Remarks to the HRSA/CDC Advisory Committee on HIV and STD Prevention and Treatment

by HRSA Senior Advisor Steve Smith

November 13, 2006
Washington, D.C.

It’s a pleasure to be with you this morning and to bring greetings from our Administrator, Dr. Betty Duke. She was very sorry that she couldn’t be with you, but asked me to send her best wishes for a successful and productive meeting.

On behalf of the entire HRSA family, thank you for being here today and for contributing your time, energy and talent to this very important work. I know that Secretary Leavitt greatly appreciates your efforts and desires your advice and counsel.

We are very glad to have Dr. Kevin Fenton as CDC’s new Designated Federal Official. We look forward to continuing our work with you in this new capacity, Kevin.

I’d also like to thank Dr. Deborah Parham Hopson and Dr. Laura Cheever for their fine leadership of our HIV/AIDS Bureau, and I thank their staff for helping to coordinate this meeting and supporting the important work of the CHAC.

At HRSA, we observed a very special milestone this year -- the 15th anniversary of the Ryan White CARE Act. Our grantee conference in August was a time of remembrance, renewal and recommitment. We were reminded of how much progress we’ve made in treating the epidemic -- but also how far we still need to go. Working collaboratively, we continue to make real progress -- and the work we’re doing together on HIV testing recommendations is a great example. The knowledge, experience, and commitment each of you brings to the table are invaluable as we set policies for future HIV/AIDS prevention and care.

In my time with you today, I want to give you a brief overview of current CARE Act activities and priorities at HRSA. I will give you brief updates on:

• Where we stand with reauthorization of the CARE Act and and the FY 2007 budget;
• HRSA priorities and new initiatives in FY 2007;
• Concerns we have about how the so-called “donut hole” in Medicare Part D coverage will impact CARE Act clients; and
• Some information about our follow-up activities for Gulf Coast recovery efforts and our own HRSA Emergency Preparedness.

First, let me briefly touch on the topic that I know is of high interest to us all -- CARE Act reauthorization.

We’ve all worked long and hard on reauthorization, and I want to thank each of you for all your efforts to support and inform this process. Where we stand now is that we have a bill that reflects the Administration’s themes, including HIV counting, core services, better coordination between Titles, and better accountability. The themes are consistent with the President’s principals of serving the neediest first and better targeting of resources.

We had hoped that by the time of this meeting we would have had a fully reauthorized CARE Act. But since that is not the case, we stand ready to implement the law as it stands today. At the same time, we will continue to support the reauthorization process as opportunities arise.

Once we have passage, we will work diligently with grantees to assure that they have all of the necessary information and guidance to implement the new provisions.

Here’s a brief update on the FY 2007 budget: we’re pleased that the President’s budget request includes an additional $95 million for new activities under the Domestic HIV Initiative. Currently, we’re on a continuing resolution through November 17, 2006. The House and Senate have “marked up” the President’s budget, with differing proposed budgets. When we will have an HHS appropriation for FY 2007 is anybody’s guess. We will be tracking what Congress does during the lame duck session.

While the reauthorization and budget processes move forward slowly, CARE Act dollars have been hard at work, helping those who need it most. We’re still analyzing 2005 data in preparation for a final report, but initial findings show that a total of 954,323 duplicated clients were served by CARE Act-funded service providers in 2005. More than one-third were women, and over 70% were people of color. These clients had over 4.06 million visits for health care services; a 1% increase over the number of health care visits reported in 2004.

In addition to reaching more than one-half million individuals with CARE Act services, we’re looking forward to a number of new initiatives in 2007.

A top priority for HRSA in 2007 is continuing to work closely with CDC on new testing recommendations.

And we’re very excited about a number of other new initiatives that will improve our ability to deliver HIV/AIDS care. First, I’ll talk about four new Special Projects of National Significance (SPNS) initiatives:

• Jail-based Initiative – The first new SPNS initiative will award ten grants to implement and evaluate innovative methods for linking PLWHAs who are in jail or have been recently released from local jail facilities with primary medical care and ancillary services.
  
  
• Oral Health – Dr. Duke recently announced a new SPNS grant program totaling more than $6.5 million to support innovative oral health care for people living with HIV/AIDS.
  
  
• Information Technology – The SPNS Information Technology Networks of Care Initiative will award funds to support organizations that promote enhancing and evaluating existing electronic information network systems to serve people living with HIV/AIDS in underserved communities.
  
  
• Case Management Initiative – The fourth SPNS initiative identifies the types of case management models and services that are most important for improving access to and retention in care for patients.

Other HRSA initiatives include our:

• Quality Initiative – Quality is a thread that runs through all of HRSA’s programs and quality improvement efforts in HIV/AIDS include developing quality indicators for the HIV/AIDS Bureau and grantee care and services through client-level data and NQC guidelines, and providing quality training and support for HAB staff and quality TA for grantees.
  
  
• MAI Initiative – Five new projects funded under Secretary Leavitt’s Minority AIDS Initiative will focus on (1) HIV care for women of color; (2) intervention strategies to help clinics retain patients in care; (3) evaluating MAI activities; (4) assessing the needs of providers who serve AI/AN in AETC regions; and (5) studying the issues and barriers to increasing the capacity of health professions immigrants to provide HIV care in the U.S.
  
  
• TARGET Center – The TARGET Center is a new Web site and Help Desk that centralizes an array of technical assistance for Ryan White CARE Act (RWCA) programs and provides a “virtual community” for CARE Act grantees to learn and share ideas.
  
  
• The National Perinatal HIV Consultation and Referral Service (Perinatal Hotline) – The Perinatal Hotline provides around-the-clock advice on standard and rapid HIV testing in pregnancy as well as consultation on antiretroviral use in pregnancy, labor and delivery, and the postpartum period. The Perinatal HIV Consultation and Referral Service also links HIV-infected pregnant women with appropriate health care.

And on the global front, we will continue our outreach through the President’s Emergency Plan for AIDS Relief (PEPFAR). Here are a few accomplishments to date:

• HIVQUAL has been implemented in 142 hospitals sites in Thailand.
• In FY 2006, HIVQUAL expanded to Uganda, Namibia and Mozambique.
• ITECH implemented clinical mentoring in three new countries in 2006; ITECH clinical training is now in 25 countries. In Namibia, after rapid test training, the rate of post-test counseling has increased from 20% (Feb-July 05) to 66% (Aug 05-Jan 06).

Another issue we’re tracking closely is Medicare Part D and the “Donut Hole” effect on CARE Act grantees. Approximately 70-80% of Medicare beneficiaries living with HIV don’t have to worry about the Medicare donut hole because they qualify for low-income subsidies.

But due to the high cost of antiretroviral medication, the Medicare beneficiaries who do not qualify for extra help are affected by the donut hole and should consider strategies for reaching the catastrophic coverage level, where costs are lower.

AIDS Drug Assistance Programs (ADAPs) can assist with Medicare Part D costs and provide antiretroviral medications while clients are in the donut hole. ADAPs have flexibility with this, so Medicare beneficiaries should contact their state ADAP to find out how they will assist with costs.

Medicare beneficiaries can also look at Part D plans that have higher premiums but provide partial coverage to compensate for the donut hole or eliminate it completely.

At this time last year, the nation was gripped by the devastation of Hurricanes Katrina and Rita. Our grantees in Alabama, Louisiana, Mississippi and Texas are still recovering and face daunting challenges. We’re having difficulty tracking clients who were displaced and meeting CARE Act requirements and restrictions, as well as conditions of award. But every day we’re working with our grantees to improve this situation. We thank each and every one of them for their awe-inspiring work and dedicated spirit of public service. We’ve overcome many obstacles in 15 years and, working together, we’re confident that we can turn this situation around too.

Now I will highlight how we improved HRSA’s readiness to handle emergencies.

We created an Emergency Operations Center and an “e-Room,” which provides an electronic system to collect data from grantee project officers in all of HRSA’s bureaus.

The Office of Commissioned Corps Affairs (OCCA) was established in May 2006 to provide a central focal point for all HRSA officer activities, including deployments. The OCCA will oversee implementation of the Secretary’s vision for a transformed Commissioned Corps to ensure that the future force is prepared to meet the public health and emergency needs of the Nation.

In closing, thank you again for the vital role you play in improving HIV/AIDS prevention, care and treatment across our nation and throughout the world. We rely on your expertise and guidance and look forward to your recommendations. I will be happy to answer any questions you might have.

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