Day 2 Pt 1: Subcommittee Updates and Ending the HIV Epidemic: Work of the Federal Government Panel


>>GOOD MORNING.
WELCOME TO THE SECOND DAY OF THE 65th PRESIDENTIAL ADVISORY COUNCIL ON HIV/AIDS,
IN MIAMI, FLORIDA, I’M CARL SCHMIDT JOINT BY FELLOW CHAIR JOHN WEISMAN.
FIRST I HOPE EVERYONE ENJOYED SOME TIME IN MIAMI LAST NIGHT.
I KNOW SOME OF US ENJOYED SOME CUBAN FOOD. AND WE WELCOME EVERYONE WHO IS LISTENING ONLINE
AS WELL, AND TO REMIND PEOPLE THAT THIS AFTERNOON NO, LATER THIS MORNING WE’LL HAVE PUBLIC COMMENT.
SO PEOPLE CAN ALSO SEND IN PUBLIC COMMENTS AS WELL.
SO, I’M GOING TO START BY ASKING KAYE TO DO OUR ROLL CALL.
>>GREAT. GOOD MORNING, EVERYONE.
I’LL START WITH OUR MATCH A MEMBERS, CO CHAIR CARL SCHMIDT.
>>HERE.>>CO CHAIR JOHN WEISMAN.
>>HERE.>>MEMBER GREGG ALTON.
>>HERE.>>MEMBER WENDY HOLMAN.
>>HERE.>>MEMBER MARC MEACHEM.
>>HERE.>>MEMBER RAFAEL NARVEZ.
>>HERE.>>MEMBER MIKE SAAG.
>>HERE.>>MEMBER JOHN SAPERO.
>>HERE.>>MEMBER ROBERT SCHWARTZ.
>>PRESENT.>>MEMBER JUSTIN SMITH.
>>HERE.>>MEMBER ADA STEWART.
>>LIAISON JEN KATES. I’LL ACKNOWLEDGE ROLL CALL NOW FEDERAL PARTNERS
AT THE TABLE. FROM CDC EUGENE MCCRAY.
>>HERE.>>NORMA HARRIS.
JOHN BROOKS.>>HERE.
>>FROM HRSA, LAURA CHEEVER.>>HERE.
>>ANTIGONE DEMPSEY.>>HERE.
>>INDIAN HEALTH SERVICE RICK HAVERKATE.>>HERE.
>>NATIONAL INSTITUTES OF HEALTH MAUREEN GOODENOW.>>HERE.
>>FROM SAMHSA, NEERAJ GANDOTRA. FROM OASH REGION 2 SHARON APRIL SMITH IROK.
SHARON HICKS.>>HERE.
>>CRYSTAL SIMPSON.>>HERE FROM HUD RITA HARGROVE.
OFFICE OF INFECTIOUS DISEASE AND HIV/AIDS POLICY, I HAVE TIM HARRISON.
>>HERE.>>JUDITH STEINBERG.
>>HERE.>>THAT CONCLUDES IT.
NOT QUITE. NOT QUITE.
THE DIRECTOR OF THE OFFICE DR. TAMMY BECKHAM.>>HERE.
>>YES, EXACTLY. AND I ALSO HAVE OUR CHIEF OFFICER FOR ENDING
THE HIV EPIDEMIC, HAROLD PHILLIPS.>>HERE.
>>NOW THAT CONCLUDES IT.>>THANK YOU.
AGAIN, THANK YOU ALL, OUR FEDERAL PARTNERS, TO BEING AT THE TABLE AS WELL.
I WOULD LIKE TO ANNOUNCE WE HAVE SPANISH/ENGLISH TRANSLATION SERVICES FOR PEOPLE WHO REQUIRE
THAT. YOU MAY NEED IT NOW.
YOU MAY WANT TO USE IT DURING THE PUBLIC COMMENT PERIOD.
BUT OUR TRANSLATOR IS IN THE BACK OF THE ROOM IF ANYONE NEEDS THOSE SERVICES.
TO START, WE’LL DO SUBCOMMITTEE REPORT AND CALL ON JOHN SAPERO, CO CHAIR OF ENDING THE
HIV EPIDEMIC, PLAN FOR AMERICA AND UPDATED NATIONAL HIV STRATEGY.
>>SURE. THANK YOU.
SO, OUR COMMITTEE, WHEN OUR COMMITTEE MET, WE REVIEWED WHAT THE WONDERFUL MEETING THAT
WE HAD IN JACKSON, MISSISSIPPI, AND THE GREAT TAKEAWAYS THAT WE HAD FROM THE MEETING, BOTH
IN TERMS OF INCREDIBLE WORK THAT THE AGENCIES THAT WE VISITED WERE DOING, AS WELL AS REALLY
WOULD CALL THEM INTIMATE AND PERSONAL STORIES THAT WERE SHARED, BOTH DURING THE MEETING
AND AS WE DID THE TOUR, AS AN EXAMPLE I THINK WE HAD A YOUNGER GENTLEMAN WHO WAS MAYBE 17
OR 18, WHO DISCLOSED HIS HIV STATUS, CHALLENGES HE HAD ACCESSING CARE, WHAT PUT HIM TO RISK.
AND THAT VERY INTIMATE DISCLOSURE HAPPENED A NUMBER OF TIMES DURING THE MEETING, AND
IT WAS EXCITING TO SEE PEOPLE TAKE SUCH A STAND IN FRONT OF A NATIONAL AUDIENCE BECAUSE
WE WERE BEING BROADCAST OVER THE WEB AS WELL. AND IT WAS ACTUALLY ONE OF THE REASONS THAT
WE CONTINUE THE WORK AND WE REALLY FELT THAT PACHA TO THE PEOPLE WAS BEING WELL RECEIVED
AND THAT WE WERE REALLY RECEIVING IT VERY WELL FROM THE COMMUNITY.
IT’S ONE OF THE REASONS WE’VE CONTINUED THAT AS PART OF OUR ONGOING EFFORT TO ENGAGE COMMUNITIES
TO BETTER UNDERSTAND WHAT’S GOING ON AND INFORM WHAT WE’RE DOING.
WE ALSO ASKED AND PUT IN A FORMAL REQUEST ABOUT� FOR BETTER COMMUNICATION TO PACHA
ABOUT WHAT WAS GOING ON AT THE FEDERAL LEVEL. I THINK WE REALLY FELT AT THE MEETING WE FOUND
OUT A LOT OF THINGS THAT WE FELT WE SHOULD HAVE BEEN INFORMED ABOUT WHEN THOSE DECISIONS
WERE MADE. AND I THINK THAT HAS HAPPENED, AND WE’VE HAD
A LOT BETTER COMMUNICATION, BUT WE WOULD STILL STRIVE TO REALLY HAVE THAT ONGOING DIALOGUE,
SO THAT WE’RE I DON’T WANT TO SAY CAUGHT OFF GUARD BUT ARE A LITTLE BIT MORE PREPARED WHEN
WE’RE DOING OUR WORK. AND THEN THE OTHER THING WAS AT THAT TIME
WE WERE A LITTLE CONCERNED ABOUT THE PEOPLE THAT FROM OUR FEDERAL PARTNERS THAT WEREN’T
AT THE TABLE YET, AND WE PUT IN A FORMAL REQUEST TO OUR COORDINATION STAFF TO INVITE AND REALLY
MOTIVATE OUR FEDERAL PARTNERS THAT WEREN’T SITTING WITH US TO COME AND JOIN THE MEETING,
AND I THINK YOU’LL SEE BASED ON THE FOLKS IN THE ROOM TODAY THAT THAT WAS IMMEDIATELY
ADDRESSED, AND IT’S REALLY EXCITING TO SEE THAT HAPPEN AS WELL.
>>THANKS, JOHN. I THINK IN TERMS OF COMMUNICATION, IT WASN’T
ONLY COMMUNICATION WITH PACHA BUT JUST COMMUNICATING WITH THE OUTSIDE WORLD AND THE COMMUNITY ON
ALL THE THINGS HAPPENING. I THINK WE’VE SEEN SOME IMPROVEMENT IN THAT
REGARD AS WELL. THANK YOU.
ANY QUESTIONS FOR JOHN FROM THE PACHA MEMBERS? OKAY.
NEXT I’D LIKE TO CALL ON THE STIGMA AND DISPARITIES SUBCOMMITTEE, AND JUSTIN AND RAFAEL?
>>THANK YOU. WHAT WE’VE BEEN TALKING ABOUT IS A LOT OF
THE CONCERNS OF THE COMMUNITY AROUND THEIR LEVEL OF ENGAGEMENT AND INPUT IN THE PROCESS,
AND SO WE WILL TALK ABOUT THAT A LITTLE BIT LATER ON THIS AFTERNOON, WHEN WE DISCUSS A
FORMAL PROPOSED RESOLUTION FROM THE FULL PACHA THAT CONCERNS ROBUST COMMUNITY ENGAGEMENT,
SO WE’LL ENTER INTO THAT DISCUSSION A LITTLE BIT LATER ON, BUT THAT WAS SOMETHING THAT
WE IN THE STIGMA AND DISPARITIES WORK GROUP WORKED ON AND WERE HAPPY TO SHARE THAT WITH
THE FULL HATCH A FOR FULL CONSIDERATION THIS AFTERNOON.
WE ALSO ALONG WITH THE COCHAIRS OF PACHA WERE INVITED TO HAVE A MEETING WITH THE DEPARTMENT
OF HEALTH AND HUMAN SERVICES OFFICE OF CIVIL RIGHTS.
WE MET WITH THE HEAD OF THAT OFFICE, ROGER SERVINO AND HAD A ROBUST DISCUSSION AROUND
PROPOSED RULE CHANGES TO SECTION 1557 OF THE AFFORDABLE CARE ACT ALTHOUGH THE COMMENT PERIOD
HAD CLOSED BEFORE WE HAD THE MEETING, WE WERE STILL ABLE TO HAVE A DISCUSSION ABOUT AND
RAISE SOME OF OUR CONCERNS THAT WE’D HEARD FROM THE COMMUNITY PARTICULARLY AS IT RELATES
TO POTENTIAL DISCRIMINATION AGAINST LGBT COMMUNITIES, AND SO THE OFFICE DID PROVIDE A FORMAL RESPONSE
TO OUR MEETING WHICH IS PROVIDED IN YOUR MEETING MATERIALS.
YOU CAN SEE THE RESPONSE FROM THE OFFICE. WE HOPE THAT THAT WILL BE AN ONGOING CONVERSATION,
WITH RESPECT TO THE IMPORTANCE OF ELIMINATING DISCRIMINATION.
WE KNOW THAT STIGMA IS THE ENEMY OF PUBLIC HEALTH.
AND WE ALSO KNOW THAT IN ORDER FOR THIS INITIATIVE TO BE SUCCESSFUL, MEMBERS OF THE COMMUNITIES
THAT ARE MOST VULNERABLE TO HIV, PARTICULARLY MEMBERS OF THE LGBT COMMUNITY, ARE NEED TO
BE PROTECTED, AND WE NEED TO MAKE SURE THAT NOTHING THAT WE DO FROM OUR FEDERAL EFFORTS
GIVES THE APPEARANCE IN DEED, ACTION OR WORD THAT DISCRIMINATION IS TOLERATED IN OUR EFFORTS.
AND SO WE WANT TO BE SURE THAT WE PARTNER WITH ALL OUR FEDERAL AGENCIES TO MAKE SURE
THE COMMUNITIES MOST VULNERABLE, FOLKS LIVING WITH HIV, HAVE ACCESS TO THE SERVICES THAT
THEY NEED. SO WE ARE STEADFAST IN OUR COMMITMENT TO THAT
WORK.>>THANK YOU VERY MUCH.
AND OF ANY QUESTIONS FOR THE STIGMA AND DISPARITIES SUBCOMMITTEE?
NOW I CALL ON BOB SCHWARTZ TO GIVE THE REPORT FOR THE GLOBAL SUBCOMMITTEE.
>>THANK YOU, THANK YOU. WE LOOK FORWARD TO BRINGING THE GLOBAL EXPERIENCE
FIGHTING HIV/AIDS HOME TO AMERICA, WHAT WE CAN TAKE FROM THAT.
WE EXPLORED AND DISCUSSED SOME OF THE EXPERIENCES IN SOUTHERN AFRICA, BOTSWANA, AND ALSO IN
POLAND, WHERE THEY HAVE A MASSIVE INFLUX. THEY GRACIOUSLY ACCEPTED A HUGE POPULATION
FROM UKRAINE AND RUSSIAN SPEAKING AREAS, WHO HAVE MUCH HIGHER INCIDENCE THAN THE REGULAR
POPULATION IN POLAND. AND HOW THEY ARE HANDLING THAT.
SO WE’VE BEEN DISCUSSING THAT. WE’VE BEEN DISCUSSING SPECIAL TECHNOLOGY,
VAGINAL RINGS WITH ANTIRETROVIRAL MEDICATION, DISCUSSING ALSO REDUCING COSTS, HOW PrEP MAY
BE LESS EXPENSIVE IN OTHER COUNTRIES BECAUSE EVERYBODY KNOWS MEDICINES OUTSIDE AMERICA
ARE OFTEN MUCH MORE AFFORDABLE. NOBODY CARES WHAT A MEDICINE COSTS, ALL YOU
CARE IS WHAT YOU PAY. AND SO WE’VE BEEN EXPLORING THAT AND WE’RE
LOOKING FORWARD TO ADVANCING FORWARD IN THAT AREA.
THANK YOU.>>THANK YOU, BOB.
WE NOTE YOU ARE SO LOW IN YOUR CHAIRMANSHIP, THE OTHER SUBCOMMITTEES DO HAVE SO CHAIRS
SO WE MAY BE SHOPPING AROUND FOR A CO CHAIR FOR YOU AS WELL.
SO THANK YOU. WE’RE NEXT GOING TO TURN TO A SESSION, WE
HAVE TWO HOURS TO DO THIS, TO HEAR FROM OUR FEDERAL PARTNERS, TO NOT ONLY RECEIVE A REPORT
FROM ALL OF WHAT YOU’VE BEEN DOING, BUT ALSO WELL, ON WHAT YOU’RE DOING FOR ENDING THE
HIV EPIDEMIC BUT WE ALSO ASKED THEM TO ADDRESS THE LATINO COMMUNITY AS WELL AND WHAT YOU’RE
DOING TO ADDRESS THE HIV IN THE LATIN COMMUNITY. AND THEN WE’RE GOING TO HAVE A DIALOGUE WITH
PACHA MEMBERS TO ADDRESS SOME OF THE CONCERNS AND BARRIERS TO END HIV AS BEING ANNOUNCED,
AND HOW OUR FEDERAL PARTNERS ARE ADDRESSING THOSE BARRIERS IN THE WORK THAT THEY ARE DOING.
SO DIFFERENT PACHA MEMBERS HAVE QUESTIONS, AND WE’VE GIVEN THOSE QUESTIONS IN ADVANCE
TO OUR PARTNERS IN THE FEDERAL GOVERNMENT. WE’RE NOT GOING TO OBVIOUSLY GET TO ALL THE
QUESTIONS TODAY, AND ALL THE ANSWERS, BUT WE WOULD ASK AS YOU GO ABOUT DOING YOUR WORK
THAT YOU CONSIDER THESE ISSUES AS YOU DO YOUR WORK.
SO, FIRST I HAVE THE PLEASURE OF CALLING TAMMY BECKHAM, DIRECTOR OF OFFICE AND INFECTIOUS
DISEASE IN HIV AND AIDS POLICY, WITH THE OFFICE OF ASSISTANT SECRETARY OF HEALTH AT HHS.
TAMMY?>>GOOD MORNING, EVERYBODY.
AND THANK YOU TO PACHA MEMBERS AND CO CHAIRS FOR HAVING US HERE THIS MORNING TO GIVE YOU
AN UPDATE. I’M GOING TO GIVE A BRIEF OVERVIEW ON THINGS
GOING ON WITHIN THE INITIATIVE FROM A HIGH LEVEL AND TALK TO YOU A LITTLE BIT ABOUT WHAT
WE’VE BEEN DOING WITH PARTNER YOU SEE AT THE TABLE BECAUSE THIS IS VERY MUCH AN INTEGRATED
EFFORT WITH ALL THE OpDivs AND WE’VE BEEN WORKING CLOSELY TOGETHER SO EVERYTHING I’M
PRESENTING TODAY, EVERYBODY AROUND THE TABLE HAS BEEN WORKING ON.
AND THEN ADMIRAL GIROIR WAS ABLE TO PRESENT A HIGH LEVEL OVERVIEW OF SOME OF THESE THINGS
TODAY, YESTERDAY, SORRY, I’M A LITTLE THANK YOU.
PRESENTED A HIGH LEVEL THERE WE GO OF MOST OF THESE PROJECTS YESTERDAY, AND SO I’M GOING
TO GIVE YOU A LITTLE BIT MORE DETAIL OF EACH OF THESE TODAY AND THEN I’M HAPPY TO ANSWER
ANY QUESTIONS, OBVIOUSLY, DURING THE TIME THAT WE HAVE THE DIALOGUE ABOUT THE ACTIVITIES
AND IMPLEMENTATION OF SOME OF THESE INITIATIVES THAT WE’RE TALKING ABOUT.
SO, THE INITIATIVE IS ONGOING, WE’VE COMMITTED A SUBSTANTIAL AMOUNT OF FUNDING TOWARD THE
INITIATIVE GETTING IT JUMP START AND GETTING SEVERAL THINGS OFF THE GROUND.
AS HE SHOWED YESTERDAY TOO, ONE OF THE FIRST THINGS THAT WE DID IN 2019 IS WE FORMED AN
INDICATOR WORKING GROUP AND WE CAME AROUND THE TABLE TO DISCUSS WHAT WERE THE INDICATORS
THAT WE REALLY NEEDED TO MEASURE OUR SUCCESS AS WE MOVED ALONG IN THE INITIATIVE.
AND NORMA HARRIS IS GOING TO TALK ABOUT THESE TODAY SO I WON’T GO INTO GREAT DETAIL BUT
WE HAD A WORKING GROUP, CAME TOGETHER. YOU SAW THE ORGANIZATIONAL STRUCTURE YESTERDAY.
SO THE INDICATOR WORKING GROUP PUT TOGETHER THE INDICATORS.
WE THEN DISCUSSED THEM AT THE OPERATIONAL LEADERSHIP TEAM LEVEL AND IT WENT TO PLC,
POLICY LEADERSHIP COUNCIL, THAT THE ADMIRAL MENTIONED YESTERDAY FOR APPROVAL.
AND SEWS EVERYTHING HAS A PROCESS WITHIN THE INITIATIVE, JUST GETTING BACK TO HIS COMMENTS
YESTERDAY ABOUT THE INITIATIVE BEING VERY STRUCTURED.
THESE ARE SOME ACTIVITIES HE PRESENTED YESTERDAY ABOUT THINGS THAT ARE ONGOING.
AND AS HE MENTIONED, WE USED MINORITY HIV AIDS FUNDING TO PROBABLY FOR THE FIRST TIME
EVER SUPPORT CDC AND IHS GIVING MONEY TO COMMUNITIES TO DO PLANNING.
AND SO I THINK THAT THAT WAS OBVIOUSLY A HUGE STEP FORWARD AND THAT MONEY WENT OUT, AND
PLANS ARE DUE DECEMBER 31st. AND I KNOW THAT CDC AND IHS IS WORKING WITH
THE COMMUNITY AND STATE HEALTH DEPARTMENTS AND LOCAL HEALTH DEPARTMENTS IN THE PLANNING
ACTIVITIES, AND AS WAS SAID YESTERDAY, WE REALLY EXPECT FROM THE HHS LEVEL THAT THE
COMMUNITY WILL BE HEAVILY INVOLVED IN PLANNED DEVELOPMENT.
WE ALSO KNOW THAT DECEMBER 31st IS AN AGGRESSIVE TIME LINE AND THESE PLANS WILL BE UNDERGOING
DUE DECEMBER 31st, THERE WILL BE SEVERAL BACK AND FORTH AT THE BEGINNING OF THE YEAR TO
CONTINUE TO IMPROVE ON THE PLANS AND CONTINUE TO ENHANCE THE PLANS, TO MEET THE INITIATIVES
GOALS AS WE MOVE FORWARD. I THINK CDC WILL TALK ABOUT THIS MORE, EUGENE
WILL TALK ABOUT IT MORE AS WE MOVE FORWARD, AND IHS AS WELL.
ALSO AS WAS MENTIONED YESTERDAY, WE FUNDED AN IMPLEMENTATION SCIENCE PROJECT WITH NIH
AS WELL TO GET THAT OFF THE GROUND, AND I KNOW YOU’LL HEAR MORE ABOUT THAT TODAY.
I’M NOT GOING TO SPEND TIME TALKING ABOUT WHAT THEY ARE DOING WITHIN THOSE PROJECTS
BUT I’M GOING TO MOVE ON. I’M GOING TO TALK ABOUT SOME THINGS THAT ARE
OCCURRING OUT OF OUR OFFICE AT OID, APPROXIMATE, DEVELOPMENT OF THE DATA ANALYSIS AND VISUALIZATION
SYSTEM, PACE PROGRAM WHICH IS OCCURRING OUT OF OASH, THE JUMP STARTS AS YOU HEARD ALSO
WAS MONEY THAT CAME FROM THE MINORITY HIV/AIDS FUNDS, THEY WENT TO AS YOU HEARD YESTERDAY
BALTIMORE CITY, EAST BATON ROUGE, DEKALB COUNTY. CDC HAS BEEN ACTIVE WORKING WITH PILOT SITES
AND THOSE WERE SITES THAT HAD TO BE SHOWING STEADY PROGRESS OVER A PERIOD OF TIME.
AND REALLY WE’RE HOPING WE CAN GET SOME GREAT EXAMPLES AND GREAT EVIDENCE BASED PRACTICES
OUT OF THOSE PILOT SITES OR JUMP START SITES TO APPLY TO FY 2020 AS WE MOVE OUT ACROSS
THE JURISDICTION, AND THEN THERE WAS THE JUMP START IN CHEROKEE NATION IN OKLAHOMA AS WELL.
I’M GOING TO TALK ABOUT PrEP AND WHAT’S GOING ON WITH DONATION FROM GILEAD, IMPLEMENTATION,
AND EDUCATION AWARENESS AROUND THAT AS WELL. I WON’T SPEND A LOT OF TIME ON THIS SLIDE
BECAUSE I KNOW DR. MCCRAY IS GOING TO TALK ABOUT JUMPSTART SITES AND ACTIVITIES THERE,
THESE WERE THE SITES, AS I MENTIONED, $1.5 MILLION THAT WENT TO EACH SITE TO HAVE THE
JUMPSTART INITIATIVE IN THE JURISDICTIONS. BUT I’M GOING TO SPEND A LITTLE TIME ON THE
PrEP DONATION. AS ADMIRAL SAID YESTERDAY, WE HAVE REALLY
A GREAT OPPORTUNITY HERE WITH 200,000 PEOPLE PER YEAR DONATION FROM GILEAD.
SO GILEAD DONATED THE MEDICATION TO HHS, BUT ON THE OTHER SIDE OF THAT HHS WILL BEAR ALL
THE COSTS TO IMPLEMENT THIS PROGRAM AND TO DISTRIBUTE THE MEDICATION.
AND SO WHAT THAT MEANS IS WE NEED TO BE ABLE TO VERIFY THE PATIENT ELIGIBILITY, AND WE’RE
GOING TO TALK ABOUT WHAT THAT ELIGIBILITY IS.
WE NEED TO BE ABLE TO ENROLL PATIENTS IN THE PROGRAM.
WE HAVE TO HAVE A NETWORK OF PARTICIPATING PHARMACIES, AND WE HAVE TO BE ABLE TO DISTRIBUTE
THE DONATED MEDICATION AND PROCESS CLAIMS. AND SO WE KNOW THAT GILEAD ALREADY HAD A SYSTEM
THAT WAS UP AND RUNNING TO DO THIS, AND GIVEN THE FACT THAT THIS DONATION WAS FOR A FINITE
AMOUNT OF TIME AND URGENT NEED TO MEET PATIENTS WHO ARE AT RISK FOR HIV AND TO GET MEDICATION
AND DONATED PRODUCT INTO THEIR HAND, WE WENT AHEAD AND DID A SOLE SOURCE WITH GILEAD FOR
SIX MONTH PERIOD TO LEVERAGE MEDICATION ASSISTANCE PROGRAM TO BEGIN TO LEVERAGE THAT INFRASTRUCTURE
THAT I TALKED ABOUT EARLIER WHICH IS VERIFYING PATIENT ELIGIBILITY, ENROLLING PATIENTS, HAVING
THAT NETWORK OF PHARMACIES, AND BEING ABLE TO MOVE THAT DONATED PRODUCT OUT TO PATIENTS.
AS WAS SAID DURING THE SIX MONTH PERIOD WE’RE WORKING ON FULL AND OPEN COMPETITION TO SELECTING
CONTRACTOR OR CONTRACTORS TO DO THE THINGS IN BULLET POINT 3, ALL THOSE THINGS HAVE TO
OCCUR. WE’VE BEEN DOING EXTENSIVE MARKET RESEARCH
AND WE’RE MOVING OUT QUICKLY ON LOOKING FOR A LONGER TERM CONTRACT OR CONTRACTORS THAT
CAN HELP US DISTRIBUTE THE PRODUCT DOWN THE ROAD.
AND OUR INITIAL ROLLOUT WITH GILEAD FOR THE FIRST SIX MONTHS ESTIMATED THAT WE WOULD HAVE
4,250 PATIENTS ENROLL IN THE FIRST SIX MONTHS, REALIZING WE’RE GOING TO HAVE RAMP UP TIME,
A COUPLE MONTHS TO GET THIS OPERATIONAL, FROM THE DATE WE SIGN THE CONTRACT WE HAD 8 WEEKS
TO GET IT OPERATIONAL, AND SO SOMETIME BETWEEN NOVEMBER 25th AND A LITTLE BIT AFTER DECEMBER
1st WE EXPECT TO BE MOVING PRODUCT INTO PATIENTS’ HANDS.
TO BE ELIGIBLE FOR THIS PROGRAM, YOU HAVE TO LACK HEALTH INSURANCE COVERAGE FOR OUTPATIENT
PRESCRIPTION DRUGS, HAVE A VALID ONLABEL PRESCRIPTION, HAVE APPROPRIATE TESTING TO SHOW THAT YOU’RE
HIV NEGATIVE. AND SO WE EXPECT THIS TO BE A NATIONWIDE ROLLOUT;
ANY PATIENT WITH INDICATIONS WILL BE ABLE TO ACCESS THE PROGRAM.
THERE WILL BE A CALL CENTER, A PORTAL SITE WHICH THE PROVIDER OTHER PATIENT CAN ACCESS
THE PATIENT, ALL EXPECTED TO LAUNCH BETWEEN THE 25th AND AFTER THE 1st OF DECEMBER.
WE’RE WORKING VERY AGGRESSIVELY WITH GILEAD AND SUBCONTRACTORS TO MAKE SURE WE GET THIS
ROLLED OUT, AND THAT WE ALSO DEVELOP AN EDUCATION AWARENESS CAMPAIGN AROUND THIS.
I WANT TO POINT OUT TOO THERE’S A SIX MONTH OPTION, WE REALIZE THERE’S GOING TO BE WE’RE
GOING OUT WITH FULL AND OPEN COMPETITION THERE NEEDS TO BE A TRANSITION PERIOD, WE WANT TO
MAKE SURE EVERYTHING WORKS VERY SMOOTHLY. WE’VE ALLOWED FOR UP TO 10,000 PATIENTS THE
FIRST YEAR. SO, AS I SAID, 8 WEEKS FROM SIGNING OF THE
CONTRACT, WHAT THIS INVOLVES IS US DEVELOPING ALL THE ENROLLMENT FORMS, THE PORTALS, BUILDING
THE SYSTEM, SPECIFICALLY FOR THIS PROGRAM, STANDING UP THE CALL CENTER, ONLINE PORTAL,
MAKING SURE ALL THE ENROLLMENT AND REIMBURSEMENT FOR THE VENDORS AND LOGISTICS ARE THERE.
AS I SAID, IT WILL BE A NATIONWIDE ROLLOUT, THAT WILL BE PHASE 1.
AND THEN WE ALSO HAVE WILL FOCUS ON THE PHASE 1 JURISDICTIONS EVEN THOUGH IT WILL BE A NATIONWIDE
ROLLOUT. AND THEN WE’RE ALSO DEVELOPING A VERY ROBUST
PROVIDER AND COMMUNITY EDUCATION AND AWARENESS CAMPAIGN AT THE SAME TIME.
SO, IN THAT VEIN, WE HAVE AWARDED BURNETT GARCIA A CONTRACT TO WORK WITH US TO ROLL
OUT AN EDUCATION AND AWARENESS CAMPAIGN AROUND PrEP.
WE’VE HEARD OVER THE LAST DAY AND I’VE HEARD FOR WEEKS DOING, AGAIN, RESEARCH HOW IMPORTANT
IT’S GOING TO BE FOR US TO HAVE A ROBUST EDUCATION AND AWARENESS CAMPAIGN AROUND PrEP.
SO, THIS IS THE FIRST PHASE, THE NEXT SIX WEEKS IS THE FIRST PHASE OF THAT CAMPAIGN.
THE NEXT SIX WEEKS WE HOPE TO MAKE PEOPLE AWARE OF THE PROGRAM, HOW TO ACCESS THE PROGRAM,
AND GET OUT MATERIALS AROUND EDUCATION ABOUT PrEP.
WE’RE GOING TO BRAND THE PROGRAM AND CREATE ALL THESE MATERIALS IN THE EFFECTS SIX WEEKS
AND WE’LL BE WORKING TO GET THIS ROLLED OUT AROUND THE SAME TIME WE’RE READY TO DISTRIBUTE
THE MEDICATION. THERE WILL BE A MORE EXTENDED EDUCATION AWARENESS
CAMPAIGN, WE’LL BE WORKING DIRECTLY WITH JURISDICTION AND COMMUNITY FOCUS GROUPS TO HELP DETERMINE
HOW WE CAN LEVERAGE ONGOING ACTIVITIES ALREADY WITHIN THE JURISDICTION, AND OTHER ACTIVITIES
THAT WE NEED TO HELP THE JURISDICTIONS WITH AROUND EDUCATION AND AWARENESS FOR PrEP.
WE WANT THE CAMPAIGN TO BE TAILORED FOR MAXIMUM IMPACT.
I HEARD YESTERDAY THAT THERE WAS ALREADY ACTIVITIES ONGOING, CARE RESOURCES WITH DEVELOPING A
PrEP THAT FOCUSED ON DIFFERENT POPULATIONS. WE CERTAINLY DON’T WANT TO RECREATE THAT WHEEL.
WE WANT TO WORK WITH THOSE JURISDICTIONS TO HELP LEVERAGE WHAT THEY ARE ALREADY DOING
BECAUSE THEY KNOW THE COMMUNITIES BEST AND THEY KNOW HOW TO REACH THEM, WITH APPROPRIATE
CULTURAL SENSITIVITIES. IT WILL BE AN INTEGRATED APPROACH WITH MEDIA,
SHARED MEDIA, FACEBOOK,R SOCIAL MEDIA ADS, SPONSORED CONTENT, ET CETERA, COMPREHENSIVE
AND AGAIN PHASE 1 WILL BE UNTIL THE ROLLOUT, GETTING EDUCATION AWARENESS AND WE’LL MOVE
OUT PHASE 2 WITH A BROADER CAMPAIGN. AS YOU HEARD YESTERDAY THE ADMIRAL MENTIONED
WE’RE DEVELOPING THE DATA ANALYSIS AND VISUALIZATION SYSTEM.
WE AWARDED A CONTRACT TO A GROUP TO DEVELOP THE DASHBOARD SO WE CAN TRACK OUR METRICS
AND INDICATORS THAT I SHOWED YOU EARLIER, AND BASICALLY THIS WILL SERVE AS THE SITE
TO GO TO LOOK AT PROGRESS FOR THE INITIATIVE AND PROGRESS TOWARD METRICS AND INDICATORS,
AT JURISDICTIONAL LEVEL AND NATIONAL LEVEL, SUPPORT TOOL FOR THE INITIATIVE.
AND IT WILL SUPPORT NATIONAL AND JURISDICTIONAL MONITORING OF OUR PROGRESS.
WE HAVE AN INTERAGENCY WORKING GROUP OF OpDivs TO HELP US DEFINE REQUIREMENTS, BECAUSE WE
WANT TO STAND UP THE DASHBOARD QUICKLY AND DATA IS ALREADY AVAILABLE WE’LL HAVE A PHASE
1 AND PUT UP A STATIC VERSION FOR LAUNCH, WORKING WITH THE OpDivs, PHASE 2 A MORE ENHANCED
INTERACTIVE VERSION THAT WILL INTEGRATE AND ANALYZE DISPARATE DATA SOURCES AND GIVE REALTIME
DATA BACK TO THE JURISDICTIONS AND WE HOPE TO HAVE THAT LAUNCHED IN 2020.
PREVENTION THROUGH ACTIVE COMMUNITY ENGAGEMENT, THE PACE PROGRAM YOU HEARD ABOUT YESTERDAY.
THIS WAS BASICALLY PUTTING THREE COMMISSION CORPS OFFICERS ON THE GROUND IN REGION 4,
6 AND 9, PUBLIC HEALTH COORDINATORS, MULTIPLIERS, ENGAGE THE PUBLIC AT FORUMS, WORK WITH REGIONAL
CDC AND HRSA AND OTHER OpDiv PERSONNEL AS WELL.
WHERE WE’RE AT WITH THAT WAS THAT WE HAVE TWO SENIOR OFFICERS HIRED FOR EACH REGION,
A THIRD THAT WILL BE FORTHCOMING. SENIOR OFFICERS WILL ASSIST AND SERVE AS PUBLIC
HEALTH EDUCATORS, ENGAGE THE PUBLIC. YOU CAN SEE THE NAMES OF THE INDIVIDUALS UP
HERE, AND THE SLIDE THAT HAS THE REGIONS ON IT SO YOU CAN SEE WE’RE VERY CLOSELY ALIGNED
WITH THE FOCUS OF THE PHASE 1 JURISDICTIONS IN REGIONS 4, 6 AND 9.
I’M GOING TO YIELD MY TIME BACK TO WHATEVER IS LEFT TO THE OTHER OpDivs TO TALK ABOUT
WHAT THEY ARE DOING TO GIVE AN OVERVIEW AND I’M HELP TO HAVE DISCUSSIONS ON THE PANEL
LATER THIS MORNING. SO THANK YOU VERY MUCH.
>>GREAT. THANKS, TAMMY.
[APPLAUSE] DO YOU HAVE A QUESTION, DR. SAAG?
I HAVE A QUESTION JUST BASED ON THIS. FIRST, CONGRATULATIONS ON THE WORK YOU’RE
DOING.>>THANKS.
>>IT’S A LOT OF WORK.>>IT IS.
>>IS IT WITH TIGHT TIMELINES. SO, YES, THE FREE DRUG FROM GILEAD IS WONDERFUL.
NOW WE’RE SEEING THERE ARE COSTS ASSOCIATED WITH IT.
AND DOES THE HHS NEED ADDITIONAL FUNDING NOW AND IN THE FUTURE TO DO ALL OF THIS WORK?
>>SO, CARL, WE’RE LOOKING AT DOING MARKET RESEARCH, LOOKING TO GAIN INSIGHT INTO WHAT
THE NEXT STEPS LOOK LIKE, RIGHT NOW, AND HAVING SAID THAT, WE KNOW WE HAVE THE CONTRACT WITH
GILEAD AND I WANT TO POINT OUT THAT IN THAT CONTRACT WITH GILEAD, GILEAD’S NOT TAKING
A DIME, AS THE ADMIRAL SAID YESTERDAY, TO IMPLEMENT THIS PROGRAM.
WE’RE HOPING THAT WE CAN WORK THROUGH OUR MARKET RESEARCH TO IDENTIFY THE LOWEST COST
BEST OPTION FOR THE GOVERNMENT, AND WE’RE LOOKING AT MANY UNIQUE SCENARIOS WHICH WE
MIGHT BE ABLE TO ACHIEVE THAT. SO I CAN’T GIVE YOU THE DIRECT ANSWER ON WHAT
THAT’S GOING TO LOOK LIKE RIGHT NOW, BUT I CAN TELL YOU WE’RE WORKING TOWARD THAT VERY
AGGRESSIVELY. AND IN FACT, I DIDN’T MENTION THIS, BUT THE
PRE SOLICITATION FOR THE FULL RFP WENT OUT YESTERDAY.
SO HAVING SAID THAT, AGAIN, WE’RE LOOKING FOR BEST PRICE SCENARIOS, LOOKING AT DOING
MARKET RESEARCH AND EVALUATING WHAT’S OUT THERE FOR OPTIONS FOR DISTRIBUTION, AND SO
WE’LL BE ABLE TO GET BACK WITH YOU WITH MORE SPECIFICS LATER.
>>THANKS. YEAH, PLEASE KEEP US INFORMED ABOUT THAT.
NOW DR. SAAG DOES HAVE A QUESTION.>>I WON’T SAY GREAT MINDS BUT SIMILAR MINDS
THINK ALIKE. MY QUESTION ALONG THE SAME PATH, DO YOU HAVE
AN ESTIMATE OF WHAT YOU THINK IT’S GOING TO COST ANNUALLY?
YOU HAVE THE BUDGET SOMEHOW OR ANOTHER, RIGHT?>>SO, I HAVE AN ESTIMATE BASED ON WHAT WE’RE
PAYING RIGHT NOW, FOR GILEAD. AGAIN, WE’RE CONTINUING TO DO OUR MARKET RESEARCH.
WE BELIEVE THERE’S SOME OPTIONS OUT THERE THAT COULD BE LESS EXPENSIVE FOR US.
AND SO WE’RE EXPLORING THOSE OPTIONS.>>I’M NOT GOING TO HOLD YOU TO THIS NUMBER,
BUT I’M DOING MATH IN MY HEAD AND FIGURING, ALL RIGHT, LET’S SAY $20 MILLION, THAT’S $100
PER YEAR PER PERSON, SOMETHING LIKE THAT. AND I’M JUST THINKING OUT LOUD ABOUT AND JUST
MAKE AN AD LIB COMMENT THAT IF WE HAD A DIFFERENT DELIVERY SYSTEM FOR HEALTH CARE WE WOULD NOT
HAVE THIS COST. SO IT’S A LOT OF PEOPLE A LOT OF PEOPLE TALK
ABOUT HEALTH CARE REFORM BUT IF PEOPLE HAD COVERAGE WE WOULDN’T HAVE TO DO THIS.
THIS IS A SAFETY NET ISSUE THAT I JUST WANTED TO GO ON THE RECORD AND MAKE A COMMENT ABOUT.
>>GREAT. THANK YOU.
JOHN SAPERO AND THEN RAFAEL.>>THANK YOU.
I GUESS MY QUESTION IS, YOU KNOW, OUT IN OUR COMMUNITY FOLKS HAVE KIND OF UNLIMITED ACCESS,
NOT UNLIMITED BUT WE HAVE COMMUNITY NAVIGATORS THAT ARE NAVIGATING PEOPLE TO PrEP, THOSE
INDIVIDUALS THAT ARE GETTING PrEP THROUGH THEM SEEM TO BE DOING SO AT VERY LITTLE COST
OR WITH THE PATIENT ASSISTANCE PROGRAM, WHAT HAVE YOU.
AND SO, TO ME, I KIND OF WONDER WHY THERE’S SUCH A HUGE WHAT I’LL CALL PROGRAM BEING BUILT
AROUND PROVIDING FREE MEDICATION THAT WE SEEM TO ALREADY HAVE GETTING OUT TO THE COMMUNITY
RELATIVELY EASY. AND IN MY MIND, IF IT’S I’LL SIMPLIFY IT AND
SAY IT SEEMS LIKE THE DRUG IS SITTING ON THE SHELF AND ALL YOU NEED TO DO IS HAND IT OFF
WITHOUT A LOT OF PROGRAM, KNOWING THAT THESE PEOPLE WOULD ALREADY QUALIFY FOR IT, AND YESTERDAY
CARE RESOURCE AND SALUD LATINO SHARED THEY NEEDED MORE NAVIGATORS AND MANAGEMENT.
I’M HAVING A DISCONNECT WHY WE COULDN’T DIRECT RESOURCES TO SUPPORTIVE NEEDS AND NOT WORRY
SO MUCH ABOUT HOW THE DRUG GETS TO THE CLIENT.>>SO, LAST TIME WE CHECKED, THERE’S ABOUT
12,000 TO 15,000 PEOPLE THAT TAKE ADVANTAGE OF THE GILEAD PROGRAM RIGHT NOW.
WE FEEL WE HAVE THE OPPORTUNITY THROUGH THIS DONATION TO BRING MORE PEOPLE INTO THIS PROGRAM
AND GET MORE PEOPLE ON PrEP THROUGH THIS PROGRAM, A WIDER RANGE OF USING FEDERAL QUALIFIED HEALTH
CARES AND CAPABILITIES AND WE HAVE THE DONATED PRODUCT.
WE WANT TO USE IT AND GET IT TO PATIENTS, LOOKING AT LOWEST COST METHODS TO DO THAT.
I HEAR WHAT YOU SAY ABOUT PrEP NAVIGATORS AND IMPORTANCE OF THAT AND ABSOLUTELY UNDERSTAND
THAT, AND I’M GOING TO LET OUR COLLEAGUES HERE TALK ABOUT THEIR NOFOs AND ABILITY TO
USE THAT MONEY NEXT YEAR TOWARDS THOSE THINGS AS WELL.
WE’RE HEARING THINGS AROUND THE TABLE NOW AND WE’VE HEARD PREVIOUSLY, DR. HARRISON AND
I HAD A GREAT CONVERSATION THIS MORNING ABOUT MAY FUNDING AND HOW WE MIGHT BE ABLE TO UTILIZE
SOME OF THAT NEXT YEAR AND ONGOING YEARS AS WELL, SO I THINK THERE’S OPPORTUNITIES AROUND
THE TABLE TO ADDRESS SOME THINGS YOU’RE TALKING ABOUT WITH NOFOs AND OTHER DOLLARS WE HAVE
AS WELL, BUT WE WANT TO MAKE SURE WE TAKE ADVANTAGE OF THIS DONATION, AND WE’RE DOING
MARKET RESEARCH TO PUT LOWEST COST, BEST ESTIMATE FORWARD SO WE CAN IMPLEMENT THE PrEP PROGRAM.
>>TAMMY, THANK YOU FOR YOUR PRESENTATION AND CLARIFY A COUPLE THINGS FOR ME.
WHEN WE ARE TALKING ABOUT THE DISTRIBUTION AND FREE DRUGS, THE COMMUNITY HAD A DISTRUST
ABOUT THIS WHOLE PROCESS. WE’RE GETTING THE FREE MEDICATION, AND YET
WE’RE CONTRACTING THE SAME PEOPLE GIVING THE FREE MEDICATION TO DISTRIBUTE.
IT SEEMS LIKE WE’RE GIVING FREE MEDICATION AND NOW WE’RE PAYING THEM TO DISTRIBUTE.
SO THANK YOU FOR THE CLARIFICATION, AND ALSO FOR LOOKING FOR A DIFFERENT PROVIDER PERHAPS
TO DISTRIBUTE MEDICATION LATER, LIKE THAT, THAT DISTRUST AND THE COMMUNITY DOESN’T HAPPEN.
AGAIN, THANK YOU FOR CLARIFICATION, FOR THAT CLARIFICATION.
>>SURE.>>AGAIN, THANK YOU, TAMMY.
WE’LL ENGAGE WITH YOU. NEXT I’LL CALL ON LAURA CHEEVER, ASSOCIATE
ADMINISTRATOR FOR HIV/AIDS BUREAU AT HRSA. LAURA?
>>GREAT. THANK YOU.
THANK YOU VERY MUCH FOR HAVING US HERE TODAY. I’M GOING TO SPEND MAJORITY OF MY TIME TALKING
ABOUT THE DATA WE HAVE LOOKING AT SAN JUAN, PUERTO RICO, AND MIAMI AND FLORIDA AS A WHOLE
SO THAT WILL HELP FURTHER DISCUSSION WE’RE GOING TO HAVE AFTERWARDS.
I’LL ALSO BE TALKING ABOUT WHAT WE’VE BEEN DOING IN THE LAST FEW MONTHS AROUND THE INITIATIVE
AS WELL. SO, THE PROGRAM, WE’VE HAD QUITE A BIT OF
SUCCESS IN THE LAST 30 YEARS IN BUILDING SYSTEMS OF CARE.
WE HAVE BY STATUTE REQUIRED COMMUNITY ENGAGEMENT WHICH I THINK HAS BEEN ROBUST OVER THE YEARS.
AND WE PLAN TO BRING ALL OF THAT INTO THE WORK THAT WE’RE DOING IN THE ENDING THE EPIDEMIC
INITIATIVE, VISION IS OPTIMAL HIV CARE AND TREATMENT FOR ALL.
OUR MISSION IS TO PROVIDE BOTH LEADERSHIP AND RESOURCES TO ASSURE ACCESS AND RETENTION
IN HIGH QUALITY INTEGRATED CARE AND TREATMENT SERVICES FOR THE VULNERABLE PEOPLE WITH HIV
AND THEIR FAMILIES. SO, THIS SLIDE IS JUST TO GIVE YOU A CONTEXTUAL
OVERVIEW OF THE OTHER SLIDES I’LL SHOW. WHEN YOU LOOK AT THE PROGRAM OVERALL, ABOUT
HALF OF OUR PATIENTS ARE AFRICANAMERICAN, AND THEN ABOUT A QUARTER ARE BOTH WHITE AND
HISPANIC, WITH MUCH SMALLER PROPORTIONS AMERICAN INDIAN, NATIVE HAWAIIAN, ASIAN, AND MULTIPLE
RACIAL CATEGORIES. LOOK AT PUERTO RICO, NOT SURPRISINGLY 99%
ARE HISPANIC, SIMILARLY IN SAN JUAN THE SAME. I WASN’T TO POINT OUT THE 11,700 PATIENTS
IN PUERTO RICO, 9969 ARE IN SAN JUAN. THE DISPARITIES BETWEEN SAN JUAN AND PUERTO
RICO ARE MAGNIFIED IF WE REMOVE SAN JUAN FROM THE DATA.
IN CALIFORNIA, OVERALL HALF AFRICANAMERICAN AND A QUARTER LATINO, WHEN WE LOOK AT MIAMI
THAT CHANGES, AND WE HAVE HALF THE CLIENTS IN MIAMI ARE LATINO.
>>(INAUDIBLE).>>YES, SO� OH, SORRY, OKAY.
THERE WE GO. I’M SEEING
>>CALIFORNIA.>>OH, I’M SORRY.
FLORIDA. I DON’T KNOW WHERE CALIFORNIA CAME FROM.
OKAY. SORRY ABOUT THAT.
THANK YOU VERY MUCH. THAT’S GOOD.
WE CLARIFIED THAT. I’M DOING GETTER NOW.
NOW, THIS IS REALLY DRILLING DOWN INTO LOOKING AT OUR DATA IN PUERTO RICO AND SAN JUAN.
FOR CLARIFICATION ON THIS SLIDE THE DARK BAR IS PUERTO RICO, AND THE LIGHTER BARS ARE SAN
JUAN. ONCE AGAIN, PUERTO RICO IS REALLY DRIVING�
SAN JUAN IS REALLY DRIVING THE PUERTO RICO DATA HERE, AND YOU CAN SEE THE TOP BARKER
BLUE LINE IS PUERTO RICO, VIRAL SUPPRESSION IS 88%, IN THE PROGRAM 86%, PEOPLE ARE DOING
TREMENDOUSLY WELL. AMONG PEOPLE IN CARE AND VIRAL SUPPRESSION
AMONG PEOPLE THAT HAVE COME INTO MEDICAL CARE AT LEAST ONCE IN THE YEAR BUT AMONG PEOPLE
IN CARE PUERTO RICO IS DOING A REALLY PHENOMENAL JOB, VERY GOOD I THINK COMMUNITYBASED ORGANIZATIONS
VERY ENGAGED WITH THE COMMUNITY AND IT SHOWS HERE.
BUT WHEN WE LOOK AT HISPANICS AND LATINOS IN PUERTO RICO THEY DO BETTER THAN THE RYAN
WHITE NATIONAL AVERAGE. LOOK AT WHERE WE MIGHT HAVE DISPARITIES, YOU
CAN SEE MSM DO BETTER THAN THE OVERALL AVERAGE IN PUERTO RICO, SIMILARLY AMONG THOSE STABLY
HOUSED. HOWEVER, WE DO HAVE SOME DISPARITIES WITH
PEOPLE WHO INJECT DRUGS, WE DON’T SEE DISPARITIES ACROSS THE RYAN WHITE PROGRAM BUT DISPARITIES
AMONG YOUTH, TEMPORARILY HOUSED AND UNSTABLY HOUSED, CONSISTENT WITH OUR NATIONAL DATA
AS WELL. IN PARTICULAR, AS I ALREADY SAID, SINCE SAN
JUAN IS REALLY DRIVING THE REST OF PUERTO RICO, YOU CAN SEE IF WERE TO REMOVE IT, THE
VIRAL SUPPRESS RATES AMONG THOSE UNSTABLY HOUSED AND TEMPORARILY HOUSED OUTSIDE SAN
JUAN ARE QUITE LOW. TURNING NOW TO FLORIDA, FLORIDA AND MIAMI.
FLORIDA ONCE AGAIN IS THE GREEN, DARK GREEN, AND MIAMI IS THE LIGHTER GREEN OR MINT GREEN.
ONCE AGAIN WE HAVE THE VIRAL SUPPRESS OVERALL FOR THE RYAN WHITE PROGRAM WHICH IS ABOUT
86%, FOR FLORIDA OVERALL 85, SO VERY CLOSE, THOSE LINES SEEM TO BE ALMOST MERGED THERE.
YOU CAN SEE ONCE AGAIN THAT FOR HISPANIC AND LATINO POPULATIONS AMONG PEOPLE THAT HAVE
COME INTO CARE AT LEAST ONCE IN THE YEAR, A HUGE IMPORTANT FACTOR, WE SEE THAT WE DO
NOT HAVE ANY DISPARITIES COMPARED TO THE NATIONAL AVERAGE, ACTUALLY DOING BETTER, SIMILAR AMONG
MSM AND PEOPLE WHO INJECT DRUGS, ONCE AGAIN DOING QUITE WELL IN TERMS OF VIRAL SUPPRESSION
RATES BUT WE CONTINUE TO SEE DISPARITIES WE’VE SEEN ELSEWHERE IN TERMS OF USE, STARE AND
UNSTABLY HOUSED, AMONG HISPANIC PATIENTS SINCE I WAS ASKED TO FOCUS ON THAT, IN FLORIDA.
THE OTHER THING BASED ON DISCUSSION WE HAD YESTERDAY, I HAD OUR STAFF PULL SOME DATA.
THE NUMBERS ARE SMALL HERE SO WE DON’T USUALLY PUBLISH THEM, 35 TO 50 CLIENTS, BUT WHEN YOU
LOOK AT HISPANIC TRANSGENDER PATIENTS IN PUERTO RICO, OVERALL VIRAL SUPPRESSION RATE IS 84%,
IN SAN JUAN 87%, SO NOT BIG DISPARITIES AND BETTER THAN NATIONALLY.
ONCE AGAIN IT SPEAKS TO COMMUNITYBASED POPULATIONS WORKING CLOSELY WITH THEM.
IN FLORIDA LIKEWISE SURPRISING FOR ME THAT IN FLORIDA OVERALL THE TRANSGENDER POPULATION
IS 84% VIRAL EXPRESSION, IN MIAMI IT’S 90%. DOING VERY, VERY WELL AMONG TRANSGENDER CLIENTS,
HISPANIC CLIENTS WHO ARE IN CARE, DOING VERY WELL IN TERMS OF REALLY MEETING THE NEEDS
OF THOSE CLIENTS TO GET THEM VIRALLY SUPPRESSED. SO, I’D HEARD YESTERDAY THAT YOU ALL THE�
WE’VE HEARD THIS BEFORE, THAT WE’VE DONE QUITE A BIT OF LISTENING SESSIONS AND COMMUNITY
ENGAGEMENT, PEOPLE DON’T HEAR BACK REFLECTED WHAT WE’VE HEARD, SO ANTIGONE HAS TAKEN THE
LEAD PULLING THIS TOGETHER. WE’VE HEARD COMMON AND IMPORTANT THEMES, FIRST
TO ADDRESS SOCIAL DETERMINANTS OF HEALTH, HOUSING, INCARCERATION.
WE NEED TO LOOK AT COMMUNITIES FOR EXISTING STRENGTHS, CAN’T BE� IT HAS TO BE A STRENGTHBASED
APPROACH LOOKING AT EXISTING RESOURCE AND PARTNERSHIPS BUT ALSO WHERE THEY HAVE OTHER
RESOURCES AND PARTNERS THAT HAVE NOT YET REALLY BEEN TAPPED FOR THE HIV PROGRAM SO WE NEED
TO BE GETTING THEM TO OUR TABLE AND ENGAGING THEM AS PARTNERS.
WE NEED TO BE LOOKING AT NEW AND INNOVATIVE INTERVENTIONS, APPROACHES TO REACH PEOPLE.
BUT BEFORE WE CAN DO THAT, WE REALLY DO NEED TO TAKE A CLOSE LOOK AT WHAT WE CAN DO AROUND
IMPROVING STIGMA AND REDUCING DISTRUST IN AFFECTED COMMUNITIES.
SO, IN TERMS OF THE RYAN WHITE PROGRAM WE HAVE RELEASED OUR NOFOs, WE’VE GOTTEN APPLICATIONS
IN. EVERYONE APPLIED ON TIME SO THAT WAS VERY
EXCITING FOR US. SAVED US SOME HEARTBURN THERE.
BUT IN THAT NOFO WE’RE SPECIFICALLY WORKING ON THREE DIFFERENT AREAS, FIRST AMONG THE
PEOPLE THAT ARE CURRENTLY IN CARE, THOSE WHO CAME TO CARE AT LEAST ONCE, AND ARE NOT VIRALLY
SUPPRESSED, YOU SAW WHO THOSE PEOPLE WERE, YOUNG PEOPLE THAT DON’T HAVE STABLE HOUSING,
HOW ARE WE GOING TO BETTER ADDRESS THEIR NEEDS? SECONDLY WE EXPECT TO DIAGNOSE QUITE A FEW
MORE PEOPLE IN THIS EPIDEMIC, SO THROUGH THIS INITIATIVE, SO FOR THE NEWLY DIAGNOSED WE
NEED TO ENHANCE LINKAGE AND ENGAGEMENT IN CARE.
WE HAVE GOOD DATA ACROSS THE BOARD, MOST COMMUNITIES, AROUND REALLY IMPROVING LINKS TO CARE WITHIN
30 DAYS BUT WE STILL KNOW THE FIRST YEAR IS FRAUGHT WITH COMPLICATIONS FOR PEOPLE.
HOW DO WE BETTER STRENGTHEN THAT ENGAGEMENT OVER THE FIRST YEAR?
AND THIRDLY, MOST IMPORTANT FOR US, THE PEOPLE THAT ARE OUT OF CARE.
WE ESTIMATE THERE ARE ABOUT 250,000 PEOPLE IN THIS COUNTRY DIAGNOSED AND OUT OF CARE,
MANY LINKED AND NO LONGER IN CARE, HOW DO WE REACH THEM?
WE HAVE EXAMPLES. WE KNOW FROM TALKING TO OUR JURISDICTIONS
OVER THE YEARS THERE’S THINGS LIKE BETTER LINKAGE TO THE CRIMINAL JUSTICE SYSTEM, PEOPLE
COMING IN AND OUT OF JAIL AND PRISONS, WE NEED TO LINK PEOPLE THROUGH TRANSITIONS.
PEOPLE HAVE SEVERE MENTAL HEALTH ISSUES, WE HAVEN’T BEEN ABLE TO PROVIDE INTENSITY OF
SERVICES TO REACH THE PEOPLE, AND INHOME CARE, PEOPLE CARING FOR PEOPLE IN HOMES, NOT HOME
BOUND, NOT COMING TO CLINIC AND PROVIDE CARE IN THOSE SETTINGS.
WE’VE HAD EXCELLENT AND EXCITING EXAMPLES. ONE IN DETROIT, PATIENTS FELL OUT OF CARE,
THEY WOULD GO INTO THE HOME AND FIND THEM AND OFFER CARE AND OFTEN FOUND MULTIPLE PEOPLE
IN THAT HOME. A WOMAN WAS OUT OF CARE, A BOYFRIEND WASN’T
IN CARE FOR FIVE YEARS SLEEPING ON THE COUCH. WAKE HIM UP AND ENROLL HIM.
WE GOT TWO FRIENDS CRASHING IN THE BACK BEDROOM, WHAT ABOUT THEM?
GREAT IDEA. SO THEY OFTEN WOULD FIND MORE THAN ONE PERSON
WHEN THEY WENT INTO THE HOME, WHICH MAKES SENSE LIKE A SNOWBALL SAMPLING, EXCITING EXAMPLES.
WE CAN PROVIDE MORE INTENSIVE SERVICES. WE’RE REALLY EXCITED ABOUT THE DIFFERENT INNOVATIVE
THINGS PEOPLE ARE DOING AROUND THIS COUNTRY AND WE’LL BE ABLE TO BRING THEM TO SCALE IN
MANY OF THESE COMMUNITIES. SO, IN TERMS OF ADDRESSING THE CHALLENGE,
MEETING THE NEEDS OF THE POPULATION, WE’RE DOING SEVERAL THINGS ACROSS THE BUREAU WE’VE
BEEN DOING FOR MANY YEARS, SOME IN PARTICULAR AS WE WERE GETTING READY FOR THIS NEW INITIATIVE.
FIRST WE NEED TO BETTER ADDRESS STIGMA THROUGH CULTURALLY APPROPRIATE INTERVENTIONS, THE
ANTIGONE GROUP IS LEADING THROUGH SCIENCE, INTERVENTIONS THAT ARE EVIDENCE AND FORMED,
AND PAYING PAYING TOO DEVELOP A METHODOLOGY OR MANUAL AND IMPLEMENTING, PAYING CLINICS
TO IMPLEMENT THEM. THROUGH THAT WE’VE LEARNED QUITE A BIT, IT’S
BEEN SUPER INFORMATIVE TO US AND CLINICS WHAT THEY NEED TO DO TO IMPLEMENT THESE INTERVENTIONS
THAT HAVE BEEN SHOWING EFFECTIVE SOMEWHERE BUT TO BRING THEM INTO A RYAN WHITE CLINIC
AND MAKE IT HAPPEN ON A RELATIVELY SMALL BUDGET. SO WITH THAT WE’VE ALSO BEEN REALLY TRYING
VERY HARD TO CATALOG OUR INTERVENTIONS THAT WORK, WHEN HAROLD WAS STILL AT HRSA RUNNING
THE PROGRAM WE MOVED THE PROGRAM FROM JUST DEVELOPING NEW INTERVENTIONS AND GETTING THEM
PUBLISHED INTO A JOURNAL TO REALLY BEING ABLE TO BETTER ARTICULATE AND DISSEMINATE AND GET
THEM IN CLINICAL PROGRAMS, SO WE HAVE MUST BE DIFFERENT INITIATIVES IN THAT DIRECTION
RIGHT NOW. IN TERMS OF ENGAGING COMMUNITIES AND EXPERTS,
WE RECEIVED FUNDING FROM MINORITY INITIATIVE FUND SEVERAL YEARS AGO TO DEVELOP CAPACITY
OF PEOPLE WITH HIV, DEVELOP CAPACITY TO SIT AT THESE TABLES AND REALLY ENGAGE IN A MEANINGFUL
WAY THROUGH NEW VOCABULARY, UNDERSTANDING PRINCIPLES OF PUBLIC HEALTH, TERMS PEOPLE
ARE THROWING AROUND SO THAT AS THEY ARE TALKING AND EXPLAINING WITH THINGS, THERE WOULD BE
A BETTER COMMON LANGUAGE. SO WE CONTINUE TO WORK WITH THAT.
WE’RE GOING TO THAT, BUILDING LEADERS OF COLOR INITIATIVE THAT WE FUNDED IN THE PAST, THIS
YEAR WE GOT FUNDING SPECIFICALLY TO TRANSLATE IT INTO SPANISH SO WE’RE DOING THAT RIGHT
NOW. WE ALSO ARE LOOKING AT ISSUES AROUND RYAN
WHITE ELIGIBILITY AND RECERTIFICATION, SOME PROGRAMS DO IT WELL, SOME IT’S A BARRIER FOR
PATIENTS SO WE NEED TO CHANGE UP HOW THAT’S HAPPENING TO MAKE IT WORK FOR EVERYONE.
WE’RE LOOKING AT PART D PROGRAM THAT FOCUSED ON WOMEN, INFANT, CHILDREN AND YOUTH, HAVE
A MORE NATIONAL IMPACT SO IT’S NOT JUST ABOUT 100 RECIPIENTS AROUND THE COUNTRY RECEIVING
FUNDING BUT HOW DO WE LEVERAGE THAT MONEY EFFECTIVELY NATIONALLY.
WE’RE HAVING TECHNICAL EXPERT PANELS WHERE WE BRING IN PEOPLE WITH HIV, RECIPIENTS, PEOPLE
THAT ARE OUTSIDE OF THE USUAL HIV NETWORKS, HAVING SEVERAL OF THOSE THIS YEAR, ONE SPECIFIC
ON HOUSING AND HOW TO MOST EFFECTIVELY INTEGRATE HOUSING AND LEVERAGE HOUSING RESOURCES INTO
THE RYAN WHITE PROGRAM, PEOPLE WHO ARE JUSTICE INVOLVED, A MAJOR BARRIER, ONE AROUND WOMEN,
ONE AROUND PEOPLE OVER 50. WE ARE ALSO ALWAYS WORKING IN CAPACITY BUILDING,
I THINK ALL THESE I’VE TALKED TO SPEAK TO CAPACITY BUILDING.
BUT SPECIFICALLY, WE FUNDED RECIPIENTS THIS YEAR TO FIGURE OUT HOW WE WITH LEVERAGE FUNDING
THAT FLOWED INTO SAMHSA RECIPIENTS WITH THE RYAN WHITE PROGRAM, THAT A LOT OF MONEY HAS
COME INTO STATES TO SINGLE STATE AUTHORITIES FOR SUBSTANCE ABUSE RARELY LINKED TO RYAN
WHITE RESOURCES, HOW DO WE BETTER LINK TO HELP RYAN WHITE RECIPIENTS BETTER LINK TO
THAT. WE’VE DEVELOPED GUIDANCE AROUND RAPID ELIGIBILITY
DETERMINATION SO PEOPLE CAN DO SAME DAY STARTS MORE EASILY IN THE RYAN WHITE PROGRAM, ARTICULATED
HOW PEOPLE CAN ACTUALLY DO THAT. WE’VE REVISED GUIDANCE AROUND RYAN WHITE SERVICES
AND CORRECTIONAL SETTINGS, MADE IT EXPLICIT IF NO ONE IS LEGALLY RESPONSIBLE FOR PAYING
FOR PATIENTS IN JAIL THEY CAN YOU SHOULD BE USING RYAN WHITE FUNDS AND IMPROVEMENT ON
HOUSING RESOURCES. I LOOK FORWARD TO DISCUSSION WE’RE GOING TO
HAVE, THANK YOU VERY MUCH.>>THANK YOU.
[APPLAUSE] THANK YOU, LAURA.
DOES ANYONE HAVE A QUESTION ON WHAT LAURA PRESENTED OR ARE WE OKAY TO MOVE ON TO OUR
NEXT SPEAKER AND WE’LL ENGAGE WITH LAURA LATER? GREAT.
THANK YOU, LAURA. NEXT SPEAKER WILL BE DR. NEERAJ GANDOTRA,
WHO IS THE CHIEF MEDICAL OFFICER FOR SAMHSA.>>GOOD MORNING.
I WANT TO THANK YOU ALL FOR INVITING SAMHSA. I KNOW A LOT OF INDIVIDUALS, PARTICULARLY
THE OTHER OpDivs, WERE VERY HAPPY TO HAVE US BE INVOLVED, AND SAMHSA IS HAPPY TO BE
INVOLVED. WE UNDERSTAND WE REPRESENT A SUBGROUP OF THE
POPULATION AT PARTICULARLY HIGH RISK, THOSE WITH MENTAL ILLNESS AND SUBSTANCE USE DISORDER
CONSTITUTE A POPULATION THAT IS ESSENTIALLY DOUBLE THE RISK OF OF THE GENERAL POPULATION.
IN PARTICULAR SAMHSA’S GOAL IS IMPROVE PREVENTION, INCREASE TESTING FREQUENCY AND PROVIDE LINKAGE.
THOSE SUFFERING FROM HIV AND AIDS ALSO CARRY TWICE THE RISK OF DEPRESSION, ANXIETY, AS
WELL AS SUBSTANCE USE DISORDER. SO, UNDERSTANDING THAT WE HAVE TO OVERCOME
STIGMA IS ANOTHER PART TO THIS. THERE’S PARTICULARLY STIGMA THAT COMES FROM
MENTAL ILLNESS, AND SUBSTANCE USE DISORDER. LAST NIGHT, AFTER THE COLLEAGUES FROM PUERTO
RICO DISCUSSED THE STIGMA AND BARRIERS THEY WERE FACING, I LIKENED THAT TO ALSO THE STIGMA
THOSE WITH MENTAL ILLNESS ALSO SUFFER. PRIOR TO ME JOINING SAMHSA, I HAD A LOT OF
DIFFERENT HATS THAT I WORE. ONE IN PARTICULAR WAS I DID A FAVOR FOR A
FEDERALLY QUALIFIED HEALTH CARE CENTER THAT WAS AN OUTPATIENT MENTAL HEALTH CLINIC MONTGOMERY
COUNTY, MARYLAND. AND 50% OF THOSE PATIENTS WERE OF HISPANIC
ORIGIN. AND WE HAD QUITE A FEW PATIENTS WHO WERE DISPLACED
FROM PUERTO RICO. I FOUND IT TROUBLING THAT STILL ADDICTION
AND SUBSTANCE USE DISORDER GENERALLY BUT ALSO MENTAL HEALTH WAS STILL NOT VIEWED AS A DISEASE,
STILL VIEWED AS A MORAL FAILING. THERE’S NO ISSUE WITH PRESCRIBING AN ANTI
HYPERTENSIVE FOR SOMEONE WITH HIGH BLOOD PRESSURE, BUT TO PRESCRIBE ZOLOFT, I ENCOUNTERED TREMENDOUS
RESISTANCE, EVEN FROM THOSE INDIVIDUALS THAT UNDERSTOOD THAT DEPRESSION WAS INFLUENCING
NOT JUST THEIR BEHAVIOR BUT THEIR UPWARD TRAJECTORY. AND THE IDEA THAT WHEN WE TALK ABOUT PrEP,
AND WE TALK ABOUT HIV, AND HOW WE CAN OVERCOME THAT, I THOUGHT ABOUT HOW D.C. HANDLED IT.
WE REQUIRED THAT THE INDIVIDUALS WHO WERE SUBMITTING FOR MEDICAL LICENSURE GOT TRAINING
IN HIV. SAME THING FOR THE OPIATE USE DISORDER, NOW
IT’S REQUIRED TRAINING, REQUIRED BEFORE YOU GET YOUR LICENSE BEFORE YOU GET YOUR RENEWAL
YOU MAKE SURE YOU SUBMIT DOCUMENTATION YOU HAVE THAT TRAINING.
SMALL STEPS, BUT THE IDEA THAT WE GET TO THAT POINT WHERE NOW NOBODY TALKS ABOUT AT LEAST
IN D.C. THE SAME AMOUNT OF STIGMA THAT PERHAPS PUERTO RICO IS FACING.
SO, IT’S AN UNDERSTATEMENT TO SAY THAT HIV, SUBSTANCE USE DISORDERS AND MENTAL ILLNESS
INTERACT IN A COMPLEX FASHION. WE KNOW THAT WHEN ONE GETS WORSE, PARTICULARLY
THE OUTCOMES FOR THE OTHERS GET WORSE TOO. SOMEBODY WHO IS DEPRESSED IS UNLIKELY TO B
ADHERENT, AND MOST IMPORTANTLY SOMEONE WHO IS USING IS VERY UNLIKELY TO BE ADHERENT TO
THEIR REGIMEN. WE KNOW THAT THOSE WHO INJECT DRUGS WITH ALSO
AT INCREASED RISK FOR CONTRACTING HIV. SYRINGE SUPPORT PROGRAMS CAN BE ONE AVENUE
TO REDUCE HARM. BUT REALLY SUBSTANCE USE TREATMENT SERVES
AS ANOTHER ENTRY POINT, ANOTHER TOUCH POINT INTO TREATMENT.
WE KNOW THAT INDIVIDUALS WHO ENGAGE IN SUBSTANCE ABUSE TREATMENT WILL ENGAGE IN OTHER TREATMENT
SEEKING BEHAVIORS. SO, IT WILL REDUCE RISK.
IT WILL HELP MINIMIZE RISKY BEHAVIORS FOR NOT JUST THE SUBSTANCE USE PRACTICES BUT ALSO
RISK REDUCTION AS A COMPREHENSIVE APPROACH, CHANGING SEX RELATED BEHAVIORS TO REDUCE THE
CLIENT’S RISK. NOW, A LOT OF MENTAL HEALTH PROGRAMS AND SUBSTANCE
USE PROGRAMS HAVE STAFF THAT’S NOT WELL EQUIPPED, AT TIMES, FOR ADDRESSING HIV.
WE HAVE TO LINK PATIENTS TO TREATMENT AND A LOT OF TIMES WE FIND OURSELVES IN SITUATIONS
WHERE WE KNOW THAT BUT IT’S STILL VERY DIFFICULT TO ACTUALLY GET THEM LINKED.
THAT’S WHAT SAMHSA MAY COME IN. OUR JOB IS TO PROVIDE LINKAGE, TO PROVIDE
EVIDENCE BASED PRACTICES, AND I’LL HIGHLIGHT ONE OTHER THING SAMHSA IS WORKING ON A, A
GUIDE BOOK SPECIFICALLY FOR OUR GRANTEES REGARDING HIV LINKAGE.
EXPECT THAT TO COME OUT SHORTLY, MAYBE WITHIN THE NEXT SEVERAL WEEKS.
SO, I’VE SORT OF HIGHLIGHTED A COUPLE THINGS WE DEFINITELY WANT TO DO.
WE WANT TO PROVIDE PREVENTION INTERVENTIONS. PRE AND POST TEST COUNSELING REGARDING HIGH
RISK BEHAVIORS. WE WANT TO ASSURE THAT EVERYONE WHO IS IDENTIFIED
WITH HIV INFECTION OR HIGH RISK GETS LINKAGE TO TREATMENT.
WRAP AROUND SERVICES, SOCIAL DETERMINANTS OF HEALTH, YOU KNOW, WE TALK ABOUT THEM AS
THIS SORT OF ESOTERIC IDEA, BUT THE IDEA THAT SOMEONE CAN MANAGE TO GET TO A TREATMENT FACILITY
WHEN THEY ARE HOMELESS, WHEN THEY NEED FOOD, WHEN THEY NEED TRANSPORTATION, WRAP AROUND
SERVICES ARE NOT JUST, YOU KNOW, THE NAVIGATOR GETTING THEM THE APPOINTMENT, IT’S ALSO PROVIDING
THE TRANSPORTATION, GETTING PAYMENT FOR THOSE THINGS.
OUR TECHNOLOGY TRANSFER CENTERS IS ANOTHER AREA WHERE I THINK A LOT OF OUR GRANTEES REALLY
NEED TO LEAN ON, AS WE HAVE, YOU KNOW, NINE REGIONS, AND PARTICULARLY TWO FOR THE HISPANIC
POPULATION IN NEW MEXICO AND PUERTO RICO, I WOULD ASK THAT GRANTEES, ANY NON PROFIT,
EVEN THOSE WHO ARE NOT INVOLVED IN ACTUAL GOVERNMENT FUNDING CAN STILL ACCESS THOSE
THINGS. SO, OUR GOAL IS TO REDUCE THE RISK OF HIV.
NEW HIV INFECTIONS, WE WANT TO INCREASE THE PROVISION OF LINKAGE TO HIV CARE, AS WELL
AS ANY OTHER ASPECT OF WRAP AROUND SERVICES. NOW, I’M FAIRLY CONCRETE, SO WHEN I GOT THE
IDEA OF HOW TO DESCRIBE SOME OF THE OTHER RISKS, CAME ACROSS THIS INFORMATION ABOUT
THERE IS A DIFFERENCE BETWEEN FIRST GENERATION AND NATIVE BORN INDIVIDUALS OF HISPANIC ORIGIN.
THIS IS FROM THE NATIONAL COMORBIDITY SURVEY REPLICATION.
WE SEE THAT THERE’S SIGNIFICANT DIFFERENCE BETWEEN THOSE WHO ARE BORN IN THE UNITED STATES
VERSUS THOSE WHO ARE FIRST GENERATION WHEN IT COMES TO THE INCIDENCE OF SUBSTANCE USE
DISORDER AS WELL AS MENTAL HEALTH. THERE’S A COUPLE REASONS WE MAY THINK ABOUT
THAT. ONE MAY BE THAT THERE’S AN ACCULTURATION EFFECT,
AND THE OTHER PART THAT MAY ALSO BE THE OTHER SIDE OF THE COIN IS THAT THERE ARE BARRIERS
TO TREATMENT. AND CERTAINLY UNDERSTANDING BOTH IS GOING
TO BE THE WAY THAT WE CAN UNDERSTAND HOW TO APPROACH THIS POPULATION.
SO, WHEN I LOOKED AT WHAT WAS THE PARTICULAR RISK FOR DEPRESSION, AND THERE WAS ONE SUBGROUP
THAT REALLY STOOD OUT, AND THAT WAS ADOLESCENT HISPANIC FEMALES.
THEY TEND TO HAVE TWICE THE RISK OF SUICIDAL IDEATION, AND A QUARTER RISK HIGHER OF ACTUAL
SUICIDE ATTEMPTS. MAKES IT IMPORTANT WHEN WE DO SCREENING TO
UNDERSTAND THE POPULATION MAY BE AT GREATER RISK.
AS WELL AS WHEN I MENTIONED THE BARRIERS TO MENTAL HEALTH TREATMENT.
IMMIGRANTS ARE LESS LIKELY TO ACCESS MENTAL HEALTH TREATMENT.
THERE MAY BE STIGMA THAT’S STILL ATTACHED THAT I THINK WITH EDUCATION I’D LIKE TO BELIEVE
THE SCHOOLS MAY BE ONE PLACE BUT ACTUALLY OUR PRIMARY CARE COLLEAGUES ARE GOING TO BE
THE ONES THAT ARE THE MOST LIKELY ENTRY POINT. EXPANDING XPERT MAY BE ANOTHER WAY TO GET
THOSE INDIVIDUALS LINKED TO TREATMENT. AND THEN THE ACTUAL LANGUAGE OF HOW THE DISTRESS
IS COMMUNICATED. IT MAY NOT ALWAYS BE CRYING SPELLS, IT MAY
BE INCREASED ANXIETY, MAY BE SOCIAL WITHDRAWAL, AND MAY BE EVEN INCREASED ALCOHOL USE OR SUBSTANCE
USE. LACK OF INSURANCE, LONG WAITING TIMES, THE
CLINIC I WAS WORKING AT OUR WAITING TIME TO SEE A PSYCHIATRIST WAS ABOUT 8 WEEKS.
YOU CAN IMAGINE HOW MUCH DISTRESS SOMEBODY HAS TO GO THROUGH FOR 8 WEEKS BEFORE THEY
CAN ACTUALLY GET RELIEF. SO, THIS IS LAST YEAR’S DATA.
ABOUT ALMOST 40% OF HISPANIC ADULTS HAVE ILLICIT USE AS FAR AS IN THE LIFETIME HISTORY, WHILE
OVER A QUARTER OF THOSE ADOLESCENTS HAVE REPORTED LIFETIME USE.
AND THEN WHEN WE TALK ABOUT OPIATES, IT’S ABOUT 1 OUT OF EVERY 30 INDIVIDUALS.
AND THIS IS SPREAD OUT CONSISTENT AMONG ADOLESCENTS AND ADULTS THAT HAVE USED OPIATES IN THE LAST
YEAR. BIG SURPRISE, WE HAVE AN OPIOID CRISIS THAT
WE HAVE TO ADDRESS AND IT’S TOUCHED THE HISPANIC POPULATION EQUALLY.
WELL, I DON’T WANT TO SAY EQUALLY, WHICH IS THE NEXT SLIDE.
THIS IS A LOOK AT THE OVERDOSES, I’M GOING TO THANK MY CDC COLLEAGUES FOR PROVIDING THIS
INFORMATION, AS POINT OF REFERENCE, I MAKE MY OWN SLIDES SO FORGIVE ME WHEN THEY LOOK
A LITTLE DRY. BUT THE IDEA THAT HISPANIC OVERDOSES IN THE
LAST YEAR GOT TO 4000. NOW, WHEN WE COMPARE TO GENERAL POPULATION,
AND IN PARTICULAR WHEN WE COMPARE TO OTHER DEMOGRAPHIC GROUPS, IT’S ABOUT HALF OF THE
AFRICAN AMERICAN POPULATION, AND ABOUT A THIRD OF CAUCASIAN POPULATION.
BUT WE SEE THE OVERDOSES ARE CONCENTRATED IN CALIFORNIA, NEW YORK, FLORIDA, AND TEXAS.
INTERESTINGLY ENOUGH, ALSO OUR GRANTEES ARE CONCENTRATED IN THOSE AREAS, WHICH IS HOPEFUL
THAT WE’LL BE ABLE TO ADDRESS THOSE THINGS. SO I’M GOING TO GIVE A COUPLE EXAMPLES WHERE
WE’RE ACTUALLY WORKING TOWARDS SUBSTANCE ABUSE PREVENTION.
I’LL STATE FOR THE MINORITY AIDS INITIATIVE WE HAVE 292 GRANTS, AND 70% OF THEM ARE CONCENTRATED
WITHIN THE 48 JURISDICTIONS. AS FAR AS THESE TWO, THESE ARE FOR OUR CENTER
FOR SUBSTANCE ABUSE PREVENTION, WE HAVE THE PASADENA COMMUNITY COALITION AND NEW MEXICO
STRATEGIC ABUSE PREVENTION. THESE ARE PRIMARILY AIMED AT ADOLESCENTS,
AND SCHOOL AGE CHILDREN. YOU KNOW, YOU GET THEM WHILE THEY ARE YOUNG,
YOU CAN IMPRINT A LITTLE BIT MORE INFORMATION SO THEY CAN COMMUNICATE TO THEIR HOUSEHOLDS.
AND MOST IMPORTANTLY, WE TRY TO MEET THEM WHERE THEY ARE AT.
WE UNDERSTAND THE GRANTEES KNOW THEIR COMMUNITIES BETTER THAN WE DO.
WE CAN’T DICTATE FROM ROCKVILLE OR FROM WASHINGTON, D.C. WHAT EXACTLY THOSE COMMUNITIES NEED.
WE CAN TRY, BUT I THINK THEY KNOW BETTER. THIS IS FOR OUR MEDICATION ASSISTED TREATMENT,
AND PEOPLE WHO ARE USING PRESCRIPTION OPIATES. THOSE THREE EXAMPLES OF OTHER GRANTS THAT
WE HAVE, THIS IS IN ARIZONA, NEW YORK, AND THIS IS ESSENTIALLY INCREASING THE EXPANSION
OF MEDICATION ASSISTED TREATMENT. WE KNOW THAT OVER 85% OF INDIVIDUALS WITH
OPIATE USE DISORDER ARE NOT IN TREATMENT. THAT’S A TREMENDOUS OPPORTUNITY THAT WE HAVE
AMONGST OUR COMMUNITIES TO LINK THEM TO TREATMENT. MOST IMPORTANTLY, WHAT WE HAVE TO DO IS WE
HAVE TO REDUCE THE STIGMA, THAT IT’S NO LONGER JUST A MORAL FAILING, BUT IT IS A DISEASE
THAT WE CAN TREAT. NOW, INTERESTINGLY ENOUGH, ONCE INDIVIDUALS
ENGAGE IN MEDICATION ASSISTED TREATMENT, THEY ARE MORE LIKELY, WHETHER THEY HAVE INSURANCE
OR NOT, TO GET TESTING FOR HIV. IN FACT, THIS IS THE OTHER PART OF SAMHSA’S
BIG CHANGE, AND THAT IS THAT EVERY GRANTEE IS GOING TO BE REQUIRED TO REQUEST HIV AND
HEPATITIS TESTING FOR EVERYONE ENROLLED. AND WE’RE GOING TO TRACK NOT JUST THE TESTING
RESULTS, BUT THE LINKAGES TO TREATMENT. SO MENTAL HEALTH IS THE OTHER ASPECT TO THIS.
AND CERTAINLY AMONG THE VARIOUS CENTERS WE HAVE AN OPPORTUNITY, INDIVIDUALS ARE PROBABLY
MUCH MORE LIKELY TO ENGAGE IN MENTAL HEALTH TREATMENT THAN THEY ARE EVEN SOMETIMES SUBSTANCE
ABUSE TREATMENT. THESE ARE JUST THREE EXAMPLES OF DIFFERENT
PROGRAMS THAT WE HAVE, MOST IMPORTANTLY THESE ARE COMMUNITY BASED CENTERS.
AND INTEGRATING CARE IS THE OTHER ASPECT I DO WANT TO HIGHLIGHT.
XPERT, I’VE MENTIONED JUST FOR A MOMENT, BUT WE DO NEED TO UNDERSTAND THAT MAJORITY OF
PEOPLE ARE NOT GOING TO WALK INTO A MENTAL HEALTH CLINIC UNLESS THEY GET SOME IDEA THAT
IT’S NEEDED. THAT CAN COME FROM PRIMARY CARE, PERHAPS THEIR
FAMILY, BUT MORE LIKELY WHEN THE DOCTOR OR THERAPIST IS ABLE TO DO A BRIEF SCREENING
AND REFER THE PERSON TO TREATMENT, IT CARRIES A LITTLE MORE WEIGHT.
MOST IMPORTANTLY WHEN WE TALK ABOUT PUERTO RICO, WE HAVE TO ADDRESS THE YOUTH.
THOSE INDIVIDUALS ARE MORE LIKELY TO BE RECEPTIVE. WE FIND THAT THEY ARE MUCH MORE IN TUNE TO
THEIR DISTRESS. GETTING THEM TO AGREE TO TREATMENT AND GETTING
THEIR FAMILY TO AGREE MAY BE A DIFFERENT STORY, BUT CERTAINLY WE’VE BEEN ABLE TO ENGAGE YOUTH
AND ACTUALLY ACROSS THE COUNTRY I FIND THAT ENROLLMENT AMONG ADOLESCENTS IS BARRIERS ARE
PARTICULARLY LESS. SO, BRIEFLY YOU CAN LOOK AT THIS TO SEE WE
HAVE TWO TECHNOLOGY TRANSFER CENTERS FOR ADDICTION AND PRE SCREENINGS, TREATMENT IN NEW MEXICO,
AS WELL AS MENTAL HEALTH IN PUERTO RICO. THERE’S THE SAMHSA NATIONAL HELP LINE.
WE ALSO HAVE THAT AVAILABLE IN SPANISH. SUICIDE PREVENTION HELP LINE AS WELL.
AS WELL AS OVERDOSE TOOLKIT. HERE ARE THE LINKS.
THE MORE PEOPLE ACCESS THE TREATMENT THE MORE LIKELY THEY ARE TO ENGAGE IN OTHER TREATMENT
SEEKING BEHAVIORS. AGAIN, CIRCLING ALL THE WAY BACK TO HIV AND
PrEP, PrEP IS OUR NEXT STEP IN OUR GUIDE BOOK. WE’RE GOING TO HAVE THE GUIDE BOOK COME OUT
HOPEFULLY WITHIN THE NEXT 12, 16 WEEKS, WHERE WE’LL HIGH LIED THE NEED FOR PrEP AMONGST
OUR MENTAL HEALTH AND SUBSTANCE ABUSE CLINICS. THE LATIN AMERICA YOUTH CENTER IF WE CAN ENGAGE
ADOLESCENTS WE’RE MORE IKELY TO TURN THE CORNER WHEN IT COMES TO PREVENTION AS WELL AS TREATMENT.
I RUSHED THROUGH A LOT OF THINGS BUT I’LL BE OPEN TO DISCUSS ANY QUESTIONS THAT ANYONE
HAS.>>THANK YOU VERY MUCH, NEERAJ.
IN THE INTEREST OF TIME WE’LL MOVE ON TO OUR NEXT SPEAKER, BUT I DO WE APPRECIATE YOUR
INFORMATION. I THINK WE’RE ALL LOOKING FORWARD TO THE UPDATE
OF THE HANDBOOK AND YOUR DIRECTIVES ABOUT THE ENROLLEES BEING TESTED FOR CARE.
THAT SOUNDS ENCOURAGING. TO NOTE AS MAUREEN GOODNOW COMES UP TO THE
PODIUM FROM THE NIH, ALL THE PRESENTATIONS FROM YESTERDAY AND TODAY WILL BE ON THE PACHA
WEBSITE SO THERE’S A LOT OF GOOD INFORMATION WE’RE HEARING AND OTHERS WOULD BE INTERESTED.
NOW WE’RE HEAR FROM MAUREEN GOODNOW, ASSOCIATE DIRECTOR FOR AIDS RESEARCH AT NIH.>>GOOD MORNING.
I’D LIKE TO WELCOME THANK YOU FOR THE INVITATION ON BEHALF OF THE NIH DIRECTOR, FRANCIS COLLINS.
AND FOR INCLUDING THE OFFICE OF AIDS RESEARCH IN THIS.
WHAT I YOU WANT TO GIVE YOU TODAY IS A QUICK OVERVIEW OF THE NIH AND HIV ACTIVITIES THAT
WE DO AND HOW THEY ARE COORDINATED. AND THEN DRILL DOWN INTO SOME OF THE RECENT
ACTIVITIES RELATED TO ENDING THE HIV EPIDEMIC IN AMERICA.
SO, THE NIH RESEARCH AGENDA IS FOCUSED AT TO ENDING THE HIV/AIDS PANDEMIC, IMPROVING
THE HEALTH OF PEOPLE AT RISK FOR AFFECTED BY HIV.
AND THE ROLE OF THE OFFICE OF AIDS RESEARCH IS TO ENSURE THAT THE RESEARCH FUNDING AT
THE NIH IS DIRECTED TO THE HIGHEST PRIORITY RESEARCH AREAS FOR HIV AND WE HAVE A SEPARATE
ALLOCATION OF DOLLARS WITHIN THE NIH BUDGET FOR HIV/AIDS RESEARCH.
AND THE GUIDING PRINCIPLES, GUIDE FOR DOING THE ACTIVITIES AND DEVELOPING THE PLAN FOR
HIV FOR THE NIH IS REALLY DONE BY THE STRATEGIC PLAN AND THAT IS, AGAIN, DEVELOPED AND AND
COORDINATED BY THE OFFICE OF AGE RESEARCH. WITHIN THE NIH THE OFFICE OF AIDS RESEARCH
INDICATED IN RED IS EMBEDDED IN OFFICE OF NIH DIRECTOR, ALLOWS FOR ALLOCATION TRACKING
AND REPORTING OF ALL THE ACTIVITIES AND FUNDING. INDICATED ARE THE VARIOUS INSTITUTES, CENTERS
AND OFFICES WITHIN THE NIH THAT ARE INVOLVED IN THE HIV BE AGENDA AND THERE’S SEVERAL POINTS.
ONE IS THAT A GOOD PORTION OF THE NIH IS INVOLVED HAS AN AGENDA IN HIV BASED ON THEIR RESEARCH
EXPERTISE, AND WHAT YOU CAN’T REALLY SEE HERE THOUGH IS THERE ARE A NUMBER OF OFFICES THAT
YOU MAY NOT BE AWARE OF INCLUDING TRIBAL HEALTH, SEXUAL MINORITY GENDER, OFFICE OF RESEARCH
IN WOMEN’S HEALTH, OFFICE OF BEHAVIOR AND SOCIAL SCIENCE RESEARCH, THAT ALL ALSO HAVE
A COORDINATION WITH OUR OFFICE IN APPLYING THEIR EXPERTISE IN THESE DIFFERENT AREAS TO
THE HIV AGENDA. AND JUST FOR HISTORICAL CONTENT, YOU KNOW,
THE OFFICE OF AIDS RESEARCH WAS ACTUAL IN PLAY, IN THE EARLY ’80s, AROUND 1983.
IN 1988 CONGRESS AUTHORIZED OAR OFFICIALLY, AND SO IT WAS REALLY THE OUTCOME OF A LOT
OF ADVOCACY, A LOT OF COMMUNITY INVOLVEMENT, AND A LOT OF WORK WITH THE LEGISLATORS THAT
THIS WAS ABLE TO HAPPEN SO EARLY IN THE EPIDEMIC, AND I THINK THE OUTCOMES ARE REALLY IMPORTANT.
THE WAY THE NIH WORKS IN TERMS OF HIV AND HIV RELATED RESEARCH IS WE HAVE THE PRIORITIES,
WHICH MANY OF YOU PARTICULARLY THE RESEARCHERS KNOW ABOUT, INCLUDING REDUCING THE INCIDENCE,
DEVELOPING NEXT GENERATION THERAPIES, RESEARCH TOWARD A CURE, ADDRESSING HIV ASSOCIATED COMORBIDITIES,
COINFECTIONS, AND THEN CROSS CUTTING AREAS THAT INCLUDE BASIC SCIENCE, IMPLEMENTATION
SCIENCE, BEHAVIOR AND SOCIAL SCIENCE RESEARCH, AREAS OF RESEARCH THAT REALLY COVER ALL OF
THESE PRIORITIES. AND THESE PRIORITIES REALLY ALIGN VERY, VERY
WELL WITH THE PILLARS OF ENDING THE HIV EPIDEMIC, SO DIAGNOSE REALLY IS PART OF REDUCING INCIDENCE,
TREATMENT IS REALLY INVOLVED WITH RESEARCH AND DEVELOPING NEXT GENERATION THERAPIES,
PROTECTION AGAIN REDUCING INCIDENCE, AND RESPONDING IS REALLY IN THE CROSS CORRELATE AREAS PARTICULARLY
IMPLEMENTATION SCIENCE AND BEHAVIORAL AND SOCIAL SCIENCE RESEARCH.
THE IMPORTANT THING THE WAY WE LOOK AT IT AT THE NIH IS THAT THE RESEARCH IS REALLY
A CONTINUUM, STARTING WITH VERY BASIC RESEARCH AT THE FAR SIDE OF THE SCREEN, AND THE OUTCOMES
BEING PUBLIC HEALTH AND POLICY. SO REALLY WHAT THE NIH DOES IS DEVELOP KNOWLEDGE
AND MAKE DISCOVERIES THAT ARE IMPLEMENTED BY ALL OF YOUR AGENCIES IN THE FIELD, AND
THIS IS A FANTASTIC PARTNERSHIP WHEN YOU LOOK AT IT BECAUSE WE HAVE A WHOLE PIPELINE HERE
FROM VERY BASIC INQUIRY TO GETTING THINGS OUT IN THE PUBLIC HEALTH THAT YOU’VE BEEN
HEARING ABOUT TODAY. KEY ROLES THE NIH PLAYS IN ENDING THE HIV
EPIDEMIC IN PARTICULAR IS AGAIN COORDINATING, HARMONIZE NIH RESEARCH ACTIVITIES, IMPLEMENTING
THE NEW STRATEGIC PLAN THAT’S COMING OUT BEFORE THE END OF THE CALENDAR YEAR AND WE’RE VERY
EXCITED ABOUT THAT. TRACK, MONITOR AND EVALUATE NIH RESEARCH AND
ACTIVITIES TO ACHIEVE GOALS AND CONVENE LISTENING SESSIONS, SIMILAR TO OTHER COMMENTS ABOUT
STAKEHOLDERS, THE OAR HAS BEEN SPONSORING LISTENING SESSIONS FOR THE NIH.
THERE ARE TWO OVERARCHING THEMES THAT WE’VE BEEN HEARING.
THERE’S REALLY STRONG OPINION ABOUT HAVING FEDERAL COORDINATION AND COLLABORATION TO
FACILITATE THE PREVENTION, TREATMENT AND CARE ACROSS THE SPECTRUM OF SOCIAL AND STRUCTURAL
ISSUES AND A SECOND THEME WE HEAR IS INCREASED COMMUNICATION WITHIN AND OUTSIDE THE NIH AS
NEEDED TO HIGHLIGHT NIH SUPPORTED RESEARCH. WE HAVE A MORE DETAILED REPORT THAT WE’RE
DEVELOPING NOW BASED ON OUR FIRST 18 MONTHS OF LISTENING SESSIONS, AND WE PLAN TO HAVE
THAT OUT LATER IN THE CALENDAR YEAR, BEGINNING OF NEXT CALENDAR YEAR.
WHAT HAVE WE BEEN DOING MORE SPECIFICALLY? A LOT OF RESOURCES AT THE NIH DEPLOYED ALREADY
FOR ENDING THE HIV EPIDEMIC HAVE GONE TO THE TWO PARTICULAR AREAS, AND THAT IS THE CENTERS
FOR AIDS RESEARCH, CFARs, MULTI FUNDED ACROSS A NUMBER OF INSURE TIGHTS AND CENTERS AT THE
NIH, THEY ARE ADMINISTERED THROUGH THE NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES
BUT THERE’S OTHER INPUT, AND NATIONAL INSTITUTE OF MENTAL HEALTH, AIDS RESEARCH CENTERS, OR
THE ARCs, SERVE AS RESEARCH PLATFORM TO SUPPORT IMPLEMENTATION SCIENCE, COLLABORATION WITH
OUR OTHER SISTER AGENCIES, TO INFORM LOCAL PARTNERS ON BEST PRACTICES AND COLLECT AND
DISSEMINATE. THE NIH HAS BEEN ABLE TO DEPLOY SOME RESOURCES
TO JUMPSTART ASPECTS RESEARCH TOWARD ENDING THE HIV EPIDEMIC, AND SO IN ADDITION TO SOME
HHS FUNDING FROM THE MINORITY HEALTH INITIATIVE WE’VE BEEN ABLE TO PROVIDE SUPPORT, ONE YEAR
SUPPLEMENTAL SUPPORT, IN 2019, FOR 65 OUT OF ALMOST 100 SUPPLEMENTS THAT WERE SUBMITTED
TO THE DIFFERENT AGENCIES. MOST OF THE PROJECTS WILL INVESTIGATE DELIVERING
EVIDENCEBASED INTERVENTION AND SERVICES FOR POPULATIONS THAT PHYSICAL CITIES PROPORTIONATE
RISK OF HIV. MORE SPECIFICALLY, ACTUALLY PRIOR TO THE INITIATION
OF THE ENDING THE HIV EPIDEMIC I, RELATED TO PUERTO RICO, WE WERE ABLE TO RAPIDLY PROVIDE
HURRICANE RELIEF AND FUNDING TOWARDS REBUILDING THE NONHUMAN PRIMATE CENTER.
I DON’T KNOW HOW MANY OF YOU KNOW BUT THERE’S A VERY IMPORTANT NON HUMAN PRIMATE CENTER
IN PUERTO RICO THAT IS BASICALLY A FREE RANGE TO COMMUNITY OF NON HUMAN PRIMATES THAT PROVIDE
AMAZING RESOURCES FOR RESEARCH NOT ONLY FOR HIV BUT ALSO IN THE BEHAVIOR AND SOCIAL SCIENCE
ASPECTS OF HOW THESE PRIMATE COMMUNITIES INTERACT WITH EACH OTHER.
AS A RESULT OF HURRICANE MARIA, IT WAS THE WHOLE FACILITY WAS TOTALLY DESTROYED.
AND IT’S LOCATED ON TWO SMALL ISLANDS OFF THE COAST OF PUERTO RICO, SO THE DESTRUCTION
NOT ONLY WAS INVOLVING VEGETATION AND THE BUILDINGS BUT ALSO OF THE LANDING PLACES WHERE
THE BOATS COME IN TO PROVIDE AND PROVIDE PROVISIONS AND RESOURCES FOR THE FACILITIES, SO WE WERE
VERY EXCITED THAT WE WERE ABLE TO GET WITH OUR PARTNERS, BE ABLE TO GET RESOURCES ROLLED
OUT VERY RAPIDLY, AND WE’RE LOOKING FORWARD TO VISITING NEXT YEAR TO SEE HOW THINGS ARE
GOING AND WHAT OTHER RESOURCES NEED TO BE DEPLOYED THERE.
THERE’S ALSO PARTNERSHIPS WITH AIDS EDUCATION AND TRAINING CENTERS IN NEW YORK, NEW JERSEY,
AND PUERTO RICO, TO IDENTIFY BEST IMPLEMENTATION STRATEGIES, AND THE CENTER FOR COLLABORATIVE
RESEARCH FOR MINORITY HEALTH AND HEALTH DISPARITIES IS ALSO FUNDING A RESEARCH CENTER FOR MINORITY
INSTITUTIONS IN SAN JUAN. LATIN RESEARCH FOCUSING ON SCIENCE SUPPLEMENTS,
AMONG THE 65 SUPPLEMENTS FUNDED, ONE FOR SAN DIEGO, TEXAS, WASHINGTON AND PUERTO RICO,
TOPICS INCLUDE COMMUNITY ENGAGEMENT, PrEP, ALTERNATIVE SERVICE DELIVERY, SELF TESTING
LINKAGE, AND U=U, AS WELL AS THE MINORITY CENTER IN MIAMI.
WE ALSO WERE ABLE TO IDENTIFY I SOME PROJECTS THAT WE COULD SUPPLEMENT FOR THE OFFICE OF
SEXUAL AND GENDER MINORITY RESEARCH. AND THESE WERE RELATIVE TO ACTIVITIES IN VULNERABILITIER
IN MEN TO IMPROVE HIV PREVENTION. YOU CAN READ THEM.
BUT THE ACADEMIC INSTITUTIONS INCLUDED CITY UNIVERSITY OF NEW YORK, UNIVERSITY OF FLORIDA
AND SEVERAL NEW YORK NEW YORK UNIVERSITY. WE WANT TO BRING TO YOUR ATTENTION THAT THE
NIH WORLD AIDS DAY THIS YEAR WILL BE CELEBRATED ON DECEMBER 2, WHICH IS THE MONDAY AFTER THANKSGIVING
WEEKEND. THE THEME IS COMMUNITY IN NIH, IN PARTNERSHIP
TO END THE HIV EPIDEMIC. IT WILL BE VIDEOCAST LIVE, AND WE WOULD INVITE
EVERYONE TO COME IN PERSON AS WELL. AND I’M HAPPY TO ANSWER ANY QUESTIONS.>>THANK YOU VERY MUCH, MAUREEN.
WE’RE GOING TO MOVE ON SINCE WE’RE FALLING BEHIND.
>>OKAY, PERFECT.>>BUT THANK YOU VERY MUCH.
WE LOOK FORWARD TO THE Q&A WITH YOU AS WELL.

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