STD Quarterly

Public health officials focus on HIV efforts in DC

When it comes to HIV/AIDS, the nation's capitol is experiencing some of the highest rates in the United States. At least 3% of District of Columbia (DC) residents have HIV or AIDS, according to a 2009 epidemiology report by the DC HIV/AIDS office.1 HIV and AIDS cases increased 22% from 2006 statistics and touched every race and sex across the city's population and neighborhoods.2

To combat the problem, the National Institutes of Health (NIH) and the city of Washington, DC, have rolled out the DC Partnership for HIV/ AIDS Progress, a collaborative research initiative between the federal agency's National Institute of Allergy and Infectious Diseases (NIAID) and the DC Department of Health. NIH has allocated $26.4 million for the first two years of the partnership through funding from the NIAID and the NIH Office of AIDS Research.

The collaboration is designed to decrease the rate of new HIV infections in the city, improve the health of district residents living with HIV infection, and strengthen the city's response to the HIV/AIDS epidemic.

"Tragically, our nation's capital has one of the highest rates of HIV/AIDS, where about 3% of adults and adolescents are infected with the virus," said Anthony Fauci, MD, NIAID director, in announcing the partnership. "By collaborating with Mayor [Adrian] Fenty's administration to establish the new DC Partnership for HIV/AIDS Progress, NIH will seek to answer critical HIV research questions that could positively affect the district's HIV/AIDS problem and serve as a model for programs in other U.S. cities as well."

Focus on four areas

The new partnership will focus on four strategies of attack:

  • identifying populations at high risk for HIV acquisition and developing effective risk reduction interventions;
  • establishing a citywide data analysis mechanism to identify and address health issues and outcomes for those receiving HIV care and treatment;
  • enhancing the city's HIV-related subspecialty medical care and supplementing access to research studies;
  • conducting a pilot program to study the voluntary test-and-treat concept to curtail new HIV infection cases.

According to DC Department of Health statistics, African Americans make up 76% of the district's HIV/AIDS cases.1 Two NIAID observational studies are including DC residents to better understand the risk factors for HIV infection in developing effective interventions for reducing risk. Both studies are being conducted by the agency's HIV Prevention Trials Network (HPTN). Local efforts are being coordinated through a HPTN clinical site at the George Washington University School of Public Health and Health Services.

The first study, HPTN 061, focuses on black men who have sex with men. Participants receive HIV risk-reduction counseling and condoms; testing for HIV and other sexually transmitted infections; screenings for substance use, mental health issues, and partner and/or homophobic violence; and a peer system to help them navigate the health care system and use HIV services. Already under way, the two-year study will enroll 2,460 men in six U.S. cities, including about 400 DC participants.

The second study, HPTN 064, is designed to estimate HIV incidence among African-American women from areas with high rates of HIV and poverty. The six-city study will enroll 1,200 women, including 200 DC women.

An important element of the new partnership will be the development of a districtwide data system, achieved by linking information from 13 of the city's largest health care providers. By establishing such a system, public health officials hope to better assess the clinical and treatment status of individual HIV-infected patients, evaluate outcomes of specific clinics and health programs, and measure the impact of HIV testing and treatment initiatives within the city.

Partnership officials also are focusing on enhancing care for HIV-related medical issues, because non-AIDS defining illnesses and HIV coinfections, such as cardiovascular disease, diabetes, and hepatitis, are significant causes of illness and death for many HIV-infected patients.

The NIH and the DC Department of Health are working with Washington medical providers to establish clinics designed to provide HIV-related subspecialty care to underinsured patients in district communities most in need. At the present time, three clinics — Family & Medical Counseling Service, Walker Jones Health Center of Unity Health Services, and Whitman-Walker Clinic — have been included in the collaborative effort.

Henry Masur, MD, chief of the NIH Clinical Center's Critical Care Medicine Department, says, "The goals of the clinics are to enhance subspecialty medical care for underinsured HIV-infected patients, assess the need for specific clinical trials on given issues, and if clinical trials are deemed necessary, provide those patients with access to the latest treatments available. This program also will focus on mentoring promising young leaders in HIV medicine who could enhance the district's reputation as a leader in developing new strategies for the prevention, diagnosis, and treatment of HIV/AIDS."

Partnership officials also plan a test-and-treat pilot study to compare current community standards for HIV testing and treatment with accelerated expansion of routine testing services. The study will be designed to identify HIV-infected people and evaluate enhanced methods to rapidly link them to care and successful treatment.

References

  1. District of Columbia Department of Health HIV/AIDS Administration. District of Columbia HIV/AIDS Epidemiology Update 2008. February 2009. Accessed at doh.dc.gov.
  2. Vargas JA, Fears D. HIV/AIDS Rate in D.C. Hits 3%. The Washington Post, March 15, 2009. Accessed at www.washingtonpost.com.