Transcending the Syndemic - files.hiv.gov · Ending the HIV and Opioid Epidemics in America...

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OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH Transcending the Syndemic: Ending the HIV and Opioid Epidemics in America Presented to the National HIV Prevention Conference March 20, 2019 ADMIRAL BRETT P. GIROIR, M.D. Assistant Secretary for Health and Senior Advisor for Opioid Policy

Transcript of Transcending the Syndemic - files.hiv.gov · Ending the HIV and Opioid Epidemics in America...

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    O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H

    Transcending the Syndemic: Ending the HIV and Opioid Epidemics in America

    Presented to the

    National HIV Prevention Conference March 20, 2019

    ADM IRA L BRETT P. G IRO IR , M .D. Ass i s tant Secre ta r y fo r Hea l th and Sen ior Adv isor fo r Opio id Pol i c y

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    U.S. DRUG OVERDOSE DEATHS THE MOST CRITICAL PUBLIC HEALTH CHALLENGE OF OUR TIME

    80,000

    70,000

    60,000

    50,000

    40,000

    30,000

    20,000

    10,000

    0

    70,237 All Drug Overdoses

    47,600 Opioid Overdoses

    O F F I C E O F T H E SOURCE: NCHS, National Vital Statics System, Mortality A S S I S T A N T S E C R E T A R Y F O R H E A L T H

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    OVERDOSE MORTALITY BY CLASS OF DRUG ADAPTED FROM CDC STATISTICS, MARCH 2019

    HEROIN NAT & SEMI –SYNTHETIC METHADONE SYNTHETIC

    OPIOIDS COCAINE PSYCHO-

    STIMULANTS

    AUG 2017 * 16,371 15,336 3,283 27,373 14,215 9,783

    AUG 2018 * 15,514 13,504 3,216 31,958 15,495 12,350

    Change - 5.23% - 11.95% - 2.04% 16.75% 9.00% 26.24%

    https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

    ~70% of Cocaine Deaths also have Opioids Detected

    O F F I C E O F T H E • Number of 3predicted deaths for the 12 months ending in August of the indicated yearA S S I S T A N T S E C R E T A R Y F O R H E A L T H

    https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

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    INFECTIOUS CONSEQUENCES OF THE OPIOID EPIDEMIC

    • HIV • Hepatitis B • Hepatitis C • Endocarditis • Skin, bone, and

    joint infections

    National Academies Workshop Sponsored by OASH, Report July 2018

    O F F I C E O F T H E

    A S S I S T A N T S E C R E T A R Y F O R H E A L T H

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    IV DRUG USE ASSOCIATED WITH ~9% OF NEW HIV CASES

    *

    * www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-23-4.pdf, all other data from https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2017-vol-29.pdf 5

    https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2017-vol-29.pdfwww.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-23-4.pdf

  • 6https://www.hhs.gov/opioids/

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    ENHANCED RESOURCES IN PRESIDENT’S FY2020 BUDGET REQUEST (HHS Budget in Brief)

    Due to the opioid epidemic, the United States is experiencing increases in certain infectious diseases as well as an increased number of disease outbreaks

    • The FY 2020 Budget provides $58 million to increase CDC’s Infectious Diseases and the Opioid Epidemic activities, $53 million above FY 2019

    • This program addresses the infectious disease consequences of the opioid epidemic and supports prevention and surveillance interventions in high-risk areas to reduce the spread of infectious disease

    O F F I C E O F T H E

    A S S I S T A N T S E C R E T A R Y F O R H E A L T H 7

  • COMPREHENSIVE SYRINGE SERVICES PROGRAMS: AN ESSENTIAL PART OF THE SYNDEMICS SOLUTION

    SSP participants are 5X more likely to enter drug treatment and 3.5X more likely to cease injecting compared to those who don’t use SSP programs

    88O F F I C E O F T H E

    A S S I S T A N T S E C R E T A R Y F O R H E A L T H

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    Our first two HCWs discharged

    SYRINGE SERVICE PROGRAM POLICY ENVIRONMENTS ACROSS THE UNITED STATES

    O F F I C E O F T H E

    A S S I S T A N T S E C R E T A R Y F O R H E A L T H https://www.nastad.org/maps/syringe-service-program-policy-environments-across-united-states

    https://www.nastad.org/maps/syringe-service-program-policy-environments-across-united-states

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    INTEGRATION OF HIV PREVENTION INTO PROGRAMS

    • Organizational tool to help clinic leadership and administrators evaluate capacity and organizational readiness for PrEP service delivery based on their clients’ needs

    • Extensive formative research including informational interviews, in-depth literature review, expert work group meeting, and pilot project

    • Dissemination and training plan implementation currently underway

    www.hhs.gov/opa/reproductive-health/hiv-and-staying-healthy O F F I C E O F T H E

    A S S I S T A N T S E C R E T A R Y F O R H E A L T H

    www.hhs.gov/opa/reproductive-health/hiv-and-staying-healthy

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    INCREASE HIV / HCV SERVICES AT DRUG TREATMENT PROGRAMS

    12.6

    15.3

    14.9

    60.9

    85.9

    93.5

    8.4

    9.5

    60.7

    86.8

    93.7

    HCV medication treatment

    Hep B vaccination

    Hep A vaccination

    Testing

    Risk reduction education

    Any services

    HIV medication treatment

    Pre‐Exposure Prophylaxis

    Testing

    Risk reduction education

    Any services

    Viral H

    epatitis S

    ervices

    HIV Services

    0 10 20 30 40 50 60 70 80 90 100

    Percentage of OTPs Offering Service

    O F F I C E O F T H E

    A S S I S T A N T S E C R E T A R Y F O R H E A L T H

    Jones CM et al., OTP Survey Conducted by SAMHSA August-October 2018; Data are from 476 responding OTPs 11

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    12O F F I C E O F T H E

    A S S I S T A N T S E C R E T A R Y F O R H E A L T H

    BRETT P. GIROIR, M.D. ADM, U.S. Public Health Service Assistant Secretary for Health, Senior Advisor for Opioid Policy

    WWW.HHS.GOV/ASH WWW.USPHS.GOV

    @HHS_ASH [email protected]

    mailto:[email protected]:WWW.USPHS.GOVWWW.HHS.GOV/ASH

    Transcending the Syndemic: