HERE TO TALK ABOUT SYSTEMS OF CARE AND
DR. SEGUNIS, THE LEADING OF HRSA, THE RYAN WHITE PROGRAM.
>>[INDISCERNIBLE] PROGRAMS TO HELP END THE HIV EPIDEMIC
INITIATIVE. THESE PROGRAMS ARE THE RYAN
WHITE PROGRAM THE CENTER PROGRAM AND THE [INDISCERNIBLE] PROGRAM.
JUST AS RYAN WHITE THE HIV PROGRAM PROVIDES CRITICAL
SERVICES FOR HIV CARE AND TREATMENT IN THE UNITED STATES,
THIS PROGRAM HAS BEEN ADDRESSING THE HIV EPIDEMIC IN THE COUNTRY
FOR ALMOST 30 YEARS OR FOR APPROXIMATELY 1.1 MILLION PEOPLE
LIVING WITH HIV IN THE UNITED STATES, THE RYAN WHITE PROVIDES
SERVICES TO 535,000 PEOPLE OR MORE THAN HALF OF ALL THOSE
LIVING OR DIAGNOSED WITH HIV. THE RYAN WOMAN WAS THE RIGHT
RECORD OF SUCCESS FOR ALL THE PATIENTS SUPPORTED BY RYAN
WHITE, PROGRAM, 36% WERE LAST YEAR VIRALLY SUPPRESSED THIS IS
SIGNIFICANTLY HIGHER THAN THE NATIONAL AVERAGE OF 60% AMONG
ALL THOSE LIVING WITH DIAGNOSED HIV.
[INDISCERNIBLE] WILL LEVERAGE THE INFRASTRUCTURE AND SUCCESSES
OF RYAN WHITE PROGRAM TO HELP THE GOALS FOR THE INITIATIVE TO
ENDLET HIV EPIDEMIC IN AMERICA. WHERE IT HAS BEEN PROPOSED TO
RECEIVE $70 MILLION IN NEW FUNDING FOR THIS INITIATIVE AND
HRSA PLANS TO FUND RECEPTIENTS THAT TARGET THE CITIES AND
COUNTIES IN SEVEN [INDISCERNIBLE] THROUGH
COOPERATIVE AGREEMENTS AND PAYMENT INITIATIVE, INITIALLY,
THE QUESTION OF THE FUNDING WILL SUPPORT IMPLEMENTATION OF
EVIDENCE IN THE PRACTICES TO REMAIN ENGAGED AND RETAIN
PATIENTS LIVING WITH HIV IN CARE.
PATIENTS ARE BROUGHT INTO CARE [INDISCERNIBLE] WILL BE JUST TO
PROVIDE IMPLICATIONS AND MEDICAL VISITS AND LABORATORY SERVICES
AND CARE COORDINATION NEXT SLIDE, PLEASE.
COMING NOW TO HRSA’S CENTER PROGRAM.
THIS PROGRAM SUPPORTS MORE THAN 12,000 DELIVERY SITES NATIONWIDE
SERVING MORE THAN 27 MILLION PEOPLE ANNUALLY.
CARE CENTERS PROVIDE AFFORDABLE, ACCESSIBLE HIGH QUALITY AND COST
EFFECTIVE PREVENTATIVE AND PRIMARY SELF-CARE TO MEDICALLY
UNDERSERVED POPULATIONS NATIONALLY.
PATIENTS WHERE THE STIGMA IS VERY HIGH IN VISITING THOSE
CENTERS. IN ADDITION TO PROVIDING FOR
COORDINATED [INDISCERNIBLE] PATIENT-CENTERED CANNED WHAT
CARE SELF-CENTERS WILL DO GREAT A WIDE RANGE OF MEDICAL, DENTAL
MENTAL HEALTH SUBSTANCE USE DISORDERS.
HEALTH CENTERS ARE THE KEY POINT OF ENTRY FOR PEOPLE AND THOSE
WITH HIV, NEARLY 2 MILLION PATIENTS RECEIVE AN HIV TEST AT
THE HEALTH CENTER ANNUALLY. OVER 160,000 SELF-CENTERED
PATIENTS RECEIVE HIV RELATED CARE.
MANY OUTSIDE CONFOUNDED BY THE RYAN WHITE PROGRAM.
ALSO MANY HEALTH CENTERS PROVIDE HIV PREVENTION SERVICES
INCLUDING PREEXPOSURE PROPHYLAXIS, THE SELF-CENTERED
PROGRAM WILL PROVIDE 20 MILLION TO PROVIDE IN 2020 TO EXPAND
SELF-CENTER EFFORTS AROUND HIV OUTREACH, TESTING, CARE
COORDINATION, AND PREVENTION SERVICES ENCLUEDING PREP.
SUPPLEMENTAL GRANTS WILL BE PROVIDED TO 150 DUALLY FUNDED
CENTERS AND RYAN WHITE PROGRAMS TO CONDUCT OUTREACH AND HEALTH
CARE SERVICES, COORDINATION AND LINKAGE TO CARE IN THE
[INDISCERNIBLE] SERVICES INCLUDING PREP TO PEOPLE AT HIGH
RISK FOR HIV TRANSMISSION.>>THANK YOU.
>>I HAVE THE NEW SLIDE FOR C-FAR SO HAVE YOU IT ON YOUR
HANDOUT BUT VERY IMPORTANTLY ANOTHER INFRASTRUCTURE,
INCREDIBLE INFRASTRUCTURE WE WILL LEVERAGE ARE THE NAOEURBG H
CENTER FOR AIDS RESEARCH.>>THANK YOU ADMIRAL GIROIR, SO
THIS MAP SHOWS THE DISTRIBUTION OF THE CENTERS FOR AIDS RESEARCH
WHICH WAS STARTED A COUPLE DECADES AGO, THERE ARE 19 OF
THEM THAT ARE NAOEURBG H CENTERS OF AIDS RESEARCH WITH AN
ADDITIONAL SEVEN FROM THE NIMH THAT ARE INVOLVED IN ISSUES, THE
IMPORTANT CONTRIBUTION OF THESE CENTERS WE FEEL WILL BE
INDEGRADATIONERAL OF THE SUCCESS OF THE PLAN, WE HAVE A LEADER
HERE ON YOUR PACHA, MIKE SAGG, AT THE UNIVERSITY OF ALABAMA AT
BIRMINGHAM AND THE PURPOSE OF THE ISSUES WE’RE TALKING ABOUT
RIGHT NOW WITH REGARD TO THE CENTERS IS TO DO SOMETHING THAT
YOU GENERALLY DON’T ASSOCIATE WITH NIH’S BASIC FUNDMENTAL
RESEARCH. SO WE’RE NOT DEVELOPING DRUGS
WITH THIS, NOT DEVELOPING A VACCINE, WE’RE DOING WHAT WE
TALK ABOUT AS IMPLEMENTATION SCIENCE, IN OTHER WORDS WE HAVE
A TEN YEAR PROGRAM WHERE WE DO NOT KNOW RIGHT NOW WHAT IS GOING
TO WORK AND WHAT IS NOT GOING TO WORK ALTHOUGH WE CLEARLY ARE
OPTIMISTIC THAT MOST EVERYTHING WE WILL DO WILL WORK BUT THE
ONLY WAY WE MAKE SURE OF THAT IS BY MONITORING IT AND
COLLABORATING VERY CLOSELY WITH OUR COLLEAGUES AT THE CDC WHO
COLLABORATE VERY CLOSELY WITH INDIVIDUALS AT THE STATE, LOCAL,
FAITH BASED AREAS TOGETHER WITH THE INDIAN HEALTH SEVENS TO
DETERMINE AS WE GO FROM THE BEGINNING OF THE PROGRAM INTO
THE PROGRAM, WHAT WORKS BEST SO THAT WE CAN RESELF-CORRECT AS WE
GO ON TO GET BEST PRACTICES AND WE HAVE EXPERIENCES WITH THE
LEADERS OF OUR CFAR PROGRAMS NOW FOR SEVERAL YEARS THAT HAVE
ALREADY BEEN DOING THIS. A TYPICAL EXAMPLE OF THIS IS
WHAT I’VE TOLD SOME OF YOU IN THE PAST, THE SUCCESS WE HAD IN
WASHINGTON D. C. WHEN WE HAD A CITY THAT HAD THE HIGHEST
PREVALENCE AND THE HIGHEST INCIDENCE IN THE COUNTRY AND WE
PARTNERED WITH THE DEPARTMENT OF HEALTH OF THE DISTRICT OF
COLUMBIA AND THE WASHINGTON D. C. CFAR TO GET INTO THE
COMMUNITY TO DO THE THINGS WE HOPE TO DO ON A BROADER SCALE
AND THE INCIDENCE OF INFECTION CAME DOWN DRAMATICALLY DURING
THOSE YEARS THAT WE DID THAT AND HOPEFULLY THE CFAR THROUGHOUT
THE COUNTRY WILL DO THAT. NONAPOPTOTIC YOU THE MAP THAT
THE ADMIRAL MENTIONED TO YOU IF YOU TAKE A MAP OF THE CFARS AND
SUPER IMPOSE UPON THE MAP OF THE 48 COUNTIES OF THE DISTRICT AND
SAN JUAN, IT ISN’T A PERFECT MATCH BUT WE THINK IT’S REALLY
CLOSE. SO WE THINK WE HAPPEN TO BE IN
SITUATION WHERE WE’RE WELL LOCATE FRIDAY A GEOGRAPHIC
STANDPOINT.>>SO AS WE’VE SPOKEN SEVERAL
TIMES TODAY, THE GOALS ARE AMBITIOUS GOALS BUT WE FEEL
BASED ON COMPREHENSIVE DATA-DRIVEN EVIDENCE-BASED
MODELING THAT WE CAN REDUCE NEW INFECTION OF 70% WITH FIVE YEARS
AND 90% WITHIN TEN YEARS AS YOU MIGHT IMAGINE, ONCE YOU GET THE
FIRST 50-75%, THE NEXT INCREMENTS TAKE MUCH LONGER,
MUCH HARDER TO REACH THOSE THAT ARE NOT IN CONCENTRATED AREAS.
THE WAY WE DO THIS ARE PRETTY OBVIOUS FROM WHAT YOU JUST
HEARD, VERY KEY IS TO DIAGNOSE ALL PEOPLE WITH HIV AS EARLY AS
POSSIBLE FOR THE REASONS THAT WE’RE OUTLINES BY DR. REDFIELD.
TREAT THE INFECTION RAPIDLY, I WAS A BIT SHOCKED AGAIN AS AN
OUTSIDER, IF A PERSON AS PNEUMONIA, AND I DIAGNOSE THEM,
THEY GET ANTIBIOTICS IMMEDIATELY, WE DON’T SEND THEM
AWAY, COME BACK AND GET YOUR DIAGNOSTIC TEST AND THEN GET
ANOTHER MONTH’S APPOINTMENT TO SEE IF YOU AND GET TREATED,
TREATMENT MUST BE LINKED WITH THE DIAGNOSE AS EARLY AND
IMMEDIATELY AS POSSIBLE. PROTECT BY PREP, WE WILL GIVE
YOU METRICS, RESPOND TO CLUSTER WHICH IS IS WHAT THE CDC DOES ON
A ROUTINE BASIS AND A CRITICAL COMPONENT THAT DR. REDFIELD WILL
TALK ABOUT TWO SLIDES FROM NOW IS BUILDING THE HIV WORKFORCE IN
A COMMUNITY BASED, COMMUNITY DRIP WAY.
SO WHAT SHOULD BE OBVIOUS TO YOU NOW, THE INITIAL TARGET IS ON
HIGH INCIDENCE GEOGRAPHIES AND DEMOGRAPHICS.
WE DO NEED TO EMPHASIZE EARLY DIAGNOSIS AND IMMEDIATE
TREATMENT AND ENGAGEMENT AND FOR OUR MODEL TO BE EFFECTIVE, TO BE
FULLY EFFECTIVE, WE NEED TO INCREASE VIRAL SUPPRESSION TO
ABOUT 90% AND AS YOU’VE HEARD FROM DR. SEIGOUNAS, THAT
ACHIEVABLE IN RYAN WHITE AT 87% AND FROM ADMIRAL WEAHKEE UP TO
97%. IT IS CRITICAL TO INCREASE PREP
FROM TEN TO 20%. THOSE NUMBERS ARE HARD TO GOT A
FIRM NUMBER ON TO AT LEAST 50 AND HOPEFULLY 60 PERCENT, WE
WOULD LOVE TO GET IT TO 50%, THAT IS A GOAL, BUT WHEN YOU
CRUNCH THE NUMBERS AND DO THE TRANSMISSION, IF WE CAN GET PREP
TO 50-60% COMBINED WITH THE OTHER EFFORTS THEN WE MEET OUR
GOAL OF 75% AND 90%. SO WE DO WANT TO SPEND TIME AND
AGAIN SEVERAL OF THE SERVICES HAVE ALREADY TALKED ABOUT WHAT
THEY’RE GOING TO DO WITH THEIR FUNDING.
I WOULD SAY UP FRONT THAT WE DID NOT ASSUME ANY DRAMATIC CHANGES
IN THE LANDSCAPE OF INSURANCE, MEDICAID, ANY OTHER COVERAGE.
WE DID VERY SPECIFIC MODELS BY COMMUNITY, MADE VERY SPECIFIC
EVIDENCE-BASED ASSUMPTIONS OF WHAT PERCENT WOULD BE COVERED BY
INSURANCE, WHAT WOULD BE MEDICAID, WHO WOULD BE UNINSURED
AND HAVE BUILT A FIVE YEAR PLAN OF WHAT YOU SEE THE FIRST YEAR
THAT WOULD PROVIDE COVERAGE TO ALL THOSE IN THE GAP WITH NO
COVERAGE WHATSOEVER EITHER BY RYAN WHITE IF THEY WERE
DIAGNOSED OR BY COMMUNITY HEALTH CENTERS IF THEY NEEDED PREP.
SO IT IS VERY IMPORTANT AS WE DID NOT ASSUME A SCIENTIFIC NEW
MIRACLE, NEW DRUG, NEW VACCINE, NEW APPROACH, WE ALSO DID NOT
ASSUME A PUBLIC HEALTH CHANGE OF ANY DRAMATIC PROPORTIONS BECAUSE
WE NEED TO CONTROL WHAT WE CAN CONTROL AND THIS IS WHAT WE CAN
CONTROL. SO I WOULD LIKE TO GO DOWN, I
THINK YOU’VE HEARD MOSTLY, I THINK HRSA EXPLAINED THEIR PLAN
PRETTY WELL AND IHF, BUT A CRITICAL COMPONENT IS THE CDC IN
THE WORKFORCE WHERE WE AND ARE HOW HAY WILL ENTKPWAEPBLG IN THE
COMMUNITIES ALONG WITH ALL OF US.
>>SO MOST OF YOU PROBABLY KNOW THAT THE CDC REALLY FUNDS A
SIGNIFICANT PART OF THE UNITED STATES PUBLIC HEALTH
INFRASTRUCTURE AT THE STATE LEVEL AT THE TRIBAL LEVEL, LOCAL
LEVEL, TERRITORIAL LEVEL, JUST TO PUT THAT OUT THERE.
CLEARLY THIS INITIATIVE IS TO BUILD ON THAT, PARTICULARLY IN
THE AREAS THAT THE ADMIRAL DISCUSSED TO ENHANCE DIAGNOSIS,
TREATMENT, PROTECTION AND COMPREHENSIVE PREVENTION
STRATEGIES AND THEN TO AUGMENT THE CAPACITY TO RESPOND TO
CLUSTER WHEN IS THEY CAN OCCUR AND WE HAVE SEVERAL CLUSTERS
THAT ARE ACTIVELY OCCURRING AS WE SIT HERE TODAY.
FUNDAMENTAL TO THAT IS TO WORK WITH THE LOCAL JURISDICTION.
THIS IS NOT GOING TO BE A PLAN THAT COMES DOWN FROM THE
ADMIRAL’S OFFICE THAT GOES INTEREST THE 50 JURISDICTIONS
AND SEVEN STATES THIS, IS GOING TO BE BASKLY 50 JURISDICTIONS
INDEPENDENTLY DEVELOPING THEIR PLAN FOR HOW TO OPERATIONALLIZE
A RESPONSE THAT WILL MEET THE GOALS OF THIS INITIATIVE.
SO WE WILL OBVIOUSLY BE WORKING WITH THE COMMUNITY TO HELP DO
THAT BUT I JUST WANT TO UNDERSCORE WHAT THE ADMIRAL SAID
AT THE BEGENERATEDDING, THIS WILL BE LOCAL PLANS DEVELOPED BY
THE COMMUNITY, FOR THE COMMUNITY, IN THE COMMUNITY AND
THE GOAL FOR THAT AT THE END OF THE DAY AND MIKE AND OTHERS KNOW
HOW IMPORTANT THIS IS IS TO DEVELOP AN HIV WORKFORCE.
WHETHER THAT WORKFORCE IS INTRINSICALLY DEVELOPED IN THE
COMMUNITY, FOR THE COMMUNITY, BY THE COMMUNITY OR WHETHER IT
NEEDS AUGMENTATION FROM CDC, THOSE WILL BE INDIVIDUAL
DECISIONS ON HOW THAT WORKFORCE GETS BUT WE–WE ARE DEVELOPING A
WORKFORCE AND THOSE OF YOU KNOW I HAVE AN OLD MILITARY
BACKGROUND TO GET THE MISSION DONE.
AS TONY SAID, THE ADMIRAKA WILLA SAID, THIS IS A REALISTIC GOAL,
WE INTEND TO ACCOMPLISH THIS GOAL AND THE PUBLIC
INFRASTRUCTURE AND ACCOMPLISH THAT GOAL AND THE COMMUNITIES
ARE GOING TO BE ABLE–THEY WILL HAVE TO BE ABLE TO BE RESOURCED
TO DEVELOP THAT WORK FOR US TO GET THE JOB DONE.
I THINK THAT’S THE POINT I REALLY WOULD LIKE TO MAKE.
FOR US, AGAIN, IT’S DIAGNOSIS, AND REALLY HELP PEOPLE GET
LINKED INTO TREATMENT. HRSA AND THE COMMUNITY HEALTH
TRUSTEESES AND RYAN WHITE CENTERS WILL TAKE OVER.
PREVENTIONS REALLY WORK WITH GETTING COMPREHENSIVE
PREVENTION, I WAS VERY HAPPY TO HEAR A COUPLE DAYS AGO, THE
STATE OF GEORGIA HAD REALLY MOVED FORWARD ON BROADER ACCESS
TO SAFE SYRINGE PROGRAMS. WE NEED COMPREHENSIVE PREVENTION
IN THESE JURISDICTIONS BUT THEY WILL HAVE TO DECIDE WHAT THAT IS
AND HOW THEY WANT IT IMPLEMENTED AND ULTIMATELY CDC WILL BE
AVAILABLE TO HELP THE STATE, LOCAL, TRIBAL AND TERRITORIAL
HEALTH DEPARTMENTS TO IDENTIFY CLUSTERS AND TRY TO HAVE THEM
NOT HAVE A NEGATIVE IMPACT ON OUR PROGRESS.
BEFORE WE GO TO THE OTHER AGENCIES, I WANT EMPHASIZE THAT
DR. BECKHAM HAS BEEN WORKING ALONGSIDE CDC AND OTHER AGENCIES
AS I MENTION THAT WE HAVE DEDICATED APPROXIMATELY
$30 MILLION IN FUNDING FROM THE FISCAL YEAR 19 MINORITY AIDS
INITIATIVE IT THAT COMES 32 YOU OURAVEIS TO SPECIFICALLY WORK
WITH CDC TO DEVELOP COMMUNITY PLANS THROUGH COMMUNITIES AND
COMMUNITY GRANTS STARTING THIS YEAR.
SO WE’RE NOT GOING TO WAIT FOR THE NEXT YEAR’S BUMET AND AGAIN
THIS IS NOT REAL MONEY. THIS IS THE PROPOSAL FROM THE
PRESIDENT. THIS HAS TO BE APPROVED BY
CONGRESS IN APPROPRIATIONS. SO THIS IS ASPIRATIONAL.
WE HOPE THERE’S A GREAT AGREEMENT ON THIS BUT WE’RE NOT
WAITING UNTIL 2020. THAT WILL BE STARTED IN THE
APRIL-MAY TIME FRAME SO THAT COMMUNITIES WILL START HEARING
FROM US AND I WILL ALSO GO OFF SCRIPT A LITTLE BIT TO SAY THAT
WE HAD WHAT I CONSIDER A TREMENDOUS MEETING WITH US WITH
THE HIV AND CONGRESSIONAL BLACK CAUCUS AND WE HAD MEMBERS
PRESENT CONGRESSWOMAN LEE, SHEILA JACKSON LEE AND WILSON
ALL FROM VERY HIGHLY AFFECTED DISTRICTS WHO BASICALLY OPENED
THEIR ARMS TO COMMUNICATION AND COLLABORATION AND GAVE US VERY
SPECIFIC POINTERS HOW WE COULD BEST REACH THE COMMUNITIES AND
THE ORGANIZATIONS THAT WE NEED TO REACH.
DOES ANYBODY WANT TO MAKE A COMMENT ABOUT THAT?
, FREIGHT MEETING. YOU’RE ABSOLUTELY CORRECT.
>>SO DR. SIGOUNAS, DO YOU WANT TO MAKE ANY OTHER COMMENTS ABOUT
HRSA AND RYAN WHITE AT THIS POINT?
>>YEAH BY PROVIDING SYSTEM OF CARE THAT INTEGRATES PROVISION
OF MEDICAL CARE, MEDICATION AND ESSENTIAL SUPPORT SERVICES, THE
RYAN WHITE PROGRAM IS ABLE TO REACH THE MOST UNDERSERVED
POPULATIONS. RIGHT NOW IT IS ESTIMATE THAT
MORE THAN 170,000 PEOPLE ARE INFECTED WITH HIV AND THEY DON’T
KNOW IT. SO IN THIS INITIATIVE, THE RYAN
WHITE PROGRAM WILL INCREASE EFFORTS TO ENGAGE AND DETAIN
THOSE NEWLY DIAGNOSED IN CARE. IN ADDITION RYAN WHITE PROGRAM
WILL EVIDENCE-BASE TO ENGAGE AND DETAIN ABOUT 230,000 PEOPLE
LIVING WITH HIV WHO ARE DIAGNOSED NOT RECEIVING CARE
TODAY. THE HEALTH CENTER PROGRAM WILL
EXPAND THEIR WORK IN HIV, PREVENTION, TESTING AND CARE
WITH AN EMPHASIS ON EXPANSION OF PREEXPOSURE PROPHYLAXIS
SERVICES, THE HEALTH CENTERS ARE WELL POSITIONED TO DO THIS WORK
THROUGH THEIR MORE THAN 3000 SERVICE DELIVERY SITES, WITHIN
JURISDICTIONS THAT ARE THE FOCUS OF THE FIRST PHASE OF THIS
INITIATIVE.>>THANK YOU.
ADMIRAL WEAHKEE, DO YOU HAVE ANY OTHER COMMENTS?
>>NOT REALLY, JUST TO UNDERSCORE THE VITAL IMPORTANCE
OF THESE INITIATIVES BEING COMMUNITY DRIVEN AND THE INDIAN
HEALTH SERVICES INTENT TO CONSULT WITH TRIBES AND CONFIRM
WITH OUR URBAN INDRAN PROGRAMS ISSUES THE SOLUTIONS ARE AT THE
GROUND LEVEL.>>THANK YOU.
DR. FAUCI, ANYTHING MORE?>>NO, I THINK WHEN PEOPLE SEE
THE SMALL NUMBER, 6 MILLION, WE–WE HAVE THE WHERE WITH ALL
BY MOVING AREAS INTO CFAR AS SUPPLEMENTS TO GET THEM GOING
FOR THIS YEAR, IN THE SUBSEQUENT YEARS DEPENDING ON HOW THINGS
GO, WE WILL TALK ABOUT HOW MUCH ADDITIONAL MONEY WE NEED BUT WE
FEEL VERY CONFIDENT THAT WE CAN DO THE JOB AT THE CFARS CAN DO
WITH THE SUPPLEMENT SAYS I’LL BE GIVING THEM.
>>NOW ON THIS SLIDE, THERE ARE MAINTAINS CURRENT MONEY, WE DID
NOT INCLUDE THIS NEW MONEY ALTHOUGH THESE WERE NOT IN THE
PRESIDENT’S BUDGET PREVIOUSLY, THEY ARE IN THE BUDGET
NONAPOPTOTIC YOU FOR MINORITY AIDS INITIATIVE, $54 MILLION
THROUGH MY OFFICE THAT’S CHANNELED THROUGH
[INDISCERNIBLE] THAT WILL SEE THIS INITIATIVE IN THE NEXT
COUPLE OF MONTHS. BUT VERY IMPORTANT AND I THINK
MANY OF YOU KNOW BUT MANY OF YOU MAY NOT KNOW THE CRITICAL ROLE
OF SM SA IN INCREASING POPULATIONS THAT ARE HARD TO
REACH, WITH A BUDGET OF $116 MILLION, AND I WOULD LIKE
TO WELCOME ROSE MAR MARY PAIN TO INFORM US ABOUT SMSA’S ROLE.
>>GOOD AFTERNOON I AM HERE ON BEHALF OF
DR. ELINORE Mc CANCE-KATZ, WITH SAMHSA, WE FOCUS ON HIV
PREVENTION AND IDENTIFICATION AND THE TREATMENT OF HIV AND
INDIVIDUALS LIVING WITH SUBSTANCE USE AND MENTAL
DISORDERS. THE IMPORTANCE OF SAMHSA’S
EFFORTS ARE UNDERSCORED BY WELL STOKED LINKS BETWEEN HIGH RISK
BEHAVIORS FOR HIV INFECTION AND INCLUDING INJECTION DRUG USE AND
UNPROTECTED SEXUAL ACTIVITY THAT MAY OCCUR IN THOSE WITH
UNTREATED MENTAL AND/OR SUBSTANCE USE DISORDERS.
FURTHER EFFECTIVE CARE AND TREATMENT OF MENTAL HEALTH
ISSUES AND SUBSTANCE ABUSE PROBLEMS EXPERIENCED BY THOSE
LIVING WITH HIV INFECTION IS CRITICALLY IMPORTANT TO
INCREASING A PERSON’S ABILITY TO ADHERE TO HIV TREATMENT AND
POSITIVE OUTCOMES THAT RESULT IN VIRAL SUPPRESSION, CESSATION OF
HIGH RISK BEHAVIORS AND MAJOR REDUCTION IN THE LIKELIHOOD OF
VIRAL TRANSMISSION. SMHSA FUNDED OVER $100 MILLION
IN HIV TREATMENT PROGRAMS AND CENTERS FOR SUBSTANCE ABUSE
PREVENTION, TREATMENT, AND MENTAL HEALTH SERVICES.
FUNDING FROM CURRENTLY ACTIVE GRANTS HAS SUPPORTED MENTAL
DISORDER USE FOR SERVICES FOR 20,000 INDIVIDUALS.
THESE PROGRAMS EXTEND ACROSS THE NATION INCLUDING THE EIGHT
COUNTIES IN THE UNITED STATES HARDEST HIT BY HIV.
SAMSA’S FUND, CO HIV COUNSELING, HIGH RISK POPULATIONS AND
TESTING AND TREATMENT AND COMMUNITY BASED RECOVERY
RESOURCE PROGRAMS, THESE GRANT PROGRAMS ALSO FUND SERVICES TO
ADDRESS MENTAL AND SUBSTANCE USE DISORDER IN THOSE LIVING LIVING
WITH HIV AS WELL AS TO INDICATE HIV CARE INTO THOSE–EXCUSE
ME–INTEGRATE INTO BEHAVIORIAL HEALTH PROGRAMS OR TO UTILIZE
CARE MANAGERS WHO ASSIST PATIENTS WITH RECEIVING MENTAL
AND SUBSTANCE USE DISORDER SERVICES, TO ALSO GET TO
AFFILIATED PROGRAMS THAT CAN PROVIDE ONGOING HIV SERVICES.
SIMILARLY, HEALTHCARE CLINICIANS AND PROGRAMS THAT PROVIDE HIV
CARE IN COMMUNITIES ARE ASSISTED BY SOME GRANT PROGRAMS THAT
PROVIDE MENTAL HEALTH AND SUBSTANCE USE DISORDER RESOURCES
WITHIN THOSE COMMUNITY PHYSICAL HEALTHCARE PROGRAMS OR REFERRAL
TO COMMUNITY MENTAL HEALTH AND SUBSTANCE USE DISORDER TREATMENT
PROVIDERS WHO WORK COLLABORATIVELY ON BEHALF OF
THOSE LIVING WITH DISORDERS. FINALLY, EDUCATION AND TRAINING
OF PROVIDERS AND THE PUBLIC REGARDING HIV, SUBSTANCE ABUSE
AND MENTAL HEALTH ISSUES AND THE INTERSECTION OF THESE
CONTKEUPGZS IS IMPORTANT TO EXTEND EVIDENCE-BASED TREATMENT
AND INCREASING THE KNOWLEDGE AND SKILLS OF HEALTH SERVICE
PROVIDERS. SAMHSA FUNDS A SERIES OF
NATIONAL AND REGIONAL TECHNOLOGY TRANSFER CENTERS THAT AADDRESS
SUBSTANCE ABUSE PREVENTION, TREATMENT, AND MENTAL ILLNESS
EDUCATION AND PROGRAM IMPLEMENTATION.
PROGRAMS INCLUDING THE STATE TARGETED RESPONSE, OPIOID
RESPONSE T. A. CENTER, PROVIDERS CLINICAL SUPPORT SYSTEM FOR
MEDICATION, ASSISTED TREATMENTS AND THE CLINICAL SUPPORT SYSTEM
FOR SERIES MENTAL ILLNESS ALL HAVE THE CAPACITY TO FOCUS ON
THE ISSUES RELATED TO BEHARIAL HEALTH AND HIV.
SAMHSA LOOKS FORWARD TO WORKING WITH THE PARTNERS WITHIN THE
DEPARTMENT OF HEALTH AND HUMAN SERVICES IN AN EFFORT TO
ERADIATE HIV IN AMERICA OVER THE NEXT TEN YEARS.
>>THANK YOU VERY MUCH. VERY QUICKLY BEFORE WE GET TO
QUESTIONS, WE ARE VERY COGNIZANT THAT THERE IS A TREMENDOUS SURGE
IN HIV AWARENESS ACROSS THE COUNTRY.
ONE OF THE REASONS DR. WIESMAN IS HERE IS BECAUSE OF THE SURGE
IN HIS AREA, WE WANT TO CERTAINTY THESE PROGRAMS, LEARN
FROM THESE PROGRAMS SO THAT BEST PRACTICES CAN BE SPREAD ACROSS
THE COUNTRY AS THEY’RE APPLICABLE TO THE SPECIFIC
DEMOGRAPHIC IN GEOGRAPHY SO THIS IS AGAIN ONE OF THE REASONS IT
IS THE EXACT RIGHT TIME. YOU KNOW WHO THESE GUYS ARE SO I
DON’T NEED TO REINTRODUCE YOU. THE LAST ONE THIS IS A WHOLE
SOCIETY INITIATIVE. WE ARE DOING OUR FEDERAL PART,
STATE PART, COMMUNITY PART, PROFESSIONAL ASSOCIATION, PEOPLE
LIVING WITH HIV, TRIBES AND INDIAN URBAN ORGANIZATIONS,
FAITH-BASED ORGANIZATION, PATIENT ADVOCACY GROUPS,
NONPROFIT ORGANIZATIONS, THE INDUSTRIAL COMMUNITY, VENTURE
CAPITAL PHARMACEUTICAL WE ALL NEED TO BE TOGETHER.
IT’S UP TO ALL OF US TO FIGURE OUT WHOSE NAME GOES IN THAT
YELLOW BOX. BUT WE REALLY–THIS IS A VERY,
VERY LARGE TENT IS AND WE WILL HAVE TO WORK TOGETHER TO MAKE
THIS HAPPEN. AND I WILL LEAN ON DR. FAUCI,
BECAUSE I’M IMPRESSED WITH SO MANY THINGS HOOEY SAYS BUT
WHAT’S DIFFERENT ABOUT THIS EFFORT ORGANIZATIONALLY FROM THE
HHS POINT OF VIEW, AND THEN WE WILL TAKE QUESTIONS.
>>OH I THINK IT HAS TO DO WITH THE PREVENTIVEIOUS MAP YOU
SHOWED ADMIRAL THAT WE KNOW THAT A LOT OF STATES AND INDIVIDUAL
JURISDICTIONS HAVE THEIR PLANS AS WE’VE SEEN WITH WASHINGTON,
CALIFORNIA AND NEW YORK AND WASHINGTON D. C. BUT THIS IS THE
FIRST TIME EVER THAT YOU HAVE MULTIPLE AGENCIES WITHIN THE
DEPARTMENT OF HEALTH AND HUMAN SERVICES WHO ARE COMING
TOGETHER, WORKING TOGETHER ON A PLAN AS A TEAM.
WE’VE HAD NIH DO THINGS, WE’VE HAD CDC DO THINGS, WE’VE HAD
HRSA DO THINGS, INDIAN HEALTH SERVICE BUT THIS IS THE FIRST
TIME WE COME TOGETHER WITH A TEAM UNDER THE LEADERSHIP OF
ADMIRAL GIROIR WITH A SECRETARY OF HHS WHO HAS COMPLETELY BOUGHT
BO THIS SO SECRETARY AZAR IS ENTHUSIASTIC ABOUT THIS WHICH IS
WHY HE WENT TO THE PRESIDENT TO MAKE THE ANOUNMENT IN THE STATE
OF THE UNION ADDRESS. THIS IS UNIQUE.
THIS IS NOT SOMETHING THAT’S SAME OLD BY ANY MEANS.
>>THANK YOU FOR THAT AND ON THAT NOTE, I HOPE THAT EVERYONE
IN THIS ROOM CAN FEEL WHAT WAS JUST SAID IN TERMS OF THIS
COLLABORATION AT HHS AND THE LEADERSHIP WHEN THE EARLIER
SLIDE FOLKS SAID TIME IS NOW, RIGHT DATA, RIGHT TOOLS RIGHT
LEADERSHIP, IT IS BECAUSE OF THE RIGHT LEADERSHIP THAT CARL AND I
ARE AT THE TABLE AS CO-CHAIRS. I CAN SEE PERSONALLY, I’VE HAD
THE BRIEF INSIGHT INTO THE KIND OF WO, THAT WAS HAPPENING AND
THAT IS THE REASON WHY I THINK I NEED TO BE HERE AND I THINK IT’S
WHY THE FOLKS AROUND THIS TABLE ARE HERE, SO THANK YOU ALL.
I KNOW THIS IS THE BEGENERATEDDING AND THERE IS A
LOT OF WORK TO DO. BUT WE ARE GETTING OFF ON THE
RIGHT STEP AND IT IS DUE TO YOUR LEADERSHIP, TO THE YEARS OF
EXPERIENCE THAT YOU HAVE ALL HAD AND THE CAREERS HAVE YOU HAD.
AND SO, WITH THAT, IT’S GREAT TO BE AT THIS POINT IN TIME.
WE HAVE ABOUT 20 MINUTES FOR THE PACHA MEMBERS TO ASK QUESTIONS
OF OUR FEDERAL PARTNERS. WE WILL FOLLOW THAT WITH ABOUT A
15 MINUTE BREAK AND THEN WE WILL HAVE ALMOST ABOUT AN HOUR AND A
HALF FOR PACHA MEMBERS TO TALK ABOUT WHAT WE HEARD AND HAVE
DISCUSSION ABOUT THE PLAN THE CHARGE THAT DR. GIROIR HAS GIB
US AS MEMBERS SO WE WILL SIGNIFICANT TO DISCUSS THAT.
PACHA MEMBERS ALREADY KNOW BECAUSE I SEE ONE PLACARD UP
THAT WE WOULD LIKE YOU TO DO IF YOU HAVE A COMMENT OR A QUESTION
FOR OUR FEDERAL LEADERS TO PUT YOUR BLACK–PLACARD UP ON THE
SIDE AND KAY HAYES WILL TAKE YOUR NAME AND WE WILL GET AN
ORDER AND TALL FOLKS OFF AND WHEN YOU’RE DONE, IF YOU CAN
THINK ABOUT REMEMBERING TO TURN YOUR PLACARD DOWN, THAT WOULD BE
GOOD AND YOU CAN PUT IT UP WHEN YOU HAVE ANOTHER QUESTION.
SO KAYE, I’LL TURN IT OVER TO YOU.
DON’T BE SHY. THERE WAS A LOT SAID AND WE
DON’T HAVE THIS OPPORTUNITY EVERY DAY TO SPEAK DIRECTLY TO
THESE LEADERS. SO, KAYE?
>>THANK YOU JOHN. FIRST QUESTION, MIKE?
>>THANK YOU. THANKS TO EVERYBODY NOT ONLY FOR
THE PRESENTATIONS BUT FOR THIS INCREDIBLEST TO BRING ALL THESE
ENTITIES TOGETHER AND IT’S HARDENING AND SIGHTING TO BE A
PART OF IT AND MAKE IT HAPPEN AND I THINK WE CAN MAKE A
DIFFERENCE. I WANT TO ZERO IN ON PREP AND
GET INFORMATION BECAUSE I’VE BEEN NOT BACK OF THE ENVELOPE,
BUT BACK DOING MATH HERE, WOULD WE SAY THAT THE HIGH RISK
POPULATION ZERO CONVERSION, WHAT’S CALLED INCIDENCE RATE IS
ABOUT TWO% PER YEAR? IS THAT ACCURATE OR MORE?
DO WE KNOW?>>MORE?
, MORE. OKAY IF IT IS TWO% OR GREATER
THEN THAT MEANS WOO VERMEN INFECTED TO TREAT 50 PEOPLE TO
PRESREPT ONE INFECTION IF I’M DOING MY MATH RYE.
SO WHEN YOU–WHEN YOU BOYS ARE CALCULATING OUT THE NEEDS FOR
GETTING PREP AND ACCESSING IT, HOW–HOW CAN WE GO ABOUT
DETERMINING THE INVESTMENT THAT WILL BE REQUIRED TO IMPLEMENT
THIS. OR HAVE WE GONE THAT FAR.
>>LET ME TAKE THE FIRST STAB AT THAT, AND WE CALCULATED THE
INVESTMENT BY CALCULATING THE NUMBER OF PEOPLE TO REACH THOSE
PERCENTAGES WITHIN THE DISTRICTS THAT WE’RE TARGETING AT FIRST
AND ASSUMING THAT THOSE INDIVIDUALS, THE MAJORITY–WHERE
THE COST OF THIS PROGRAM WOULD BE WOULD BEING DRUGS, PAID FOR
UNDER THE 340 B PROGRAM, DONE THROUGH COMMUNITY HEALTH
CENTERS, OR TO THOSE DUAL HABIT COMMUNITY CENTERS IN THE RYAN
WHITE PROGRAM KNOWING RYAN WHITE CANNOT FUND PREP BUT IT CAN BE
DONE THROUGH THE COMMUNITY HEALTH CENTER BUDGET SO THAT HAS
BEEN INTRODUCED INTO THIS–INTO THIS WHOLE EQUATION, I DON’T
KNOW IF YOU WANT TO DEEPER THAT KNOW THAT BUT IT’S A PERCENTAGE
TIMES THE NUMBER OF PEOPLE, TIMES THE NUMBER OF PEOPLE WE
BELIEVE HAS NO RESOURCES. AS YOU KNOW THERE ARE EXCITING
THINGS RELATED TO PREP INCLUDING THE PREVENTATIVE TASK FORCE
RECOMMENDATION, ET CETERA.>>THAT’S GREAT.
IS IT IN THE PUBLIC DOMAIN WHAT PRICING IS FOR PREP.
>>NO.>>I THINK IT IS IMPORTANT–THE
ADMIRAL JUST EMPHASIZED BECAUSE WE HAVE A LOT OF QUESTIONS ON
THIS, THAT THIS PLAN A PLAN THAT IS PLANNED TO PROVIDE PREP TO
ALL PEOPLE, NOT ALL PEOPLE AT A CERTAIN INCOME, NOT PEOPLE AT
ANOTHER INCOME, ALL PEOPLE WHO ARE RISK AND REALLY WHEN DOWN TO
THE PAYOR MIX IN EACH COUNTY, WHERE IT IS, HOW MUCH IT IS,
THERE IS NO MECHANISM THERE, AND WE DID ASSUME NO CHANGE SO, YOU
KNOW IN TERMS OF ANY CHANGES IN MEDICAID, WE SAID NO CHANGE SO
IT’S IMPORTANT TO FOR PEOPLE TO REALIZE THIS WASN’T ALL PEOPLE
WHO HAD AN INCOME LEVEL LESS THAN X, IT’S ALL PEOPLE.
>>YOU KNOW MIKE ALSO, I KNOW YOU KNOW THIS FROM THE
[INDISCERNIBLE] MEETING BUT PREP IS CRITICAL TO THIS PROGRAM.
BECAUSE THERE ARE EXAMPLES IN SEVERAL STUDIES FROM AFRICAN
COUNTRIES THAT WE FUNDED THAT IF YOU JUST DO TREATMENT AS
REVENTION, YOU SAVE A LOT OF LIVES BUT YOU DON’T DECREASE THE
INCIDENTS, YOU HAVE TO DO TREATMENT AS PREVENTION PLUS
PREP. YOU KNOW I I’M WILLING YOU
SOMETHING YOU KNOW BUT I WANT TO SAY IT SO THAT EVERYBODY
UNDERSTANDS THAT PREP IS CRITICAL TO THIS.
>>AND THAT EVERYONE UNDERSTANDS THE 340 B PROGRAM IS A HIGHLY
DISCOUNTED GOVERNMENT PROGRAM THAT’S MADE AVAILABLE TO
COMMUNITY HEALTH CENTERS AND RYAN WHITE AND ELIGIBLE ENTITIES
SOPHISTICATEDY WOO WILL TAKE FULL ADVANTAGE OF THAT IN
IMPLEMENTING THE PROGRAM.>>GREAT.
NEXT, CARL?>>WELL, I WANT TO ECHO EVERYONE
ELSE’S COMMENTS AND THIS IS AN AMAZING TIME AND EFFORT AND
AMAZING LEADERSHIP. ALL FOR WHAT YOU’VE DONE FOR
BEING HERE TODAY AND WHAT WE HAVE AHEAD OF US AND ACTUALLY
SOME OF MY QUESTIONING IS GOING TO BE VERY SIMILAR TO DOCTOR
SAGS, YOU’VE GONE DOWN TO THE COUNTY LEVEL AND THERE’S
[INDISCERNIBLE] AND BUDGET REQUESTS AND I HAVE ON TO SAY
THAT THE BUMET REQUEST FOR THIS YEAR IS SIGNIFICANT BUT I ALSO
KNOW TO ACCOMPLISH THESE GOALS THAT YOU OUTLINES, 75% REDUCTION
IN NEW CASES IN FIVE YEARS IT’S GOING TO TAKE A LOT MORE MONEY
THAN THE FIRST YEAR. SO I’M WONDERING IF YOU WILL
SHARE AT THE COMMUNITY LEVEL, YOU KNOW THE MODELING THAT
YOU’VE DONE, HOW MANY PEOPLE ARE OUT OF CARE AND THINGS LIKE
THAT. HOW MUCH IT WOULD COST AND
ACTUALLY ANOTHER THING THAT I THINK THE AMERICAN PEOPLE AND
THE CONGRESS WOULD BE INTERESTED IN IS IF WE DON’T ACT HOW MUCH
MORE MONEY WILL IT COST THE U.S. GOVERNMENT AND THE HEALTHCARE
SYSTEM? AND THEN SECONDLY, I WOULD LIKE
TO DELVE INTO PREP AS WELL. YOU KNOW DR. SIGOUNAS, WE’VE HAD
MANY CONVERSATIONS AND I THINK THE COMMUNITY IS EXCITED ABOUT
IS HAVING A PAYOR SOURCE FOR PREP, FOR THE UNINSURED WE
HAVEN’T HAD IN THE PAST BUT IN LOOKING AT THE PRESIDENT’S
BUDGET FOR 50 MILLION DOCTORS FOR THE COMMUNITY HEALTH CENTERS
IT DOESN’T SEEM LIKE IT’S NEW MONEY IT SEEMS LIKE IT’S
EXISTING MONEY AND I DON’T–AS I SAID EARLIER, I THINK IT’S GOING
TO RAMP UP THE DOLLAR REQUEST IN THE FUTURE AND I JUST DON’T
THINK IT’S RIGHT TO BURDEN THE COMMUNITY HEALTH TRUSTEESS WITH
ADDITIONAL–YOU KNOW THEY COULD ALREADY DO THIS ACTUALLY BUT
WHY, IF WE’RE GOING TO ASK THEM TO BE THE PAYOR SOURCE FOR PREP
FOR THE UNINSURED THAT WE SHOULD BE ALLOCATING THE ADDITIONAL
FUNDING FOR THAT SO THAT’S JUST AN OPINION AND WOULD BE
INTERESTED IN YOUR RESPONSE AND ANY OTHERS AS WELL.
>>LET ME JUST DO THE FIRST ANSWER THE MODELING THAT’S FROM
THE CDC, IS THAT EVERY NEW HIV DIAGNOSIS ADDS AN EXTRA
ADDITIONAL BURDEN OF $500,000 IN LIFETIME COSTS.
SO YOU DO THE MATH, IF WE ARE ABLE TO SAVE 250,000 DIAGNOSIS
OVER THE NEXT TEN YEARS EVEN WITH THE COST OF THE PROGRAM,
YOU SAVE A HUNDRED BILLION DOLLARS IN FEDERAL EXPENDITURES
SO THE MATH AND THE ECONOMICS GO IN THE RIGHT DIRECTION HOWEVER,
I THINK WE ALL UNDERSTAND IF WE TAKE 100,000, 200,000 PEOPLE WHO
ARE NOT IN CARE AND BRING THEM INTO TEAR IN THE SHORT-TERM
THERE’S A TUBITANTIAL INCREASE IN INPENDITTURES THAT ARE
NECESSARY TO COVER THOSE PEOPLE, WE ALL UNDERSTAND THAT.
WE ARE NOT GOING TO TELL YOU OUR SECOND, THIRD, AND FOURTH YEAR
BUDGETS. THOSE BUDGETS ARE NOT OUT.
WE HAVE TO GO THROUGH THE PROCESS BUT THERE IS A
SUBSTANTIAL INCREASE IN FUNDING THAT WOULD BE NECESSARY AS WE
RAMP THE PROGRAM UP AND BRING MORE PEOPLE INTO CARE.
WE UNDERSTAND THAT. EVERYBODY UNDERSTANDS THAT.
WITH THE RECEPTION WE RECEIVED BOTH FROM THE PRESIDENT AND
CERTAINLY THE SECRETARY AND FROM CONGRESS, WE ARE GOING TO BE
HIGHLY DILIGENT IN THE EXECUTION AND DR. BECKHAM WITH ALL THE
INTERAGENCY HAVE BEEN MEETING AT ALL HOURS OF THE NIGHT PUTTING
AN EXECUTION PLAN THAT NOT ONLY HAS AN ORGANIZATIONAL STRUCTURE
TO MAKE SURE WE DON’T GO BACK TO OUR CORNERS AND DO OUR OWN THING
BUT WE’RE HIGHLY INTEGRATED BUT ALSO THERE ARE LEADING
INDICATORS THAT WE NEED TO MEET TO MAKE SURE THAT WE’RE BEING
HONEST AND ACCOUNTABLE TO OURSELVES AND TO YOU AND IF WE
MEET THOSE, I’M AN OPTIMISTIC PERSON BUT I KNOW WHAT JUST
HAPPENED TO GET THIS PROGRAM ON BOARD THAT IF WE’RE MEETING
THOSE AND WE’RE DOING OUR JOB, I’M HIGHLY CONFIDENT THAT WE
WILL GET THE FUNDING WE NEED IN YEAR TWO, THREE, FOUR, FIVE.
WE HAVEN’T GONE BEYOND THAT BECAUSE IF YOU THINK YOU CAN
PROJECT YEAR BE SIX AND SEVEN IT’S FANTASY BUT WE THINK WE
HAVE A GOOD HOLD ON THE REQUIREMENTS.
AND BOB DO YOU WANT TO ADD TO THAT?
>>THE ONLY OTHER COMMENT WE WOULD MAKE IS THE HEAVY LIFTING
ABOUT GETTING PREP, THE OTHER HEAVY LIFT WAS LOOK BEING WITH
REGULATORY GROUPS TO SEE WHAT THE ADMIRAL JUST SAID, WE ARE
ANTICIPATING THAT OUR 350, FOUR HELPED THOUSAND PEOPLE INTO A
NEW SYSTEM THAT NEAT TREATMENT. MANY OF THOSE WILL NEAT
TREATMENT THROUGH THE RYAN WHITE PROGRAM AND THAT WILL REQUIRE
SIGNIFICANT RESOURCES, THAT SAID IF WE DO THAT, WE ARE ABLE TO
SHOW IN THE LONG RUN, IN THE SEVEN, EIGHT, NINE, TEN YEAR
FRAME, AND BEYOND THIS NATION WILL HAVE AN ENORMOUS AND TAKE
IT OFF OFF THEY SHELF AND END ONE OF THE MOST SIGNIFICANT
HEALTH CRISIS OF OUR TIME. SECOND THING AS YOU’RE HERE AS A
VOICE, I’M SURE WE WILL HAVE PEOPLE THAT WILL WANT TO TAKE
POT SHOTS, IT COMES WITH THE TERRITORY.
WE WILL ANNOUNCE, WE’VE ANNOUNCED A PROGRAM TO BRING THE
OUTBREAK DOWN. BUT WE WILL SHOW THAT THE CAPESS
WILL GO UP BECAUSE WE’RE OPERATIONALLIZING THIS.
WE NEED OUR COLLEAGUES AT PACHA TO HELP WITH COMMUNICATION THAT
THAT’S EXACTLY WHAT WE EXPECTED. THAT’S A LEAD INDICATOR OF
SUCCESS, NONAPOPTOTIC THE FAILURE.
NOW WE’LL OBVIOUSLY BUILD INTO IT AND CDC WILL BUILD INTO IT
WAYS THAT WE CAN LOOK AT TRUE INCIDENCE BUT MOST OF WHAT WE’RE
DIAGNOSING IS NOT TRUE INCIDENCE WE WE WILL NEED THAT FROM THE
BEGINNING, TONY?>>THERE’S A REASON FOR EUGENE
SHOWING FIRST INCIDENT FIRST AS DIAGNOSIS, YOU HAVE TO
UNDERSTAND–WE’RE LETTING YOU KNOW THERE’S A DIFFERENCE THERE.
OKAY? THE MORE YOU LOOK IN, THE MORE
YOU WILL SEE DIAGNOSIS, IT’S THE INCIDENTS THAT COUNTS.
THAT’S WHAT WE’RE TALKING ABOUT, WE DON’T WANT THE DIAGNOSIS TO
GO DOWN, WE WANT THE INCIDENTS TO GO DOWN.
>>LET’S BE CLEAR, IF THERE ARE 60,000 DIAGNOSIS NEXT YEAR, WE
WILL CLAIM VICTORY BECAUSE MORE DIAGNOSED INTO THE SYSTEM.
BE PREPARED FOR THAT.>>GREAT.
THANK YOU ADA?>>AGAIN THEY THINK YOU SO MUCH
FOR THE GREAT PRESENTATION, I HAVE TWO QUESTIONS I’M MORE ON
THE FRONT LINE AND THE COMMUNITY HEALTH CENTER AND HOW CAN WE
BEST BE ABLE TO NOT ONLY GET THE FINANCIAL BACKING BUT WE’RE
STILL GOING TO BE LACKING IN WORKFORCE.
HAVING THE PEOPLE ON THE FRONT LINES TO BE ABLE TO PROVIDE THE
CARE THAT WE NEED FOR OUR PATIENTS AND
OUR COMMUNITIES. THE OTHER CONCERN IS AS WE LOOK
TO USING THE RYAN WHITE FUNDING REMEMBER THAT NOT ALL
INDIVIDUALS ARE ELEDGIBLE FOR RYAN WHITE AND SO WE STILL HAVE
THAT BUCKET OF PATIENTS WHO STILL CANNOT ACCESS CARE AND
THAT’S SOMETHING THAT YOU HAVE TO LOOK AT.
MANY OF THE STATES THAT IS PROFOUNDLY AND
DISPROPORTIONATELY IMPACTED BY THIS EPIDEMIC UNFORTUNATELY DID
NOT TAKE THE MEDICAID EXPANSION. SO WE STILL HAVE A BIG ISSUE
THAT WE NEED TO ADDRESS. THE OTHER ISSUE IS WITH PREP AND
AS WE TALK ABOUT USING 340 B FUNDING FOR THAT ENDEAVOR THAT
STILL DOES NOT COVER A LOT OF INDIVIDUALS WHO BASED ON WHAT
THAT PRICE WILL BE WILL STILL BE ABLE TO ACCESS THAT EVEN WITH
THE DISCOUNTED RATES THEY MAY GET IN THE OFFICE VITVISIT IN
THE COMMUNITY HEALTH CENTERS, THROUGH LABORATORY DISCOUNTS, ET
CETERA SO THOSE ARE A COUPLE THINGS THAT I JUDGE UTV WANT TO
KIND OF THROW OUT THERE AND SEE IF YOU HAVE ANY COMMENTS.
>>I WANT TO GIVE A HIGH LEVEL ANSWER AND THEN TURN IT OVER TO
SEVERAL PEOPLE. NUMBER ONE WE DID NOT ASSUME ANY
ATKEUPGZAL MEDICAID EXPANSION. NUMBER TWO WE TOOK THE ACTUAL
COST FOR THE WRAP AROUND SERVICES AROUND PREP, CLINICAL
TESTING, DIAGNOSTIC AND MOVED IT INTO THE BUDGETS AND AGAIN, YOU
JUST WILL HAVE TO TAKE IT BY SAYING THAT SOME OF THAT IS IN
THE FIRST YEAR BUT THERE IS A RAMP UP PERIOD HERE AND THE
THIRD GENERAL ANSWER IS, WE HAVE AN OVER ALL PLAN AND STRATEGY
BUT THE NEXT PHASE IS TO GET EXTRAORDINARILY GRANULAR AT THE
INDIVIDUAL COUNTY LEVEL. WHAT THE NEEDS ARE, AND TO FOCUS
THE RESOURCES OR BRING ADDITIONAL PROGRAMS OR RESOURCES
WHETHER IT’S MAN POWER, WORKFORCE, WHETHER YOU NEED 50
COMMISSION CORE OFFICERS TO GO IN TOMORROW TO DO TEACHINGS,
WE’RE PREPARED TO DO A FULL COURT PRESS ON THIS, BUT THAT’S
WHY THE COMMUNITY PLAN AT THE NEXT LEVEL, WE GOTTA GET DOWN TO
THAT GRANULARITY. YOU NEED THREE MORE PEOPLE AT A
COMMUNITY HEALTH SORE YOU CAN DO THAT, YOU CAN’T SEE IT FROM THE
LENS WE HAVE NOW BUT WE’RE ABSOLUTELY COMMITTED TO THAT
GRANARRITY BY THE TIME THE BUMET COMES AND BOB AND–
>>WE ASSUME THERE’S GOING TO HAVE TO BE A SUBSTANTIAL
AUGMENTATION OF THE WORKFORCE. WE HAVEN’T DECIDED TO TELL YOU
YES AND YOU NEED TO DO IT THIS WAY, WE WANT EACH COMMUNITY TO
LOOK AT WHAT SOME OF IT MAY BE BETTER COMMUNITY NAVIGATORS,
SOME OF IT MAY BE INCREASED PROVIDERS WHEN WHEN I TALK ABOUT
WORKING AND BUILDING OVERNIGHT BUT BUILDING THE HIV WORKFORCE,
SOME OF US HAVE BEEN AROUND IN THIS FOR A LONG TIME I’M LOOKING
AT MIKE BECAUSE I REMEMBER WHEN I WAS AND TALKED ABOUT THE
SITUATION IN ALABAMA AND I REMEMBER IT WAS RIGHT AFTER YOU
HAD SEVERAL NURSE PRACTITIONERS RETEAR AND YOU WERE DOWN TO A
COUPLE HEALTHCARE PROVIDERS IN YOUR RURAL CLINICS, THERE’S A
LOT OF US THAT HAVE BEEN IN THIS FOR 35 YEARS AND A LOT OF PEOPLE
LEFT AND A LOT OF PEOPLE LEFT BECAUSE THEY COULDN’T SOLVE
THESE PROBLEMS, DAY AFTER DAY THEY SAY PEOPLE WHO COULDN’T
AFFORD ACCESS DESPITE THE PROGRAMS WE HAD.
GOOD PROGRAMS LIKE YOU SAID, PEOPLE FALLING THROUGH THE
CRACKS. I’M OF THE POINT OF VIEW WHEN WE
SAW THE LATE 70S WHEN THE DECISION WAS MADE TO END SMALL
POX, THEY SAID LETTAY GET IN AND DO THIS, WE’RE HOPING THAT THESE
COMMUNITIES ARE GOING TO GENERATE INTEREST AMONG
HEALTHCARE PROVIDERS AND WORKERS AND COMMUNITY GROUPS THAT WANT
TO BE PATIENT-NAVIGATORS THEY WANT TO BE PART OF THE TEAM TO
WIN. BUT I WILL SAY WE’RE COG
NIEHSENT OF THE WORKFORCE AND ONE OF THE TASKS THAT WE HAVE IN
THIS IS TO WORK WITH THE COMMUNITY ON DIFFERENT
STRATEGIES TO ACCOMPLISH THAT ENCLUING AS ADMIRAL SAID PUTTING
THE CDC PEOPLE TO AUGMENT AS THEY BUILD THE WORKFORCE THEY
NEED OR PUBLIC HEALTH SERVICE LEADERSHIP UNDER THE ADMIRAL BUT
I DON’T WANT TO BUT I DON’T WANT TO UNDERHEST MATE THE ADVANTAGE
OF A DEEPLY COMMITTED COMMUNITY THAT REALIZE THIS IS A BIG
POSSIBILITY AND BE ON BOARD AND PART OF THE TEAM TO BRING THIS
TO NEW HIV INFECTION IN THEIR OWN COMMUNITY.
>>I THINK THE CENTERS IN THE RYAN RYAN WHITE PROGRAM, WE HAVE
CENTERS THAT HELP APPROACH IN INITIATIVE, THE FIRST CENTERS
THAT APPRECIATE IN THESE AREAS WILL BE IN THE AREA IN WHICH
WE’RE TARGETING AND THESE CENTERS ACTUALLY ADD DUALY
FUNDED BY BOTH AND THE RYAN WHITE AS WELL AS THE CENTERED
PROGRAMS. SO BY SO BY USING THOSE HEALTH
CENTERS TO START WITH IF THERE ARE OTHER SERVICES WHICH ARE
COVERED BY ONE PROGRAM, WILL BE COVEETED BY THE OTHER PROGRAM
AND WITH THE ADDITIONAL FUNDING WHICH WE’RE PROVIDING WE HOPE
THAT THIS WILL DO VERY WELL AND WILL BE ABLE TO HELP US WITH THE
INITIATIVE.>>GREAT, THANK YOU DR..
NEXT QUESTION, JUSTIN?>>THANK YOU FOR THE INFORMATION
YOU PROVIDED TO US, IT’S A LOT TO DIGEST AND I’M EXCITED TO
DELVE INTO THE DETAILS TO CONTINUE OUR THE CONVERSATION
AROUND THE IMPORTANCE OF PREP, I WANTED TO GO BACK TO THE
PRESENTATION THAT THEY GAVE AND IN ORDER TO GET CLARITY AROUND
THE ABSOLUTE NUMBER OF PRESCRIPTIONS AND THAT
INFORMATION IS AVAILABLE, BROKEN DOWN BY DEMOGRAPHIC GROUP AND
YOU MENTIONED AS WE KNOW, YOU KNOW THERE ARE DISPARITIES AND
SORT OF PREP ACCESS AND UPTAKE AND I WANTED TO KNOW IF WE HAD
NUMBERS ON THAT, SPECIFICALLY LOOKING AT PREP UPTAKE LOOKING
AMONG BLACK MEN FOR EXAMPLE, COULD WE HAVE ACCESS TO THAT THE
DATA AND MY SECOND QUESTION IS JUST AROUND THE JURISDICTIONAL
PLANS AND WHAT TYPES OF STRUCTURES ARE PUT IN PLACE TO
INSURE THAT WHEN COMMUNITIES DEVELOP THESE PLANS AT THE LOCAL
LEVEL THAT THERE IS MEANINGFUL ENGAGEMENT FROM KEY POPULATIONS
IN THE DEVELOPMENT OF THAT PLAN SO THAT WE MAKE SURE THEY ARE
RESENTATIVE OF THE COMMUNITY AND ARE THERE FUNDING MECHANISMS OR
LEVELS THAT ARE PUT IN PLACE TO INSURE THAT HAPPENS.
>>AGAIN WITH CDC BEING AGAIN THE DOMAIN NAPHTH FUNDER OF OUR
PUBLIC SYSTEM IN AMERICA FROM OUR PUBLIC HEALTH POINT OF VIEW,
WE FUND THE STATE’S TERRITORIALS, LOCAL HEALTH
DEPARTMENTS. WE WERE OBVIOUSLY IN THE FIELD
WITH THESE INTERVAL JURISDICTIONS THEY WILL HAVE TO
TRY TO UNDERSTAND WITHIN THEMSELVES EXACTLY HOW THEY WANT
TO LEAD THEIR RESPONSE, OKAY? BUT WE WILL BE THERE IN THOSE
DISCUSSIONS BECAUSE THE INTENT AS EUGENE AND OTHERS HAVE SHOWN
IS WE’RE TRYING TO END AN OUTBREAK THAT’S HRARPLGLY IN MEN
WHO HAVE SEX WITH MEN BOTH AFRICAN AMERICAN AND LATINO, AND
LARGELY BETWEEN 25-35 YEARS OF AGE.
SO OBVIOUSLY THAT GROUP’S GOT TO BE FULLY ENGAGED IN IT.
WE’RE TRYING TO END AN OUTBREAK THAT IS NEGATIVELY IMPACTED BY
THE OPIOID AND DRUG USE EPIDEMIC SO THEY HAVE TO BE.
SO WE WILL BE THERE AS THOSE PLANS GET TO GO.
WE DO, YOU KNOW WE DON’T JUST SORT OF HAND THE RESOURCES AND
SAY JUST YOU KNOW TELL US IN A YEAR HOW YOU DID IT, THERE WILL
BE A PROCESS. BUT IT’S NOT GOING TO BE–YOU
KNOW A LOT OF THESE JURISDICTIONS WHERE THE
RESOURCES GO TO THE STATE AND THEY NEVER GET DOWN TO THE
PROJECT. THIS IS A–IT’S NOT GOING TO
INFLUENCE THE ALMOST $800 MILLION FOR EXAMPLE, THE
CDC CURRENTLY HAS FOR OUR HELP TO STATE AND TERRITORIALS AND
OUR OWN, 80% OF THE THAT MONEY GOES OUT IT WILL NOT BE PART OF
THAT MONEY. THAT’S OUT.
THIS IS A NEW INITIATIVE, NEW RESOURCES, BUT I THINK WE WILL
LEARN A LOT ALONG THE WAY, YOU ARE NOT FAR FROM US.
WE WOULD LOVE TO HAVE YOU COME AND, YOU KNOW YOU’RE NOT FAR
FROM US, YOU WILL SEE IT, WE WILL WORK WITH THE GOVERNOR AND
THE STATE HEALTH DEPARTMENT AND THE FOUR JURISDICTIONS, WE HAVE
A MEETING COMING UP AND WE WILL BROWEDDEN THIS BECAUSE WE WILL
GET A LOT OF EXPERIENCE JUMP STARTING THIS BY SEEING HOW WE
GET THE FORCED JURISDICTIONS IN THE ATLANTA AREA AND I’M SURE WE
WILL LEARN A LOT AS WE ALL GET ENGAGED IN THAT AND BUT THIS IS
REALLY THE ADMIRAL SAID IT THE CLEAREST, THIS IS BY THE
COMMUNITY, FOR THE COMMUNITY AND IN THE COMMUNITY EMPLOY THE ONLY
TECHNOLOGY TRANSFER THAT’S GOING TO HARM US IS IF THE COMMUNITY
CHOOSES NOT TO ENGAGE. I SKWROUFT GOT BACK FROM THE
EBOLA OUTBREAK IN THE DRC, AND LET ME TELL YOU THE FACT THAT
THE COMMUNITY IS NOT ENGAGED IS HARMING THE OUTBREAK RESPONSE.
SO WE HAVE TO GET THE COMMUNITY ENGAGED.
WE SPENT A LOT OF ENERGY IN ENGAGING COMMUNITY LEADERS
ALREADY AT A NATIONAL LEVEL. BUT WE NEED NEED THE LOCAL
COMMUNITY ENGAGED AND THE OTHER THING WE NEED AND I’VE SAID THIS
BEFORE, PROBABLY ONE OF THE MOST IMPORTANT TEACHERS BEBEYOND THAT
TO REFINE THIS OUTBREAK AS TONY SAID, WE WILL HAVE A TEN YEAR
PROGRAM AND IT’S NOT GOING TO GET EVERYTHING RIGHT, THE MOST
IMPORTANT TEACHERS ARE ACTUALLY THE INDIVIDUALS THAT GET
INFECTED IN THE FIRST TWO YEARS SO THEY CAN TRUST US ENOUGH TO
BE PART OF THE TEAM TO HELP TEACH US WHAT DIDN’T WORK.
WHY DIDN’T IT WORK FOR THEM? AM I LIKELY TO BE THE PERSON
THAT WILL ENGAGE THEIR TRUST TO DO THAT?
PROBABLY NOT, SO THE COMMUNITY IS SO IMPORTANT IN GETTING THEIR
ENGAGEMENT. SO ONE OF THE–I’M VERY
CONFIDENT IN MY INTERACTIONS WITH COMMUNITY LEADERS THAT THE
COMMUNITY WILL ENGAGE BUT I JUST WANT TO UNDERSTAND, THEY REALLY
ARE ONE OF THE MOST IMPORTANT CRITERIA FOR WHETHER THIS WILL
WORK.>>IT’S THREE–IT’S A BIT PASSED
THREE 15:00 WHEN WE SAID WE WOULD TAKE A BREAK DO OUR
FEDERAL LEADERS HAVE FIVE OR TEN MINUTES THAT WE COULD TAKE A FEW
MORE QUESTIONS?>>SURE.
>>GREAT.>>ALL RIGHT.
THANK YOU NEXT QUESTION, JOHN SAPERO?
>>SO I’M WONDERING TWO THINGS VERY BRIEFLY, ONE IT’S GREAT TO
SIT HERE AND HEAR YOU SPEAK WITH SUCH PASSION AND COMMITTED TO
AND TO BE AGGRESSIVE ABOUT THAT PASSION BECAUSE I THINK THAT WE
HAVE FELT THAT IN THE COMMUNITY FOR A LONG TIME AND I LOVE
SEEING THAT DEMONSTRATED BACK TO US.
MY CONCERN IS JUST SOMETHING THAT YOU WERE DISCUSSING AND
THAT IS COMMUNITY VERY OFTEN IS HIGHLY MOTIVATED, HIGHLY
AGGRESSIVE AROUND DOING GREAT WORK AND ENDING OUR EPIDEMIC BUT
AT TIMES IN RURAL AREAS PERHAPS OUR PEERS TALK ABOUT IT IN THE
SOUTH WHERE WE HAVE CITY, ENTITIES THAT ARE RESISTANT TO
TALKING ABOUT HIV, PROMOTING HIV IN MEDIA, SOCIAL MARKETING, WHAT
HAVE YOU, SUPPORTING PREP AND WHAT HAVE YOU AND THAT CAN OCCUR
AT THE CITY LEVEL, COUNTY LEVEL, STATE LEVEL, WHAT HAVE YOU AND
HOW CAN YOUR–AGGRESSION, BEING AGGRESSIVE ABOUT IT TRANSLATE
INTO ACTUALLY HAVING THE COMMITMENT TO DO THE WORK AND
THE WORK IS THE WAY YOU FEEL IT NEEDS TO BE DONE.
HOW PRESCRIPTIVE CAN YOU BE IN THAT AS WE MOVE FORWARD.
>>SO THIS WILL BE IMPORTANT, PEOPLE HEARD ME SAY THIS IN MIKE
STONE AND I THINK HE KNEW I FELT THIS WAY MY WHOLE LIFE AND IN MY
OWN LIFE, I KEEP TELLING HIM, STIGMA IS THE ENEMY IN PUBLIC
HEALTH IT’S STILL IN TRANSGENDER PERSONS COMMUNITY, IT’S STILL IN
AFRICAN AMERICANS WHO HAVE SEX WITH MEN IN THE SOUTH AND LATINO
AND MEN WHO HAVE SEX WITH MEN. IT’S NOTHING COMCOMPARED TO THE
STIGMA WITH THE OPIOID EPIDEMIC AND ONE OF MY SIX CHILDREN
ALMOST DIED FROM COCAINE COUPLED WITH FENTYNL, BUT I HAD NO
CONCEPT OF ALL THE SUBTLE STIGMATIZATION THAT OCCURS.
SO I THINK ONE THING THAT ALL OF US WILL COMMIT OURSELVES TO IS
BEING LEADERS, BEING IN THE COMMUNITY.
TELL BE A LIFT. WE HAVE TO EDUCATE THE FAITH
COMMUNITY. YOU KNOW THE ADMIRAL’S TILES
THEY HAVE A CRITICAL ROLE TO PLAY.
SO GO DOES THE MEDIA. SO I THINK MORE AND MORE TO
REENFORCE THAT THAT LEADERSHIP, THE ADMIRAL WILL TALK ABOUT IT
PARTICULARLY IN THE INDIAN POPULATION AND YOU KNOW, THAT
BASICALLY, STIGMA IS A BIG DEAL AND IN THESE RURAL AREAS WE KNOW
IT THAT’S WHY WE INCLUDED SEVEN RURAL STATES BECAUSE WE KNOW
THAT’S A HEAVY LIFT BECAUSE YOU ARE GOING INTO A COMMUNITY THAT
MAY HAVE TWO OR THREE PEOPLE WITH HIV INFECTION AND THEY MAY
NOT EVEN BE COMFORTABLE GETTING THEIR MEDICATION IN THEIR OWN
CITY SO THEY GO TO SOME OTHER CITY, YOU KNOW.
I, WOOED MANY YEARS AGO, I’VE SEEN THIS, YOU KNOW IN
SITUATIONS WHERE PEOPLE WILL GO FROM ONE CITY TO ANOTHER TO GET
THEIR CARE.>>SO IF I COULD JUST, I’M NOT
REALLY SPEAKING SO MUCH FOR STIGMA IN THE COMMUNITY, I WOULD
CALL IT ORGANIZATIONAL STIGMA–[SPEAKING AT ONCE
]–THAT ACTUALLY RECEIVE OUR FUNDING AND THEIR RESISTANCE TO
MAXIMIZE ITS POTENTIAL IN THE COMMUNITY!
>>OKAY.>>I KNOW WHAT YOU’RE TALKING
ABOUT, AND AND TO SAY NO PROBLEM, WE WILL TAKE CARE OF
THAT IS BEING MISLEADING AND GLIB AND THAT’S WAWE DON’T WANT
TO BE. BUT ONE OF THE THINGS MIGHT
ADDRESS AT LEAST IN PART, IT WILL NOT SOLVE THE ISSUE YOU’RE
BRINGING UP IS TO HAVE THE WORK, THE HEALTH WORKFORCE THAT WE’RE
TALKING ABOUT AND AS MUCH OF THE COMMUNITY PEOPLE TO BE PROACTIVE
TO GET OUT INTO THE COMMUNITY AND SEEK OUT AS OPPOSED TO
SAYING OKAY, YOU WILL BE AMENABLE TO ACCEPTING PEOPLE WHO
WILL BE COMING IN FOR PREP OR COMING IN FOR TREATMENT, IT’S
MORE OF A PROACTIVELY GOING OUT AND I KNOW IT’S MUCH MORE
DIFFICULT IN RURAL AREAS BUT THE KINDS OF THINGS THAT WERE DONE
IN SAN FRANCISCO THAT WAS DONE IN NEW YORK AND THAT WE DID IN
WASHINGTON D. C., YOU WOULD BE SURPRISED WHEN YOU GO OUT AND
START PROACTIVELY GOING AFTER AND BRINGING PEOPLE INTO THE
SYSTEM THAT ALL OF A SUDDEN, THE PEOPLE WHO ARE ESSENTIALLY EVEN
NEUTRAL OR RESISTANT TO IT KIND OF PLAY ON AND DO IT.
THAT’S WHAT HAPPENED IN D. C. I MEAN IN D. C. NOTHING WAS
HAPPENING. NOBODY WAS DOING ANYTHING UNTIL
WE ACTUALLY PARTNERED WITH THE DEPARTMENT OF HEALTH.
WE PARTNERED WITH THE C-FAR AND WE WENT OUT INTO THE COMMUNITY
AND THEN ALL OF A SUDDEN THINGS STARTED TO HAPPEN.
NOW I WILL NONAPOPTOTIC THE GUARANTEE THAT IT WILL HAPPEN
ALL ACROSS THE MAP, BUT I THINK IT’S GOING TO HAPPEN IN SOME
PLACES.>>GREAT.
THANK YOU.>>AND I WILL SAY AND THIS IS
PARTIALLY MY ROLE IS WE WANT TO WORK TOGETHER, YOU KNOW FEDERAL,
STATE, COMMUNITY, BUT, THIS IS REALLY GOING TO BE MANAGED AS AN
INITIATIVE AND AS A PROGRAM. WITH REAL METRICS AND REAL
ACCOUNTABILITY BUT IT DOESN’T MEAN PUNITIVE ACCOUNTABILITY BUT
IF WE’RE FOCUS ON THE DOING WHAT WE ARE SUPPOSED TO BE DOING, WE
NEED TO FIGURE OUT WHAT OUR PART IS, AND OUR ROLE AT THE ASH IS
TO BE AN ORGANIZER AND MAKE SURE THAT EVERYONE’S WORKING WELL
TOGETHER AND WE’RE,A CHIEFING WHAT WE NEED TO,A CHIEF AND
THAT’S OUR COMMITMENT IN THIS WORKING GROUP TO BE GRANULAR AND
UNDERSTAND THAT THIS MONEY, PRECIOUS MONEY IN BUDGET TIMES
WHERE THINGS ARE BEING CULT ALL OVER THE PLACE, REALLY PRECIOUS
MONEY GETS SPENT IN THE MOST EFFECTIVE WAY WE CAN DO IT.
THIS HAS BEEN THERE FOR 30 YEARS NOW SUPPORTING THE
PATIENTS AND THEY HAVE BEEN DEVELOPED DIFFERENT MODELS
REGARDING REACHING OUT TO THE COMMUNITY AND I WILL ASK MY
COLLEAGUE THERE WHO’S LEADING THE RYAN WHITE PROGRAM TO
COMMENT ABOUT HOW HRSA AND RYAN WHITE IS DOING.
>>I THINK GETTING BACK TO ISSUES AROUND PLANNING THAT FOR
THE CITY AND COUNTIES THAT WE’RE TARGETING IF I GET THIS IN THE
ONE TEXT, THAT HIV ARE REQUIRED TO BE ON BY LAW AND IT STAYS
WHAT TYPE OF PEOPLE YOU NEED TO GET ON THERE SO WE HAVE GOOD
DIVERSITY THERE FOR THE PLANNING AND THAT’S ONE TECHNOLOGY
TRANSFER WE DO TO REDUCE STIGMA AND AS WELL AS PEOPLE LIVING
THROUGHOUT THE CLINICAL PROGRAMS AND QUALITY IMPROVEMENT AND ALL
THAT. SO DEFINITELY SOMETHING WE WILL
CONTINUE TO WORK ON, OBVIOUSLY STIGMA IS STILL HUGE, I SEE IT
IN MY OWN PRACTICE IN BALTIMORE WHERE PEOPLE EAT OFF OF PAPER
PLATES IN A COMMUNITY THAT HAD THIS FOR MANY, MANY YEAR AND WE
NEED THAT BROAD ENGAGEMENT AND WE HAVE STARTED WORKING CLOSELY
WITH CDC TO FIGURE OUT HOW THAT WILL WORK TOGETHER AND SOME OF
THAT COMMUNITY BASED EDUCATION CAMPAIGNS OR SOMETHING ARE
BETTER EXPERTISE THAN WE DO AND CERTAINLY IN DIFFERENT
DIFFERENTS IN NEW YORK IS A GREAT EXAMPLE WHERE THEY’VE
REACHED IN AND TRY TO ADDRESS STIGMA AND MESSAGING AROUND
THESE ISSUES. THEY’VE HAD GREAT SUCCESS AND WE
WILL LEARN FROM THAT AS WELL.>>I THINK WE CAN–ONE MORE
QUESTION BEFORE BREAK AND THEN WE DO HAVE OUR LIAISONS FROM THE
AGENCIES WHO WILL BE WITH US, I BELIEVE FOR THE FURTHER
DISCUSSION.>>GREAT.
THE LAST QUESTION WILL BE GO TO ROBERT.
>>THANK YOU.>>THIS IS A MAGNIFICENT MODEL,
WHOLE OF SOCIETY, INITIATIVE, THE PLANNING HAS PIONEERED IN
BURKELY IN PUBLISHING HEALTH, I WAS REMEMBERING WHAT A GREAT
SUCCESS AND WHAT A GREAT OPPORTUNITY IT IS AND PIONEERS
HERE, I REMEMBER IN 1981 [INDISCERNIBLE] MR. FAUCI,A
LEWDED TO HOW FAR WE’VE COME, THE PROBLEM IN AMERICA, IT’S NOT
IN ISOLATION, I HAVE LECTURED NOW, ON AIDS, AIDS RELATED
TOPICS IN MORE THAN 30 COUNTRIES AROUND THE WORLD, I WOULD LIKE
TO KNOW WHAT WE’RE DOING NOW TO INTEGRATE THE GLOBAL APPROACH TO
FIGHTING AIDS WHICH IS I THINK ESSENTIAL FOR US TO WIN IT AT
HOME, TOO, THANK YOU.>>SO RIGHT NOW THERE’S NOT AN
INTEGRATION PART OF THIS PARTICULAR PLAN SO QUESTIONS
AROSE WHEN WE FIRST STARTED TALKING ABOUT THIS, WOULD THIS
MEAN LESS OF A COMMITMENT FROM THE STANDPOINT OF EVERYTHING
FROM RESEARCH TO IMPLEMENTATION IN THE INTERNATIONAL PROGRAMS WE
HAVE AND THE ANSWER IS NO, SO IT ISN’T AS IF WE’RE SWITCHING
INTEREST FROM INTERNATIONAL TO HERE, BUT WE DO HAVE TARGETED
TYPES OF APPROACHES THAT ARE SO DIFFERENT FOR DIFFERENT
COUNTRIES, SOUTH AFFRIC AYOU KNOW ISSUES THE EAST CAPE VERSUS
THE WEST CAPE ARE DIFFERENT, DIFFERENCES IN KENYA, DIFFERENTS
IN ROUGH ATOM WANDA, SO I’M NOT SURE WHAT YOU MEAN BY
INTERNATIONAL CLASSIFICATIONIATION, TO THE
EXTENT THAT WE REALIZE THAT ONE SIZE DOES NOT FIT ALL THAT WE’VE
INTEGRATED THE PLAN. SO THIS PARTICULAR PLAN THAT WE
HAVE RIGHT NOW IS FUNDAMENTALLY BASED ON THAT WE HAVE IN THIS
COUNTRY A DIFFERENT KIND OF AN OUTBREAK THAN YOU HAVE IN OTHER
COUNTRIES THAT ARE–THE ONES THAT ARE DRIVING THE PANDEMIC
FROM A GLOBAL STANDPOINT. THIS IS A VERY RESTRICTED
EPIDEMIC IN THE UNITED STATES. IT’S NOT A GENERALIZED EPIDEMIC.
SO DOING IT THE WAY WE’RE DOING IT RIGHT NOW, EVEN THOUGH
CLEARLY IN SOME OF THE DEVELOPING COUNTRIES, THEY ARE
TARGETING HIGH RISK POPULATIONS, I MEAN WHEN YOU TALK ABOUT WHERE
YOU ARE IN KENYA AROUND THE LAKE AREA, WHERE YOU ARE IN ROWANDA
WHERE YOU ARE THERE, BUT TO SAY WE HAVE AN INTEGRATED PLAN, WAIT
FRANKLY IT’S NOT INTEGRATED. IT IS ONE THAT IS FUNDAMENTALLY
LOOKING AT A GEOGRAPHIC AND DEMOGRAPHIC HOT SPOT IN THE
UNITED STATES AND THAT’S WHAT THIS PLAN IS.
>>MY COMMENT WAS STIMULATED IN PART BY DR. REDFIELD’S RETURN, I
GUESS FROM THE DRC, THE FORMER BELGIAN CONGO AND HOW MANY–I
MEAN WE DO GET A FEW PEOPLE WHO IMMIGRATED FROM COUNTRIES WHERE
THERE ARE PROBLEMS AND IT’S GOOD TO KNOW I GUESS FOR THE PUBLIC
TO KNOW THAT IN FACT OUR EPIDEMIC IS CONFINED TO THIS–TO
MORE LOCALIZED SITUATIONS. BUT I DO THINK WE NEED TO
APPRECIATE THE GREAT EFFORTS BEING DONE BY YOU
INTERNATIONALLY AS WELL. IT’S VERY IMPORTANT.
>>I’M NOT ON THE PANEL, BUT I THINK CAN COMMENT ON YOUR POINT.
IN ALABAMA WE’RE TAKING A LOT OF LESSONS WE LEARNED AND HELPING
TO ADDRESS THE EPIDEMIC AND IN THIS SAY ZAPBIA, SOUTH AFFRIC
AOTHER PLACES, THINGS THAT WORK, QUALITATIVE RESEARCH,
INTERVENTIONS ON A LOCAL LEVEL AND TAKING THE BEST PRACTICES
AND APPLYING IT LOCAL EVEN THOUGH THE EPIDEMIC IS
DIFFERENT. THAT’S THE BEAUTY OF THIS, IS
THAT THE CUMULATIVE EXPERIENCE I THINK WILL MAKE THE DIFFERENCE.
>>MIKE, ALSO JUST I THINK THE ADMIRAL ALLUDED TO THIS–BOB, ALLUDED TO THIS, SO WHEN WE WERE PUTTING TOGETHER THE PEP FAR
PROGRAM WHEN I WENT TO AFRICA TO PUT TOGETHER HOW WE COULD DO
THIS, IT WAS NOW SEEMINGLY SO SIMILAR TO WHAT WE SAID HERE, WE
SAID LET’S TAKE OUT THE COUNTRY WHERE IS WE SAID WE COULD GET
50% OF THE INFECTIONS GLOBALLY WE WE WERE LOOKINGA THE
DIFFERENT COUNTRIES AND WE SAID THIS ONE IS OUT, THIS ONE’S OUT
AND WE GOT A GROUP OF COUNTRIES, THE FIRST 14 COUNTRIES WE DECIDE
TO MAKE THE PEP FAR PROGRAM WERE SO SIMILAR FROM A STRATEGIC
STANDPOINT. WE LOOKEDDA THE THIS MAP HERE
AND WE SAID YOU HAVE 48 COUNTIES PLUS THE DISTRICT PLUS SAN JUAN,
RURAL STATES THAT’S MORE THAN 50% OF THE POPULATION OF THE
CASES OF HIV. WE DID THE SAME THING WITH PEP
FAR. WE LOOKEDDA THE MAP AND SAID
GIVEN THE RESOURCES WE HAVE HOW COULD WE GET AT LEAST 50% OF THE
POPULATION AND THAT IS HOW WE GOT THOSE 14 ORIGINAL COUNTRIES
SO WE LEARNED A LESSON BACK AND FORTH.
>>THANK YOU.>>JUST FOR EVERYONE, I THINK
THE ADMIRAL SAID THIS, THE INTENT IS OBVIOUSLY TO ADDRESS
THE HIV EPIDEMIC IN ALL THE COUNTIES.
BUT I WILL TELL YOU AS SOMEBODY WHO’S BEEN A BIG ADVOCATE IS
PUTTING THE TOOLS TOGETHER IS TONY AND THE OTHERS OVER THE
YORES IS YOU HAVE TO SHOW THE POSSIBLE.
WE WANT TO MAKE SURE THAT BY TARPGETING THESE 50 COUNTIES,
THEN AND WORKING TOWARDS THIS GOAL, THAT WE CAN BEBIN TO
ILLUSTRATE VERY CLEARLY THAT WE CAN MEET OUR TARGETS
COLLECTIVELY ALTOGETHER, AND SEE THAT 75% REDUCTION IN FIVE
YEARS, THAT’S A BOLD–TAKEN–THEY’S A BOLD GOAL.
BUT IF WE TRIED TO BE MORE DIFFUSIVE IN THE BEGINNING, I
DON’T THINK WE WOULD BE ABLE TO GALVANIZE THE RESOURCES THAT ARE
REQUIRED FOR YEAR, TWO, THREE, FOUR, FIVE.
WE WERE LUKEY TO HAVE THE EXAMPLES–LUKEY TO HAVE THE
EXAMPLES THAT JOHN DID IN WASHINGTON, EXAMPLES OF TONE
NEUROECTODERMAL WASHINGTON D. C. TO SHOW THESE COMMUNITIES IN
SAN FRANCISCO, THESE COMMUNITIES WERE ACCOMPLISHING THIS SO THAT
YOU HAD, YOU KNOW YOU HAD A NUMBER OF COMMUNITIES THAT HAD
DEMONSTRATED IT’S NOT HYPOTHETICAL, IT’S POSSIBLE.
AND SO, REALLY I JUST WANT PEOPLE TO REALIZE THAT SOME
PEOPLE WONDER, YOU KNOW WHY AREN’T WE DOING IT FOR THE WHOLE
COUNTRY. WELL WE’RE TRYING TO TARGET THE
50% AND SHOW A SIGNIFICANT IMPACT SO THAT WE CAN COMPLETE
THE RESOURCES REQUIRED THROUGHOUT THE NATION.
>>I WANT TO THANK YOU ALL FOR YOUR TIME AND YOUR LEADERSHIP.
DR., WE’VE HEARD YOUR CHARGE TO US TO GIVE INPUT AND
RECOMMENDATIONS ON HOW TO REACH THOSE WHO NEED PREVENTION AND
TREATMENT, HOW TO ENGAGE COMMUNITIES, THIS WHOLE SOCIETY
EFFORT AND ADDITIONAL MEMBERSHIP ON PACHA.
WE WILL BEGIN WORKING ON THAT IN ABOUT 15 MINUTES FROM NOW, WE
WILL HAVE AN OPPORTUNITY TO CONTINUE TO I THINK THE
QUESTIONS AS WELL WITH THE FEDERAL REASONS HERE.
SO WE WILL TAKE A 15 MINUTE BREAK HERE AND RETURN.
THANK YOU.

5 Comments

  • Reply Silverthorn Landscaping June 10, 2019 at 7:06 am

    Bullshit

  • Reply Silverthorn Landscaping June 10, 2019 at 7:07 am

    Please educate yourselves for goodness sake , HIV can not lead to Aids

  • Reply Plonker Plonker June 10, 2019 at 7:09 am

    I know of thousands of people with HIV who have never taken any toxic ARV’s ever & are completely ok after many many years, you all so wrong its painful to watch your scientific mess up of the century

  • Reply Plonker Plonker June 10, 2019 at 8:06 am

    There are thousands of people now who know the truth of what’s going on , history will judge what you are doing

  • Reply Vinicio Viquez July 3, 2019 at 11:54 pm

    Its sick what they do to people in this so called 1st world country when it comes to Health issues. I speak for my own personal experice as other individuals that i met in the same or similar criteria.

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