Transcript of CDC Telebriefing – Vital Signs HIV

Operator: good afternoon.  Thank you all for standing by.  For the duration of today’s conference all participants’ lines are in a listen-only mode until the question and answer session.  At this time, if you’d like to ask a question press star 1. Today’s call is being recorded.  If you have any objections you may disconnect at this time.  It’s my pleasure to introduce Mr. Benjamin Haynes.

Benjamin Haynes:  thank you Holly, and thank you all for joining us today for the release of a new CDC vital signs on the HIV epidemic in America. We are joined by Dr. Jay Butler, CDC’s deputy director for infectious diseases, as well as Dr. Eugene Mccray, director of CDC’s division of HIV/aids prevention. Drs. Butler and Mccray, and Dr. Mermin, director of the national center for HIV/aids, viral hepatitis, std, and tb prevention. Following opening remarks, Dr. Norma harris, first author of the vital signs will join us to take your questions. I’d now turn the call over to dr.  Butler.

Jay Butler: thank you.  Good afternoon.  Good morning if you’re in the west.  Thank you for joining us today.  If you regularly join these briefings you’re aware that CDC works 24/7 to prevent Americans against health threats.

Each month, CDC vital signs is an opportunity to focus on one of CDC’s public health priorities and what we can or is being done to address them.  Today’s report provides the latest data on the status of the HIV epidemic in America.  It shows that HIV testing, treatment and prevention haven’t reached enough Americans.  It emphasizes the continued urgent need to increase these interventions.

Now is an exciting time.  As you’re probably aware the U.S.Department of health and human services and its agencies have taken on the goal of ending the HIV epidemic in America by 2030.  This is an ambitious goal but with swift and bold actions not only is it achievable we can get it done.  We can end the status quo.  Providing that we change our expectations and the culture of satisfaction of where we’re at now.

We at the CDC have been going around the country and have had opportunities to meet with many people who are committed to ending the HIV epidemic.  We have met with clinical and public health practitioners and elected officials, people with HIV, or at risk of HIV and i should say that these are not mutually exclusive groups but all people who have been working tirelessly in this field for some decades.

We have consistently heard three very important things.  One, our nation’s public health community, and all of us are ready to end the HIV epidemic.  The science is there, we have the tools.  Second, there’s a critical need to fully engage the community to include new voices and build capacity at the community level, that is by the community and for the community.  And third, to be successful we must also address social determinants of health, too many Americans including those with HIV or at risk of HIV are facing serious issues that protect health and well being, including homelessness, addiction and unaddressed mental health issues.

With the right resources, and in collaboration with public health and other community members, we can work together to end the HIV epidemic.

The three main findings of the report echo these urgent needs.  More than 150,000 Americans still don’t know that they have HIV.  And need to be tested.  Not enough Americans with HIV have the virus under control through effective treatments.  And there’s a daily pill that can prevent HIV, known as prep.  This has not reached enough people who could benefit from this important prevention tool.  We made a lot of progress in the late ’90s and into the early part of the 21st century in reducing the number of new cases of HIV.  But HIV prevention progress has stalled in America since 2013.  And this stalling underscores the need to increase resources, deploy new technologies and build expertise particularly in areas where they’re needed most.  That’s why to achieve maximize impact the federal initiative focuses on three of the areas that we’re highlight today in the vital signs report.  It also focuses on 57 geographic areas which include 48 counties, the District of Columbia, and San Juan, Puerto Rico, where half of all new HIV occurs.

Particular concerns about transmission of HIV in rural areas.  Even as we speak, these areas are currently working on their own local plans, these plans are based on local community input, direct health locally to achieve our ten-year national plan of eliminating new HIV infections.  Those strategies are — first of all, HIV testing.  With a national target of diagnosising at least 95% of, diagnosis is important because that’s the pathway to the second phase, HIV treatment.  With a national target of at least 95% of people diagnosed HIV have the virus suppressed this is not only life-saving and results in a near-normal life expectancy but it’s also an important prevention tool.  Important to note that people with unrecognizable virus unable to transmit the virus to others.  The math equation is you equal you.  Undetectable equals untransmittable.  Third, speaking of prevention, preventing new HIV infections with proven interventions including prep, 57% of people at risk of HIV and who are eligible for prep will be receiving it.

Nothing in HIV prevention has been or will ever be accomplished apart from the community.  That’s why active and ongoing community involved both locally and nationally have remain critical.  Community efforts are critical in reducing new HIV infections by 90% by 2030.  So, to summarize the goals are to — test, treat and prevent.  And we can end HIV by 2030.  Which is a summary as well as haiku.  I’m going to turn it over to Dr.  Eugene Mccray who will discuss the report’s findings in more details.

Eugene Mccray: thank you, Dr. Butler.  First I’d like to echo Dr.  Butler’s sentiment about the importance of the urgent opportunity before us.  Ending the HIV epidemic would be one of the greatest public health triumphs in our nation’s history.  That achievement would be a testament to decades of advocacy, community involvement and efforts that have driven treatment and prevention in our country.  Findings from today’s report clearly show where we need to focus efforts.

First, in 2017, 14% of people with HIV did not know they had it.  That’s about 154,000 people.  Without a diagnosis they couldn’t take advantage of a treatment that would help them stay healthy and prevent transmit to other people.  The proportion of the people who knew their status varied by age.  Half of people younger than 25 received a diagnosis.

Second in 2017, over a third of people who knew they had HIV were not virally suppressed.  That’s about 318,000 people.  Good treatment is good prevention.  Suppression is a marker for effective HIV treatment.  People who get the virus suppressed quickly live longer, healthier lives.  Effective treatments also prevent HIV transmission.  Young people, African-Americans and people who inject drugs are least likely to be virally suppressed.

Third, 1.2 million Americans could benefit from prep.  However, only about 13%, or 152,000 people were prescribed prep in 2018.  18% were prescribed it in 2018.  About 220,000 people.  This is a minimal estimate of prep coverage.  It reflects most but not all of U.S.Retail pharmacies or all organizations that fill prep prescriptions.  There’s been a rapid increase in the number of people taking prep over the past three years.  But there’s no doubt that prep uptake is too low and we’re working hard to increase access to prep especially among gay and bisexual men, women, young people, African-Americans and latinos.

Finally, the number of people who acquire HIV each year is high and is at a standstill.  CDC estimates that new infections remain stabled from 2013 to 2017.  With about 38,000 infections occurring each year during that timeframe.  In this case, stability is not good.  A previous analysis found that a number of new HIV infections declined from 2008 to 2013.  We estimate that the decline has stopped.

Again, these findings underscore the urgent need to rapid scale up HIV testing, treatment and prep.  And we know our national goal can be achieved.  Across the nation, some states have made great strides in progress.  For example, five states are close to or have exceeded diagnosing 95%.  In 18 states at least two-thirds people with HIV are already virally suppressed.  Our national goal can be accomplished with the right use of science, technology and resources and continued commitment of people with HIV, communities affected with HIV and public and private leadership all working together.

I’d like to close by highlighting three things that everyone can do right now.  First, get tested for HIV.  Second, talk to your health care provider about options.  Including prep, condoms and if relevant, prevent services programs.  Third, stay healthy by taking your medicines as prescribed if you have HIV.  These data show us exactly where we need to really focus our prevention efforts to end the HIV epidemic in America.  We have the tools.  We have a plan.  And we have national commitment.  Now, i’ll turn it back to the moderator.

Benjamin Haynes: thank you, Dr. Mccray and Dr. Butler.  Holly, we are now ready for questions.

Operator: thank you.  If you would ask a question, please unmute your phonr, press star 1.  To withdraw your question press star 2.  To ask a question, press star 1.  Please stand by.

Our first question is from mike with the U.S.Associated press.  Your line is open.

Mike Stobbe: hi, thank you for taking my call.  I have two questions if i may.  Doctors, did you say why there’s been a stall since 2013?  And also in the 57 areas that you’re focusing on, some of these areas also have been dealing with hepatitis a outbreaks and rise in stds, are there joint efforts going on to address those, too, or is it just HIV?  Thank you.

Jay Butler: sure.  Let me start with the second question first because i think you raise a very important point is that we talk about ending HIV transmission, there’s also the opportunity to end transmission of other blood-borne pathogens.  Hepatitis c is a great example of an infection that’s particularly associated with self-injected drug use.  Hepatitis a is also an example given some populations heavily impacted by the current epidemics of hepatitis a, which are occurring around the country. So it’s not going to be so much a part of a national plan as something that in at a community level can be addressed as a secondary gain to what we do as we address the HIV epidemic.

It also highlights the importance of part of what is different now is that much of what has been done in the past and has been very successful to address HIV has been to apply national plans nationally.  But there are inequities in the HIV epidemic.  To address those we recognize that these need to be different actions taken in different communities and so that’s one of the reasons why earlier we were talking about how in each of these jurisdictions they are developing individual plans that will help us move forward to sort of unstop that stalling in the decline of cases.  So, the first question i think in many ways may be a bit unanswerable because it’s going to be different in different locations.  And I’d be happy to turn it over to Dr. Mccray, he may have some further thoughts on that.

Eugene Mccray: sure, i mentioned earlier that progress in reducing new HIV infections we had a lot of progress since 2013, that progress has stalled.  Some of that stalling is related at a national level, we have seen progress in some groups but there are other groups where that progress is not — is not being seen.  For example, young people.  Especially young folks under the age of 25.  25 to 34 among black and latinos, as much as 50% to 60% in the last few years.  Then, of course, we’re not seeing a reductions in some other key groups.  Geographic areas like the south.  So, we have done a great job and we’ve gotten to a certain point but in order to really continue to see those decreases, the reverse of stalling, we have to do things differently and get to the populations that are now experiencing the most disparity and that’s what this initiative will allow us to do.  It will allow us to target those resources to those geographic areas and to those populations that are now experiencing increases in HIV.

Benjamin Haynes: next question, please.

Operator: our next question is from lenny bernstein with “the washington post.”  Your line is open.

Lenny bernstein: thank you very much for taking my question.  You guys report in the mmwr only 40% of people over 18 have ever been tested for HIV in their lifetime.  I’m just wondering, where the system is falling short, exactly where should people be tested, when they come into the e.r. For an injury, is it at a community health clinic, how can that number be so high if HIV has become sort of a routine test?

Jay Butler: thanks for that question.  This is jay Butler.  I think the answer to the question is yes, people need to be tested in all of those places.  I’d add to that, in their primary care provider’s office as well.  Wherever people are interacting with a health care provider testing needs to be performed and there’s opportunity at the community level and through our public health partners to get the testing out to where people are.  That we probably need to not assume that individuals are always going to come in to be tested.  But testing out to where the people are.

Benjamin Haynes: next question, please.

Operator: our next question is from selena with npr.  Your line is open.

Selena simmons-duffin: so, i heard you and others say 1.2 million people are at risk of getting HIV.  And this morning, there was a call talking about how, you know, more people can be reached with prep and benefit services by the program that provides prep to people who don’t have prescription drug coverage but that still doesn’t get close to providing preventive support to those 1.2 million people.  I’m wondering about how the CDC is thinking about reaching the other 1.2 million people are at risk and what programs might be coming to kind of reach those folks.

Jay Butler: okay, this is jay Butler.  One point of clarification and i apologize if we weren’t clear on this.  So prep is for people who are not currently infected.  And the 1.2 million that we were discussing are people who actually are infected with HIV and would not benefit from prep.  So, we’re focusing on treatment to suppress the virus for people who are infected and prep is a tool for prevention for people who are not infected.

Eugene Mccray: and this is Dr. Mccray.  I’d like to add that there are approximately between 1.1 million to 1.2 million people who are determined based on modelling to be eligible for prep.  They could benefit from getting on prep.  And so, CDC is doing a number of things in addition to the program that you heard about this morning, CDC is doing a number of things to really get more people on prep, we’re working — we’re working to inform and educate providers about prep.  Including updating our clinical guidelines, offering charts and checklists and various tools that can providers can use during their evaluation of patients to really help them to determine whether that person is eligible.  And we’re also supporting things like hotlines so a person can call and learn where in their community they can go and get prep if they’re interested, et cetera.  A number of programs targeted toward potential consumers, they walk in their doctor’s office they know to ask for prep.  But the key really is making — is really when people come in, making sure they have access to sort of a sexual health evaluation so that you can determine together with a client whether they’re at risk.  Some of these folks may not go to a clinic, we have to think of other ways to make available, community-based prep.  A number of different things and different options that we’re looking at that are evidence-based, help get prep to a lot of folks who haven’t been able to access it in the past.  To summarize, viral suppression is for people who have HIV and prep is for people who are at risk of HIV.

Benjamin Haynes: Holly, we have time for a couple more questions.

Operator: thank you.  Before we go to the next question, again, if you’d like to ask a question please press star 1, unmute your phone, and introduce your name.  Our next question is from Kimberly Leonard from the “Washington Examiner.”

Kimberly Leonard: hi, you touched a little bit on what i was going to ask about but i just wanted to clarify, i’m looking at California’s recent bill to allow pharmacists to prescribe prep directly to patients and there are some guardrails around it, is that kind of what you’re talking about in terms of the administration might be supportive of, in other areas the administration have encouraged states to expand scope of practice laws.  Thank you.

Jay Butler: yes, thank you for raising that question about the new law in California.  And i think it highlights the opportunities that we have all around the country to be innovately innovative.  Provide treatment and prevention services to as many people as possible.

Operator: i have no more questions at this time.  Again, if you’d like to ask a question press star 1.  Benjamin Haynes: Holly, if there are no more questions we will go ahead and conclude the call.  Thank you Dr. Butler and Dr.  Mccray for joining us today as well as the reporters.  For follow-up questions please call the press office at 404-639-3286 or send an e-mail to media@cdc.gov.

Benjamin Haynes: thank you.

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