The U.S. Department of Veterans Affairs (VA) recognizes viral hepatitis as a highly prevalent chronic disease among Veterans in VA care. VA continues to be proactive in addressing viral hepatitis, and is actively taking part in the implementation of the Action Plan for the Prevention, Care and Treatment of Viral Hepatitis, which is led by the U.S. Department of Health and Human Services (HHS).

Chronic viral hepatitis is a major public health problem in the United States because of the millions of persons who are chronically infected and because of the  potential for untreated viral hepatitis to progress to cirrhosis, liver cancer, and other life-threatening conditions. Hepatitis C virus (HCV) and hepatitis B virus (HBV) are the major causes of chronic viral hepatitis in the U.S.

In the late 1990s, VA characterized HCV as a significant health problem requiring early detection and has taken a number of steps to address the issue. In 1998, the VA’s Under Secretary for Health issued an Information Letter outlining standards for provider evaluation and testing for HCV in the Veterans Health Administration (VHA). Subsequently, VA conducted a nationwide surveillance activity, testing over 26,000 Veterans for HCV in March 1999. The testing revealed a prevalence rate of 6.6% with a wide variation by geography and era of military service. In 2000, the VA’s Under Secretary for Health designated additional funding to be distributed across VHA for outreach, testing, counseling, and treating Veterans with hepatitis C.

By 2002, a VHA National Viral Hepatitis Program had been established, and HCV screening and testing guidelines were published. All Veterans were to be screened for risk factors for HCV and tested if they had a previous or ongoing risk, or if they simply asked to be tested. Testing was also offered to those who served during the Vietnam-era and to those with a history of alcohol abuse or dependence due to the high prevalence of HCV in these populations.

VHA’s external peer review program data show that rates of testing at-risk patients are very high. In fiscal year 2005, based on a sample of 16,000 Veterans receiving care at VA medical facilities, 98% had been screened for HCV risk factors and 93% of the approximately 8,000 veterans with risk factors had been tested for HCV.

Since 2002, VHA’s National Viral Hepatitis Program has used a comprehensive population health-based approach to HCV care for Veterans, emphasizing access to high-quality clinical care and testing, counseling, patient and provider education, and quality improvement efforts. Clinical reminders in the electronic medical record have been found to be an effective way to trigger clinicians to screen Veterans for HCV risk and offer testing when appropriate. Clinical reminders were made widely available and have been successfully used to improve screening efforts.

The VA’s National Hepatitis C Program accomplishments have included extensive screening of at-risk Veterans, early and broad access to anti-viral therapy such as HCV protease inhibitors, and improvements in the management of other co-existing conditions such as depression, alcohol misuse and other substance use disorders.

VHA is the single largest HCV care provider in the U.S., with a seroprevalence rate three times that of the general U.S. population; currently there are over 170,000 Veterans in VHA care with confirmed chronic HCV.  The gradual progression of HCV in affected Veterans over a period of decades has led to increasing numbers of patients with cirrhosis, end-stage liver disease, and liver cancer. Of note, over the last ten years, the number of HCV-infected Veterans in care diagnosed with cirrhosis has tripled to over 25,000, while over the same time period the cumulative number of HCV-infected Veterans diagnosed with liver cancer has increased by ten-fold.

It has also been recognized that Veterans are at higher risk for exposure to HBV than the general U.S. population. Current VHA recommendations for HBV screening are that at risk Veterans should be offered testing for HBV, and linked to care if found to be positive. Better understanding of the prevalence of HBV in the Veteran population, the number of Veterans who have been tested, and missed opportunities for testing, will help guide appropriate HBV screening/testing recommendations in the future.

VHA is committed to identifying Veterans at risk for viral hepatitis and linking those who are found to be positive to high quality care within our healthcare system. VHA will continue to work side by side with colleagues from HHS and other federal and non-federal partners to coordinate and implement a number of strategies to promote awareness around viral hepatitis and to ensure high quality of care to those who are living with these chronic diseases.

Ms. Durfee is the Department of Veterans Affairs representative on the cross-agency work group coordinating implementation of the Action Plan for the Prevention Care and Treatment of Viral Hepatitis.

Dr. John Ward

CDC has released draft recommendations proposing that all Americans born from 1945 through 1965 (“baby boomers”) get a one-time test for the hepatitis C virus. In the United States, hepatitis C is the leading cause of liver transplants and liver cancer, which is the fastest-rising cause of cancer-related deaths in the nation. More than 2 million U.S. baby boomers are infected with hepatitis C, accounting for more than 75 percent of all American adults living with the virus. Baby boomers are five times more likely to be infected than other adults. Most of them, though, do not know that they have the virus because hepatitis C can damage the liver for many years without noticeable symptoms. More than 15,000 Americans—mostly baby boomers—die each year from hepatitis C-related illness, such as cirrhosis and liver cancer, and deaths have been increasing steadily for over a decade.

CDC estimates one-time hepatitis C testing of baby boomers could identify more than 800,000 additional people with hepatitis C and save more than 120,000 lives. CDC believes the expanded screening efforts are needed to increase the proportion of persons with hepatitis C who are diagnosed, and referred to care to slow or halt progression of the disease and avoid transmission to others. New treatments are now available that can cure up to 75% of infections, and even more promising treatments are expected in the near future. CDC believes that expanded screening efforts can prevent thousands of unnecessary deaths from hepatitis C.

CDC’s new recommendations augment current hepatitis C testing guidelines that call for testing individuals with a known risk for the disease. Studies have found that most persons do not perceive themselves to be at risk and are not screened. CDC’s recommendations propose that a one-time blood test for hepatitis C should become a standard part of medical care for all persons born from 1945 through 1965.

In a May 22, 2012 Federal Register Notice, CDC formally invited public comment on this draft recommendation. We encourage you to review and comment on these important proposed recommendations which will be available for public comment through June 8 on www.regulations.gov, docket number CDC-2012-0005. Public comment will be used to inform the final recommendations, which will be finalized later this year.

For more information, see this factsheet (PDF 374KB) on the proposed testing recommendations.

Photo from aidsquilt.org

This summer, as the global HIV and AIDS community gathers in Washington, DC for AIDS 2012, The AIDS Memorial Quilt will make a rare return to the international stage. Started in 1987, The Quilt is comprised of panels memorializing those whose lives have been lost to AIDS.

During the Smithsonian Folklife Festival , June 28-July 8, 2012, the NAMES Project—caretaker of The Quilt—and the Smithsonian Center for Folklife and Cultural Heritage will present portions of The Quilt (8,000 panels) on the National Mall. The festival program, “Creativity and Crisis: Unfolding The AIDS Memorial Quilt,” will feature visual artists, designers, quilters, dancers, and musicians, and will underscore the power of the arts as a tool for social, cultural, and economic awareness and change.

Then, in recognition of AIDS 2012, the entire AIDS Memorial Quilt will be displayed over the course of 5 days on the National Mall (between 8^th and 14^th streets), July 21-25, 2012. Panels will also be displayed in more than 55 other venues throughout July, including HHS headquarters at the Hubert H. Humphries building, as well as sites ranging from the National Cathedral to Nationals Stadium.

Throughout its long history, The Quilt has been used to fight prejudice and to raise awareness and funding through its unparalleled ability to make HIV and AIDS real, human, and compelling to every sector of society.

New panels arrive at The NAMES Project every day and, to date, more than 20 million individuals have seen The Quilt at tens of thousands of displays in schools, places of worship, community centers, business and government buildings, and other settings. Wherever it is displayed, individuals are moved by this visual demonstration of the impact of the epidemic.

There are many opportunities to get involved with The Quilt’s display this summer. Individuals can volunteer to fold or unfold The Quilt, read names on the National Mall, submit their own story to The NAMES Project, and create and submit a panel. In addition, persons who have submitted a panel and would like to request its display in Washington on a specific date or location, can do so by May 25, 2012. For more information these activities and how to get involved, visit www.Quilt2012.org .

No doubt, The Quilt will continue to serve as a catalyst for change, a driver for dialogue, and a tool for healing. Those who experience it this summer will find it difficult—if not impossible—to walk away from it unchanged. We hope you will be part of The Quilt’s call for humanity to act with compassion and resolve in the face of HIV and AIDS.

When the Internet revolution arrived in the 1990s, the U.S. Government embraced this new medium to interact with the American people.  Today, what started as basic information pages has evolved into sophisticated transactional systems that allow us to pay taxes online, download medical records, and so much more.

Like the 1990s, we are now in the midst of another important shift in how people consume and deliver information and services. In 2011, global smartphone shipments exceeded personal computer shipments for the first time in history, and more Americans will soon access the Internet via mobile devices than desktop PCs. The rise of mobile further compounds the challenge of providing high-quality digital services in a cost-effective and efficient manner.

That’s why President Obama issued a directive today to make important services accessible from your phone and charged me with developing a comprehensive strategy to build a 21st Century Digital Government that delivers better digital services to the American people.

Today marks the launch of that Digital Government Strategy (PDF / HTML5).

At its core, the strategy takes a coordinated, information- and customer-centric approach to changing how the government works and delivers services to the American people. Designing for openness from the start – making open data the default for government IT systems and embracing the use of web APIs – enables us to more easily deliver information and services through multiple channels, including mobile, and engage the public and America’s entrepreneurs as partners in building a better government.

Treating the government as an open platform in this way encourages innovation. Just look at how the government’s release of GPS and weather data fueled billion dollar industries. It also makes government more efficient and able to adapt to inevitable changes in technology.

Over the next 12 months, you will start to see an important shift across the Federal Government. Agencies will increasingly open up their valuable data to the public and set up Developer pages to give external developers tools to build new services. To make sure there’s no wrong door for accessing government data, we will transform Data.gov into a data and API catalog that in real time pulls directly from agency websites. Agencies will mobilize two of their priority customer-facing services, moving us closer to serving the American people anytime, anywhere, on the device of their choice. We will do all of this while reworking the Federal government’s own use of mobile – saving taxpayer dollars and providing better service by bringing consistency to the way we buy and build for an increasingly mobile workforce.

As President Obama has said, “I want us to ask ourselves every day, how are we using technology to make a real difference in people’s lives?” Through the Digital Government Strategy, we look forward to partnering with America’s innovators – government, industry, and citizen leaders – to implement the President’s vision.

Steven VanRoekel is the Federal Chief Information Officer – for more information visit www.cio.gov.

Dr. Ronald Valdiserri

On Monday, April 25, 2012, representatives of the six federal agencies designated by the President as lead agencies with responsibility for implementing the National HIV/AIDS Strategy (NHAS) met to continue our collaborative efforts to implement the Strategy and discuss plans for possible cross-departmental activities.

Dr. Grant Colfax, Director of the Office of National AIDS Policy at the White House, addressed the group, which is charged with better coordinating HIV/AIDS activities across departments and agencies. He expressed appreciation for the perseverance of the Federal Leads in their work to implement the NHAS.

Dr. Howard Koh, Assistant Secretary for Health, chaired the meeting and engaged participants in a discussion about opportunities to advance their collaboration with a cross-departmental project(s) that would involve many or all of the lead federal agencies working together. Two potential projects were then outlined.

Addressing the Health and Social Needs of Persons with HIV Leaving Prison
The goal of this proposed initiative is to bring together the resources of each of the Federal Leads to enhance the health aspects of the re-entry experience of people living with HIV coming out of state prisons and returning to their communities. This project would require that the Federal Leads identify and document best practices and facilitate strengthened collaborations across relevant programs and with state and local stakeholders addressing the health, housing, and employment or job skill training needs of this population at risk of falling out of HIV care. Activities being contemplated include a consultation on best practices with federal and community-based stakeholders, development of a web-based training for service providers and a resource document for use by correctional facilities, state and local departments of health and departments of corrections and community-based organizations serving the targeted population. In pursuing this project, the Federal Leads would engage colleagues from specific agencies with relevant expertise and responsibility for oversight of specific related activities.

Common Set of HIV Program Indicators
The second proposed area for broader collaboration across the Federal Leads involves building on an effort already underway at HHS to establish a set of common core indicators to be used across HIV programs to better capture data and reduce grantee reporting burden.  The Federal Leads discussed the possibility of engaging in further dialogue about the feasibility and potential benefits of adopting the indicators being developed by HHS for use across other federal departments.

The seven domains in which HHS is working to develop specific common program indicators are: HIV diagnosis, early HIV diagnosis, initial linkage to care, sustained engagement in care, initiation of antiretroviral treatment, viral load suppression, and housing status. During the discussion among the Federal Leads it was acknowledged that not every federal HIV program collects nor would they be expected to start collecting information related to all of these measures. However, the idea is that for those that do collect similar information, using a common measure across programs not only helps establish a richer, more clear national picture of our progress, but also reduces grantee burden by making standard the data elements requested and fosters the opportunity to more readily share and analyze data across programs at the local, state and national levels.

Dr. Colfax expressed gratitude to the Federal Leads for considering this important collaboration and to OHAIDP for taking the lead on this effort at HHS. He observed that an important goal of this undertaking must be to help better measure outcomes on the local level. He shared that based on his experience as a local health department administrator, he is aware that grantees are asked to gather and report on quite a lot of data, which may not be fed back to them in a way that is helpful for improving programs and services. He noted that the recent Institute of Medicine (IOM) report commissioned by ONAP, “Monitoring HIV Care in the United States: Indicators and Data Systems,” specifically calls for more coordination, collaboration and integration across federal agencies on these issues.

We agreed, as a group, to move forward with an active process to identify opportunities to adopt common HIV program measures across federal departments. We look forward to sharing news of our progress in a future blog post. In the meantime, please feel free to share your recommendations about these efforts by leaving a comment below.

Panel at HealthHIV (photo by V. Maldonado)

Along with several federal colleagues, I had the opportunity late last month to discuss the National HIV/AIDS Strategy (NHAS) and the Action Plan for the Prevention Care and Treatment of Viral Hepatitis (Action Plan) during a panel presentation at a national healthcare conference. We shared highlights of our efforts to coordinate activities as we implement both of these important plans with an audience interested in efforts to better synchronize networks of HIV and primary care, including representatives of a many community health centers at the conference organized by HealthHIV . Since many of the comments may be of interest to a wider audience, I wanted to share some of the highlights of those presentations.

In his opening statement, Dr. Kevin Fenton, Director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, noted that both the NHAS and the Action Plan call for closer coordination of efforts among federal and local agencies and non-federal partners to build on successes and move toward the clear and specific goals set forth in each. Expanding prevention through healthcare, Dr. Fenton observed, is a major crosscutting priority. This includes making HIV and hepatitis screening routine.

I shared with the audience that implementation of the NHAS was continuing not only across the Department of Health and Human Services (HHS), but also in the five other federal departments designated as leaders in the Strategy—the Departments of Housing and Urban Development, Justice, Labor, Veterans Affairs and the Social Security Administration. Meeting regularly, representatives of these agencies are seeking to improve coordination of HIV programs across departments and are seeking to identify one or more collaborative projects that will have a payoff at the service-delivery level. Within HHS, I shared that we are already engaged in conversations with the Secretary and the White House about reauthorization of the Ryan White Care Act. Finally, I shared that HHS is preparing a report highlighting important accomplishments in implementation of the NHAS over the past year. We anticipate this report will be released this summer.

Regarding the Viral Hepatitis Action Plan, I observed that an implementation group comprised of representatives from numerous HHS agencies and offices, including CDC, HRSA, IHS, NIH and SAMHSA, as well as the Department of Justice’s Bureau of Prisons and the Department of Veterans Affairs has been meeting regularly to advance implementation since the release of the Action Plan last May. We are also in the process of compiling a report of actions completed during the first year of the Action Plan and will also be sharing that this summer. Among the chief accomplishments of the first year has been significantly raising the profile of viral hepatitis as a significant health problem across all the participating agencies and laying the foundation for collaborative activities.

Dr. Deborah Parham Hopson, HRSA’s Associate Administrator for the HIV/AIDS Bureau, noted that three key challenges facing providers are identifying people with HIV earlier in the course of their infection, linking those people to HIV care, and keeping them in care. She spoke about how the Ryan White HIV/AIDS Program, which provides services to more than 500,000 people living with HIV (PLWH) across the U.S.—approximately one-half of the PLWH in the country—is working to address these challenges as well as supporting and expanding the HIV care workforce. On the latter, she highlighted HIV HRSA efforts to disseminate HIV information to providers in the National Health Service Corps, to integrate HIV training into residency programs, and to extend support to HIV providers in rural areas via a telehealth program. Dr. Parham Hopson also informed that participants that their input will be important as HRSA begins making plans for reauthorization of the Ryan White Program. She noted that HRSA will be gathering stakeholder input via a series of community meetings around the country as well as an opportunity to provide input online, which we blogged about last week. Finally, Deborah highlighted some of HRSA’s important work in implementing the Viral Hepatitis Action Plan, including efforts by the network of AIDS Education and Training Centers to scale up training on viral hepatitis diagnosis, care and treatment, noting that thousands of healthcare providers receive training annually through these centers.

Discussing efforts underway to expand and strengthen HIV care at the network of Community Health Centers (CHCs), Dr. Seiji Hayashi, Chief Medical Officer of HRSA’s Bureau of Primary Health Care (BPHC), shared that the 8,100 clinics supported through the health center program serve more than 20 million patients, approximately 90,000 of whom have a primary or secondary diagnosis of HIV according to 2010 data. More than 750,000 patients received HIV tests at CHCs in 2010. BPHC is working to increase the availability of HIV services by moving more health centers along the spectrum of HIV service delivery through various means, including program assistance letters, project officer training on HIV care, technical assistance for clinics, and other incentives.

Other important issues that were discussed during the panel presentation included violence against women, housing insecurity and homelessness, and behavioral health disorders. They were addressed by, respectively, Mr. David Vos, Director of the Housing Opportunities for People With AIDS program at the U.S. Department of Housing and Urban Development, Ms. Mary Bowers of the HHS Office on Women’s Health, and Mr. Warren Hewitt of the Substance Abuse and Mental Health Services Administration. Their comments helped place HIV/AIDS in a larger context as well as featured related federal activities that the providers may find helpful for their patients.

Dr. Howard Koh

Tomorrow (May 19) our Nation marks the eighth annual National Asian and Pacific Islander HIV/AIDS Awareness Day and the first–ever National Hepatitis Testing Day. Both observances represent “calls to action” for the country and hold special meaning for me. As an Asian American physician, I have cared for many individuals living with HIV and/or hepatitis. As I stop to honor the patients I have served, I do so knowing these conditions continue to represent substantial health burdens for the AAPI community.

As a Nation, we need to continue our efforts to reduce new HIV infections to zero as we all work to achieve an AIDS-free generation. Some slight progress can be noted. In recent years, the rate of diagnosis of HIV infection among Native Hawaiians or other Pacific Islanders decreased while the rate of diagnosis among Asians has remained stable. In 2010, the rate among Native Hawaiians or other Pacific Islanders was 19.3 per 100,000 population (a decrease from 21.3 in 2007) and the rate among Asians was 6.5 per 100,000 population (the rate in 2006 was also 6.5) in the 46 states with confidential name-based HIV infection reporting. Those diagnosed accounted for approximately 2 percent of the 47,129 persons in the U.S. diagnosed with HIV during 2010. While these rates are relatively low compared to other racial/ethnic groups in the U.S., we need to redouble our commitment.

I remain inspired by the tremendous collaboration of  HHS and community partners to address HIV in AAPI communities and beyond:

• In the National HIV AIDS Strategy (NHAS) President Obama outlined three goals: 1) Reduce new HIV infections; 2) increase access to care and improve health outcomes for people living with HIV, and 3) reduce HIV-related health disparities. We must continue to work more closely with our federal and community partners, including representatives from diverse AAPI communities, to make the NHAS vision a reality.

• The Affordable Care Act is changing the landscape for health services delivery in the U.S. The Pre-existing Condition Insurance Program has increased access to preventive care, as well as initiatives to increase racial and ethnic diversity and cultural competency in the health care professions. HHS has also been implementing improved ways to collect and report health data related to race, ethnicity, sex, primary language, and disability status. Such progress will help us to better characterize and compare health problems in targeted populations and move us closer to our vision of a Nation free of health disparities.

• The Healthy People 2020 objectives are moving us to reduce disparities across diseases and across the life span in AAPI communities and beyond.

Federal funds are helping to address HIV in AAPI communities. Using Minority AIDS Initiative funding, The Office of Minority Health manages The Pacific Project , a capacity-building training and technical assistance project to increase HIV prevention and care services provided to the peoples of the U.S. Associated Pacific Island jurisdictions. Among the funded programs is The Asian Latino Pacific Healthcare Access Project , which is addressing stigma and lack of awareness of HIV/AIDS, promoting HIV prevention, early detection, and improved HIV management among Asian, Pacific Islander and Latino populations of Los Angeles who have limited English proficiency. The Centers for Disease Control and Prevention provides HIV prevention funding to community organizations and health departments. Some of the programs target subgroups within AAPI communities to enhance implementation of effective community-based HIV prevention programs. Among the grantees are Asian & Pacific Islander Wellness Center (San Francisco) and APICHA (New York City).

May 19 is also Hepatitis Testing Day

Today we also observe the first-ever national Hepatitis Testing Day. As I discussed in a post earlier this month, viral hepatitis, particularly hepatitis B, has a disproportionate impact on Asian and Pacific Islander communities. Asian Americans and Pacific Islanders make up less than 5 percent of the total population in the United States, but account for more than 50 percent of Americans living with chronic hepatitis B.  Fostering the observance of Hepatitis Testing Day is an important aspect of our cross-agency efforts to implement the Action Plan for the Prevention, Care and Treatment of Viral Hepatitis (PDF 672KB), an effort I am honored to lead.

I encourage everyone to observe National Asian and Pacific Islander HIV/AIDS Awareness Day and Hepatitis Testing Day on May 19. You can:

• Learn more about the NHAS and the Affordable Care Act;
• Find an HIV testing site or other HIV services near you by entering your ZIP code into the HIV Prevention and Services Provider Locator;
• Use the National Asian and Pacific Islander HIV/AIDS Awareness Day resources provided by The Banyan Tree Project ;
• Visit CDC’s viral hepatitis page; and
• Use our new risk assessment tool to see if you should talk to your doctor about being tested for hepatitis.

Together we can make a difference in our response to these two epidemics within AAPI communities and beyond.

With over 20,000 participants and more than 250 sessions, you may be starting to wonder how you will navigate AIDS 2012. This week, conference organizers released the General Information Guide  to help you with your planning. The Guide contains a wealth of practical information, including details about on-site registration and check-in, a convention center map, and tips for getting around Washington, DC. The full list of categories covered in the Guide are:

• Conference Overview
• Conference Practicalities
• Business Information
• Organizers and Partners
• Affiliated Independent events
• Exhibition
• Satellites
• Tours and Programmes

The General Information Guide does not provide a detailed schedule of sessions and events (that will be available on June 8 through the online Programme-at-a-Glance). Use this time to get a lay of the land before you map out what sessions or satellites you will attend, or which webcasts you will view.

We also want to draw your attention to an important deadline for AIDS 2012. The deadline for submitting late breaker abstracts for the conference is Tuesday, May 22. We encourage authors to visit the conference website to review submission guidelines .

Tomorrow (May 18th) is HIV Vaccine Awareness Day (HVAD).  This annual observance is a day for education about the importance of preventive HIV vaccine research. And, on this day, we pause to recognize and thank the thousands of volunteers, community members, health professionals, and scientists who are working together to find a safe and effective HIV vaccine.

The National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health is the lead organizer for this day and the HIV Vaccine Awareness Day web site contains many resources to help community members support the day. To learn more about HIV/AIDS and the federal response including federally-funded research, visit AIDS.gov

Please read and share the 2012 HVAD press statement from Dr. Fauci, Director of NIAID  (also available in Spanish).

HIV Vaccine Awareness Day

May 18, 2012

Statement of Anthony S. Fauci, M.D.
Director, National Institute of Allergy and Infectious Diseases
National Institutes of Health

There is a growing consensus that we can significantly curtail the HIV/AIDS pandemic by implementing scientifically proven HIV prevention strategies, such as voluntary medically supervised adult male circumcision, prevention of mother-to-child transmission and treatment as prevention. With 2.7 million new HIV infections in 2010 alone, however, it is likely that controlling and ultimately ending the HIV/AIDS pandemic will require an effective vaccine as well. This past year, there have been a number of encouraging findings on this front.

Last month, a detailed analysis of specimens from the first HIV vaccine clinical trial to show a modest protective effect yielded important clues  about how the vaccine might have worked. These clues suggest directions for improving upon the original vaccine regimen to confer a broader, more potent and longer-lasting effect. The original vaccine regimen was tested among 16,000 adult volunteers in Thailand in a trial co-funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of NIH.

Meanwhile, several other NIAID-sponsored HIV vaccine clinical trials are under way. The largest of these is examining whether a prime-boost vaccine regimen can prevent HIV infection or reduce the amount of virus in the blood of those participants who become infected despite vaccination. These trials are possible because of the generous contributions of time and effort by thousands of study participants, community educators, health care workers and scientists. All those involved deserve our gratitude.

Preclinical animal model studies of HIV infection recently have uncovered valuable leads toward designing a preventive HIV vaccine. Scientists have demonstrated that a vaccine can prevent a virulent monkey version of HIV infection and have shown a correlation between this protection and the presence of specific antibodies to the virus.

In basic HIV vaccine research, scientists are discovering and studying HIV neutralizing antibodies that shield cells in the lab against infection with a wide array of HIV strains collected from infected people worldwide. Researchers are analyzing the structure and evolution of these antibodies and the manner in which they bind to HIV, and are using this information to design new molecules to elicit the antibodies through vaccination. In related experiments, injecting these antibodies directly into monkeys has been shown to prevent infection from a monkey version of HIV. Based on these findings, studies to test this concept in people are being planned.

All of these advances reinforce our confidence that one day we will succeed at creating a safe, highly effective vaccine to prevent HIV infection. To contain and ultimately halt the HIV/AIDS pandemic, even the most effective vaccine must be part of a combination of medical and behavioral HIV prevention tools. That is why NIAID continues to support research into promising HIV prevention strategies, such as vaginal and rectal microbicides, pre-exposure prophylaxis (PrEP) and expanded HIV testing with linkage to care. That is also why the public health community will continue to refine and implement scientifically proven HIV prevention measures, including condom use, harm-reduction strategies for injection drug users, and, notably, treatment as prevention: giving antiretroviral therapy to HIV-infected individuals to dramatically reduce their infectiousness while protecting their health.

Vaccines historically have been the single most important tool for controlling epidemics. With an ongoing commitment to HIV vaccine research, we have the potential to radically change the trajectory of the HIV/AIDS pandemic.

Anthony S. Fauci, M.D., is Director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health in Bethesda, Maryland.

Media inquiries can be directed to the NIAID Office of Communications at 301-402-1663, niaidnews@niaid.nih.gov.

Dr. Ronald Valdiserri

As part of the Department of Health and Human Services’ (HHS) efforts to plan for the 2013 reauthorization of the Ryan White HIV/AIDS Program, the Health Resources and Services Administration (HRSA) has launched a number of activities to collect ideas from stakeholders that will inform our policy deliberations.

The Ryan White Program is the largest Federal program specifically dedicated to providing HIV care and treatment. It funds heavily impacted metropolitan areas, states, and local community-based organizations to provide life-saving medical care, medications, and support services to more than half a million people each year—including the uninsured and underinsured, racial and ethnic minorities, and people of all ages. Currently authorized by the Ryan White HIV/AIDS Treatment Extension Act of 2009, the program will be up for reauthorization by the U.S. Congress in 2013.

Among the issues being discussed within HHS is the question of what the Ryan White program should look like in an environment of a health care system reformed by implementation of the Affordable Care Act (ACA). In light of the expansion of health insurance coverage that implementation of the ACA will bring, the Ryan White Program will certainly evolve. But as my colleague Dr. Deborah Parham Hopson, HRSA’s Associate Administrator for the HIV/AIDS Bureau, has noted, though the reauthorized Ryan White Program may ultimately look different, it will still serve as an important “safety net” for vulnerable populations living with HIV/AIDS.

Stakeholder Comments Sought
In a Federal Register Notice dated April 25, 2012, Dr. Mary K. Wakefield, Administrator of HRSA, invited comments from stakeholders about reauthorization of the Ryan White Program. HRSA encourages stakeholders, including grantees, advocacy organizations, State and local administrators, and other members of the Ryan White and HIV/AIDS communities to provide comments on all aspects of the program. Submit written comments online by July 31.

Listening Sessions Planned
HRSA has also announced that it will hold at least four webinar or teleconference listening sessions over the next few months to collect stakeholder input on Ryan White Program reauthorization issues. Each will focus on a different geographic region. Dates, times and other details will be published on HRSA’s Ryan White Reauthorization web page as they become available.

The services offered through the Ryan White HIV/AIDS Program continue to be an essential component of our efforts to reach the goals of the National HIV/AIDS Strategy. We look forward to working with our colleagues at HRSA and stakeholders from across the nation to consider how the program can most effectively be adapted in light of evolving needs, priorities and policies.  I encourage you to share your thoughts on reauthorization via the forums that HRSA is making available.