The Houston Health Department (HHD) requests City Council approval of an ordinance approving and authorizing the grant application to the United States Department of Health and Human Services, Centers for Disease Control and Prevention for the Houston Health Department Integrated HIV Surveillance and Prevention Program. The budget period is from January 1, 2018 through December 31, 2018. The Project Period is January 1, 2018 through December 31, 2022.
HHD also requests City Council authorize the Director or his designee to act as the City’s representative in the application process with the authority to apply for, accept and expend the grant funds, as awarded, and to apply for and accept and expend all subsequent awards, and authorize the Mayor to execute all related contracts, agreements and documents with the approval of the City Attorney in connection with the grant not to exceed 5 years.
The purpose of this application for funding is to implement a comprehensive HIV surveillance and prevention program to prevent new HIV infections and achieve viral suppression among persons living with HIV. Priority activities include (but are not limited to) HIV testing, linkage to medical care for those who are positive, and referrals for pre-exposure prophylaxis (PrEP). related activities; community-level HIV prevention activities; HIV transmission cluster investigations and outbreak response efforts. Additional activities will include: systematically collect, analyze, interpret, and disseminate HIV data to characterize trends in HIV infection, detect active HIV transmission, provide comprehensive HIV-related prevention services for persons living with diagnosed HIV infection (PLWH); provide comprehensive HIV-related prevention services for HIV-negative persons at risk for HIV infection; conduct perinatal HIV prevention and surveillance activities; develop partnerships to conduct integrated HIV prevention and care planning; implement structural strategies to support and facilitate HIV surveillance and prevention; conduct data-driven planning, monitoring, and evaluation to continuously improve HIV programs; and build capacity for conducting effective HIV program activities, epidemiological science, and geocoding.
The Houston Metropolitan Statistical Area (MSA) has one of the highest rates of HIV in the United States (US), ranking eleventh in rate of new diagnoses in 2015. There were an estimated 24,222 people living with HIV in Houston/Harris County by the end of 2015. Despite a stable rate of new HIV diagnoses since 2003 (between 28-33 diagnoses per 100,000), Houston has struggled to realize necessary improvements to reduce disparities, a major goal of the National HIV/AIDS Strategy (NHAS). The burden of HIV infection in the Houston area remains disproportionately concentrated among a few groups. In 2014, the rate of new HIV diagnoses among the black population was 5.7 times that of whites. When stratified further, the majority of this impact was among black men (110 per 100,000 persons). Other subpopulations with high rates of new diagnoses of HIV include: Hispanic males (40 per 100,000 persons) and black women (42 per 100,000 persons). There has been a substantial and encouraging decline in the rate of new HIV diagnoses among black heterosexual men and a steady, although less pronounced, decline among black women. However, rates continue to increase among men who have sex with men (MSM) who make up over 67% of new infections in Houston. Black MSM have been particularly impacted with rates 7.4 times that of white MSM, 21.5 times that of black heterosexual males, 31.1 times that of black females, and 163.3 times that of white heterosexual males. A concerning trend is also the increase in diagnoses among Hispanic MSM. This subpopulation has experienced the sharpest increases in new HIV diagnoses compared to all other MSM since 2006.
HHD uses data to strategically target high-impact strategies to reduce transmission of HIV and other sexually transmitted infections. Surveillance data is collected and analyzed to detect active HIV transmission, and transmission is interrupted through HIV testing, linkage to medical care for those who are positive, and referrals for pre-exposure prophylaxis (PrEP). For those who are uninfected but at high risk of HIV acquisition, PrEP education and referral is a new strategy that holds great promise to reduce HIV rates. PrEP is a pill that prevents HIV when taken consistently and has been shown to reduce the risk of HIV infection by up to 92%. Linkage to, and retention in, medical care for people living with HIV (PLWH) is another critical approach to reduce HIV transmission. Antiretroviral therapy leads to a near normal life expectancy for PLWH and helps greatly reduce theamount of virus in the blood. This suppression of the virus (“viral suppression”) nearly eliminates the possibility of transmitting HIV to other people. As of 2014, just 55% of PLWH in the Houston area were virally suppressed. Informed by data analysis and evaluation, the HHD will develop new and enhance existing strategies to turn the tide of HIV morbidity in Houston.
The grant is due to the CDC on September 27, 2017. The application submitted is a working draft. The program is in the process of completing the application.