Wednesday, December 17, 2014

CDC's Recommendations for HIV Prevention with Adults and Adolescents with HIV in the US, 2014

Dear Colleague,

This week, the Centers for Disease Control and Prevention (CDC), in collaboration with the HIV/AIDS Bureau at the Health Resources and Services Administration (HRSA), the National Institutes of Health (NIH), and five participating CDC partner organizations, published a new evidence-based guideline, Recommendations for HIV Prevention with Adults and Adolescents with HIV in the United States, 2014 updating and expanding the 2003 recommendations. The recommendations comprise an all-in-one set of comprehensive interventions for clinical providers, nonclinical providers, as well as staff of health departments and HIV planning groups focused on optimizing health outcomes for people with HIV and reducing their risk of exposing others to HIV.

Several factors have prompted this update—the context and method of HIV prevention, care and treatment is changing in the U.S. due to recent advances in biomedical, behavioral, and structural prevention strategies, changes in public- and private-sector health care delivery, and new national HIV prevention strategies. For example, early initiation of antiretroviral therapy (ART) has been shown to improve health, suppress viral load, and reduce the risk of transmitting HIV to others. Moreover, offering HIV treatment shortly after diagnosis can also hasten the use of other biomedical, behavioral, and structural interventions that can reduce the risk of transmitting HIV to others. Unfortunately, many interventions for people with HIV have not been optimally coordinated, consolidated, and aligned with the latest scientific evidence. By offering this expanded set of interventions, providers, health departments and HIV planning groups can enhance the health of people with HIV, prevent HIV transmission to their sex and drug-injection partners and children, as well as contribute to community well-being overall.

The updated recommendations are based on scientific evidence, program experience, or expert opinion available through July 2014. They address recent advances in biomedical, behavioral and structural interventions within 11 domains focused on optimizing health outcomes for people with HIV and reducing their risk of exposing others to HIV:
  • Linkage to and retention in HIV medical care.
  • Antiretroviral treatment for improving health and for preventing HIV transmission.
  • Adherence to HIV treatment to reduce infectiousness.
  • Services for sex and drug-injection partners of people with HIV.
  • Screening for behavioral and biomedical factors that increase the risk of HIV transmission and risk-reduction interventions.
  • Sexually transmitted diseases preventive services.
  • Reproductive health care for women and men that reduces unintended pregnancies and the risk of sexual HIV transmission when attempting conception.
  • Services that reduce the risk of sexual or perinatal transmission during pregnancy.
  • Other medical and social services that affect HIV transmission or use of HIV services, such as substance use treatment.
  • Social, ethical, and legal issues that affect HIV transmission and use of HIV services.
  • Evaluation and improvement of HIV prevention and care services.
The new recommendations are directed to a broad range of health professionals and organizations including clinical providers, nonclinical providers, and staff of health departments and HIV planning groups who, together, can share in the critical and integrated role of providing individual- and population-level prevention and care services. Collaboration and task sharing across these three groups are more important than ever as the number of people with HIV continues to grow at an estimated 50,000 new infections each year, lifespans of people with HIV are increasing, more effective interventions are available, and shortages of trained HIV service providers persist.

In addition, three summary publications feature a subset of recommendations for each of the three audiences described above. They include:
  1. Recommendations for HIV Prevention with Adults and Adolescents with HIV in the United States, 2014: Summary for Clinical Providers.
  2. Recommendations for HIV Prevention with Adults and Adolescents with HIV in the United States, 2014: Summary for Nonclinical Providers.
  3. Recommendations for HIV Prevention with Adults and Adolescents with HIV in the United States, 2014: Summary for Health Departments and HIV Planning Groups.
An online Resource Library includes links to dozens of practical decision-support tools, training aids, and other materials to help with implementation of the recommendations. Because these recommendations are both numerous and ambitious, each provider, health department, and HIV planning group can focus on interventions that are suited to their skills, resources, and professional authority and are most important for their patients, clients, or communities.

More than 80 experts in HIV prevention and care from CDC, HRSA, NIH, and several participating partner organizations: the American Academy of HIV Medicine, the Association of Nurses in AIDS Care, the International Association of Providers of AIDS Care, the National Minority AIDS Council, and the Urban Coalition for HIV/AIDS Prevention Services developed the recommendations over several phases. They also considered oral and written input from more than 60 stakeholders, including people with HIV, HIV medical care providers, nonclinical HIV prevention providers, health department program managers, and experts in HIV policy and law.

We would like to thank all of the collaborating organizations and the many experts who contributed to developing this comprehensive set of recommendations.

As we push forward in our efforts to optimize health outcomes for people with HIV, help them live longer healthier lives, and reduce risk of transmission, our approach to prevention and care services is critical. With your help, we can accelerate our progress and move closer towards our nation’s HIV prevention goals.

Sincerely,

Eugene McCray, MD
Director Division of HIV/AIDS Prevention 
National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, 
Centers for Disease Control and Prevention

Laura Cheever, MD, ScM 
Associate Administrator 
HIV/AIDS Bureau at the Health 
Resources and Services Administration

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