This measure would recognize the importance that viral load suppression plays in improving health outcomes and reducing HIV transmission in the state, and would encourage stakeholders in the HIV/AIDS community, and all Californians, to carefully examine the Office of AIDS findings and conclusions relating to a specified program on HIV when the office completes its findings and generates data related to that program.

This measure would recognize the importance that viral load suppression plays in improving health outcomes and reducing HIV transmission in the state, and would encourage stakeholders in the HIV/AIDS community, and all Californians, to carefully examine the Office of AIDS findings and conclusions relating to a specified program on HIV when the office completes its findings and generates data related to that program.

This measure would recognize the importance that viral load suppression plays in improving health outcomes and reducing HIV transmission in the state, and would encourage stakeholders in the HIV/AIDS community, and all Californians, to carefully examine the Office of AIDS to share the findings and conclusions of relating to a specified program on HIV with the Legislature when the office completes its findings and generates data related to that program.

This measure would recognize the importance that viral load suppression plays in improving health outcomes and reducing HIV transmission in the state, and would encourage the Office of AIDS to share the findings and conclusions of a specified program on HIV with the Legislature when the office completes its findings related to that program.

WHEREAS, More than 1.2 million people living in the United States are infected with HIV, and 1 in 8 is unaware of the infection; and

WHEREAS, In 2014, five states, including California, made up almost one-half of all new HIV diagnoses in the United States; and

WHEREAS, California has made significant progress through its Laying a Foundation for Getting to Zero, Californias Integrated HIV Surveillance, Prevention and Care Plan committed to zero new HIV infections, zero AIDS-related deaths, and zero stigma and discrimination against people living with HIV; and

WHEREAS, Significant advances in antiretroviral therapy (ART) for HIV have made it possible to reduce transmission rates, avoid over 862,000 premature deaths, gain over 27 million life-years, and gain $615 billion in economic value over the cost of HIV treatment in the United States alone; and

WHEREAS, A 2011 clinical study from the National Institutes of Health found that treating HIV-positive people with ART reduces the risk of transmitting the virus to HIV-negative sexual partners by 96 percent from the start of treatment; and

WHEREAS, The Centers for Disease Control and Prevention estimated that 126,241 people were diagnosed and living with HIV in California in 2014; however, only 52 percent (71,683 persons) achieved viral suppression, meaning that antiretroviral therapy has reduced a persons viral load to an undetectable level; and

WHEREAS, Medicaid expansion under the Affordable Care Act has played a critical role in decreasing the number of uninsured, particularly for people living with HIV. The states Medi-Cal program now covers about one-third of all Californians (roughly 13 million total) after Medicaid expansion added approximately 3.5 million Californians to the program since January 2014; and

WHEREAS, Viral load suppression saves state Medicaid programs an estimated $1 million per treated patient by preventing transmissions; and

WHEREAS, In its Clinical Quality Management Plan, HIV Care Program, AIDS Drug Assistance Program, the Office of AIDS report released May 2015, the State Department of Public Health, Office of AIDS expressed a vision that All people living with HIV/AIDS in California are virally suppressed and in care, and declared that viral load suppression not only improves individual health, but it also reduces HIV transmission on a population level; and

WHEREAS, The HIV Health Improvement Affinity Group (HHIAG) a joint initiative between the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, and the Health Resources and Services Administration offers federal support for state-level efforts to improve rates of sustained viral load suppression among Medicaid and Childrens Health Insurance Program enrollees who are living with HIV; and

WHEREAS, States, including California, that participate in the HHIAG benefit from direct technical assistance to develop and implement a viral load suppression improvement plan and leverage best practices to improve state viral load suppression rates; and

WHEREAS, Louisiana, also an HHIAG participant, successfully implemented an HIV surveillance data sharing agreement including viral load suppression between the states Medicaid program and Department of Public Health with the goal of improving health outcomes; and

WHEREAS, As a result of HHIAG, the Office of AIDS has committed to sharing its findings and data with the State Department of Health Care Services in order to assess and increase viral load suppression rates among Medicaid recipients living with HIV; now, therefore, be it

Resolved by the Senate of the State of California, the Assembly thereof concurring, That the Legislature recognizes the critical importance that viral load suppression plays in improving health outcomes and reducing HIV transmission on a population level in this state; and be it further

Resolved, That the Legislature encourages stakeholders in the HIV/AIDS community, and all Californians, to carefully examine the Office of AIDS findings and conclusions relating to the HHIAG when the office completes its findings and generates any related data; and be it further

Resolved, That the Secretary of the Senate transmit copies of this resolution to the author for appropriate distribution.

WHEREAS, More than 1.2 million people living in the United States are infected with HIV, and 1 in 8 is unaware of the infection; and

WHEREAS, In 2014, five states, including California, made up almost one-half of all new HIV diagnoses in the United States; and

WHEREAS, California has made significant progress through its Laying a Foundation for Getting to Zero, Californias Integrated HIV Surveillance, Prevention and Care Plan committed to zero new HIV infections, zero AIDS-related deaths, and zero stigma and discrimination against people living with HIV; and

WHEREAS, Significant advances in antiretroviral therapy (ART) for HIV have made it possible to reduce transmission rates, avoid over 862,000 premature deaths, gain over 27 million life-years, and gain $615 billion in economic value over the cost of HIV treatment in the United States alone; and

WHEREAS, A 2011 clinical study from the National Institutes of Health found that treating HIV-positive people with ART reduces the risk of transmitting the virus to HIV-negative sexual partners by 96 percent from the start of treatment; and

WHEREAS, The Centers for Disease Control and Prevention estimated that 126,241 people were diagnosed and living with HIV in California in 2014; however, only 52 percent (71,683 persons) achieved viral suppression, meaning that antiretroviral therapy has reduced a persons viral load to an undetectable level; and

WHEREAS, Medicaid expansion under the Affordable Care Act has played a critical role in decreasing the number of uninsured, particularly for people living with HIV. The states Medi-Cal program now covers about one-third of all Californians (roughly 13 million total) after Medicaid expansion added approximately 3.5 million Californians to the program since January 2014; and

WHEREAS, Viral load suppression saves state Medicaid programs an estimated $1 million per treated patient by preventing transmissions; and

WHEREAS, In its Clinical Quality Management Plan, HIV Care Program, AIDS Drug Assistance Program, the Office of AIDS report released May 2015, the State Department of Public Health, Office of AIDS expressed a vision that All people living with HIV/AIDS in California are virally suppressed and in care, and declared that viral load suppression not only improves individual health, but it also reduces HIV transmission on a population level; and

WHEREAS, The HIV Health Improvement Affinity Group (HHIAG) a joint initiative between the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, and the Health Resources and Services Administration offers federal support for state-level efforts to improve rates of sustained viral load suppression among Medicaid and Childrens Health Insurance Program enrollees who are living with HIV; and

WHEREAS, States, including California, that participate in the HHIAG benefit from direct technical assistance to develop and implement a viral load suppression improvement plan and leverage best practices to improve state viral load suppression rates; and

WHEREAS, Louisiana, also an HHIAG participant, successfully implemented an HIV surveillance data sharing agreement including viral load suppression between the states Medicaid program and Department of Public Health with the goal of improving health outcomes; and

WHEREAS, As a result of HHIAG, the Office of AIDS has committed to sharing its findings and data with the State Department of Health Care Services in order to assess and increase viral load suppression rates among Medicaid recipients living with HIV; now, therefore, be it

Resolved by the Senate of the State of California, the Assembly thereof concurring, That the Legislature recognizes the critical importance that viral load suppression plays in improving health outcomes and reducing HIV transmission on a population level in this state; and be it further

Resolved, That the Legislature encourages stakeholders in the HIV/AIDS community, and all Californians, to carefully examine the Office of AIDS findings and conclusions relating to the HHIAG when the office completes its findings and generates any related data; and be it further

Resolved, That the Secretary of the Senate transmit copies of this resolution to the author for appropriate distribution.

WHEREAS, More than 1.2 million people living in the United States are infected with HIV, and 1 in 8 is unaware of the infection; and

WHEREAS, In 2014, five states, including California, made up almost one-half of all new HIV diagnoses in the United States; and

WHEREAS, California has made significant progress through its Laying a Foundation for Getting to Zero, Californias Integrated HIV Surveillance, Prevention and Care Plan committed to zero new HIV infections, zero AIDS-related deaths, and zero stigma and discrimination against people living with HIV; and

WHEREAS, Significant advances in antiretroviral therapy (ART) for HIV have made it possible to reduce transmission rates, avoid over 862,000 premature deaths, gain over 27 million life-years, and gain $615 billion in economic value over the cost of HIV treatment in the United States alone; and

WHEREAS, A 2011 clinical study from the National Institutes of Health found that treating HIV-positive people with ART reduces the risk of transmitting the virus to HIV-negative sexual partners by 96 percent from the start of treatment; and

WHEREAS, The Centers for Disease Control and Prevention estimated that 126,241 people were diagnosed and living with HIV in California in 2014; however, only 52 percent (71,683 persons) achieved viral suppression, meaning that antiretroviral therapy has reduced a persons viral load to an undetectable level; and

WHEREAS, Medicaid expansion under the Affordable Care Act has played a critical role in decreasing the number of uninsured, particularly for people living with HIV. The states Medi-Cal program now covers about one-third of all Californians (roughly 13 million total) after Medicaid expansion added approximately 3.5 million Californians to the program since January 2014; and

WHEREAS, Viral load suppression saves state Medicaid programs an estimated $1 million per treated patient by preventing transmissions; and

WHEREAS, In its Clinical Quality Management Plan, HIV Care Program, AIDS Drug Assistance Program, the Office of AIDS report released May 2015, the State Department of Public Health, Office of AIDS expressed a vision that All people living with HIV/AIDS in California are virally suppressed and in care, and declared that viral load suppression not only improves individual health, but it all also reduces HIV transmission on a population level; and

WHEREAS, The HIV Health Improvement Affinity Group (HHIAG) a joint initiative between the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, and the Health Resources and Services Administration offers federal support for state-level efforts to improve rates of sustained viral load suppression among Medicaid and Childrens Health Insurance Program enrollees who are living with HIV; and

WHEREAS, States, including California, that participate in the HHIAG benefit from direct technical assistance to develop and implement a viral load suppression improvement plan and leverage best practices to improve state viral load suppression rates; and

WHEREAS, Louisiana, also an HHIAG participant, successfully implemented an HIV surveillance data sharing agreement including viral load suppression between the states Medicaid program and Department of Public Health with the goal of improving health outcomes; and

WHEREAS, As a result of HHIAG, the Office of AIDS has committed to sharing its findings and data with the State Department of Health Care Services in order to assess and increase viral load suppression rates among Medicaid recipients living with HIV; now, therefore, be it

Resolved by the Senate of the State of California, the Assembly thereof concurring, That the Legislature recognizes the critical importance that viral load suppression plays in improving health outcomes and reducing HIV transmission on a population level in this state; and be it further

Resolved, That the Legislature encourages stakeholders in the HIV/AIDS community, and all Californians, to carefully examine the Office of AIDS should share the findings and conclusions of relating to the HHIAG with the Legislature at the time that when the office completes its findings and generates any related data; and be it further

Resolved, That the Secretary of the Senate transmit copies of this resolution to the author for appropriate distribution.

WHEREAS, More than 1.2 million people living in the United States are infected with HIV, and 1 in 8 is unaware of the infection; and

WHEREAS, In 2014, five states, including California, made up almost one-half of all new HIV diagnoses in the United States; and

WHEREAS, California has made significant progress through its Laying a Foundation for Getting to Zero, Californias Integrated HIV Surveillance, Prevention and Care Plan committed to zero new HIV infections, zero AIDS-related deaths, and zero stigma and discrimination against people living with HIV; and

WHEREAS, Significant advances in antiretroviral therapy (ART) for HIV have made it possible to reduce transmission rates, avoid over 862,000 premature deaths, gain over 27 million life-years, and gain $615 billion in economic value over the cost of HIV treatment in the United States alone; and

WHEREAS, A 2011 clinical study from the National Institutes of Health found that treating HIV-positive people with ART reduces the risk of transmitting the virus to HIV-negative sexual partners by 96 percent from the start of treatment; and

WHEREAS, The Centers for Disease Control and Prevention estimated that 126,241 people were diagnosed and living with HIV in California in 2014; however, only 52 percent (71,683 persons) achieved viral suppression, meaning that antiretroviral therapy has reduced a persons viral load to an undetectable level; and

WHEREAS, Medicaid expansion under the Affordable Care Act has played a critical role in decreasing the number of uninsured, particularly for people living with HIV. The states Medi-Cal program now covers about one-third of all Californians (roughly 13 million total) after Medicaid expansion added approximately 3.5 million Californians to the program since January 2014; and

WHEREAS, Viral load suppression saves state Medicaid programs an estimated $1 million per treated patient by preventing transmissions; and

WHEREAS, In its Clinical Quality Management Plan, HIV Care Program, AIDS Drug Assistance Program, the Office of AIDS report released May 2015, the State Department of Public Health, Office of AIDS expressed a vision that All people living with HIV/AIDS in California are virally suppressed and in care, and declared that viral load suppression not only improves individual health, but it all reduces HIV transmission on a population level; and

WHEREAS, The HIV Health Improvement Affinity Group (HHIAG) a joint initiative between the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, and the Health Resources and Services Administration offers federal support for state-level efforts to improve rates of sustained viral load suppression among Medicaid and Childrens Health Insurance Program enrollees who are living with HIV; and

WHEREAS, States, including California, that participate in the HHIAG benefit from direct technical assistance to develop and implement a viral load suppression improvement plan and leverage best practices to improve state viral load suppression rates; and

WHEREAS, Louisiana, also an HHIAG participant, successfully implemented an HIV surveillance data sharing agreement including viral load suppression between the states Medicaid program and Department of Public Health with the goal of improving health outcomes; and

WHEREAS, As a result of HHIAG, the Office of AIDS has committed to sharing its findings and data with the State Department of Health Care Services in order to assess and increase viral load suppression rates among Medicaid recipients living with HIV; now, therefore, be it

Resolved by the Senate of the State of California, the Assembly thereof concurring, That the Legislature recognizes the critical importance that viral load suppression plays in improving health outcomes and reducing HIV transmission on a population level in this state; and be it further

Resolved, That the Office of AIDS should share the findings and conclusions of the HHIAG with the Legislature at the time that the office completes its findings and any related data; and be it further

Resolved, That the Secretary of the Senate transmit copies of this resolution to the author for appropriate distribution.

SENATE THIRD READING

STR Bill Id:SCR 74

Author:(Wiener)

As Amended Ver:August 28, 2017

Majority vote

SENATE VOTE: 38-0

SUMMARY: Recognizes the critical importance that viral load suppression (VLS) plays in improving health outcomes and reducing human immunodeficiency virus (HIV) transmissions on a population level in this state and encourages stakeholders in the HIV/acquired immunodeficiency syndrome (AIDS) community, and all Californians, to carefully examine the Office of AIDS findings and conclusions relating to the HIV Health Improvement Affinity Group (HHIAG) when the Office of AIDS completes its findings and generates any related data. Specifically, this resolution makes legislative findings and declarations related to HIV viral load suppression, including:

1. More than 1.2 million people living in the United States are infected with HIV, and one in eight is unaware of the infection.
2. In 2014, five states, including California, made up almost one-half of all new HIV diagnoses in the United States.
3. California has made significant progress through its "Laying a Foundation for Getting to Zero, California's Integrated HIV Surveillance, Prevention and Care Plan" — committed to zero new HIV infections, zero AIDS-related deaths, and zero stigma and discrimination against people living with HIV.
4. Significant advances in antiretroviral therapy (ART) for HIV have made it possible to reduce transmission rates, avoid over 862,000 premature deaths, gain over 27 million life-years, and gain $615 billion in economic value over the cost of HIV treatment in the United States alone.
5. A 2011 clinical study from the National Institutes of Health found that treating HIV-positive people with ART reduces the risk of transmitting the virus to HIV-negative sexual partners by 96% from the start of treatment.
6. Viral load suppression saves state Medicaid programs an estimated $1 million per treated patient by preventing transmissions.
7. The HHIAG – a joint initiative between the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention (CDC), and the Health Resources and Services Administration – offers federal support for state-level efforts to improve rates of sustained viral load suppression among Medicaid and Children's Health Insurance Program enrollees who are living with HIV.
8. States, including California, that participate in the HHIAG benefit from direct technical assistance to develop and implement a viral load suppression improvement plan and leverage best practices to improve state viral load suppression rates.
9. As a result of HHIAG, the Office of AIDS has committed to sharing its findings and data with the Department of Health Care Services in order to assess and increase viral load suppression rates among Medicaid recipients living with HIV; and other related findings and declarations.

FISCAL EFFECT: None

COMMENTS: According to the author, while several legislators of both parties have pursued regular exchanges with the Department of Public Health (DPH) regarding the benefits and outcomes of its participation in the HHIAG, these letters, though thorough, are no substitute for uniform and transparent information for all interested parties. This resolution will highlight this aspect of the DPH's efforts at productive collaboration, currently ongoing and expected to produce a round of informative results later in 2018.

This resolution is both consistent with and promotional of the critical goals expressed in DPH's "Laying a Foundation for Getting to Zero: California's Integrated HIV Surveillance, Prevention, and Care Plan" to: a) increase the percentage of Californians newly diagnosed with HIV who are virally suppressed within six months of diagnosis to at least 75%, b) increase the percentage of Californians with diagnosed HIV infection who are virally suppressed to at least 80%; and, c) increase the percentage of Californians with diagnosed HIV infection who are in HIV medical care (at least one visit per year) to at least 90%.

Background: According to information from the CDC, there are 119,589 Californians living with diagnosed HIV in 2014, with 4,720 new HIV diagnoses in 2015. In California, gay, bisexual, and other men who have sex with men represent the majority of those living with HIV, as well as those newly infected with the virus. Persons who inject drugs, transgender women, and other high-risk heterosexuals, including sex workers and persons with HIV-positive sex partners, represent smaller but significant HIV-infected populations.

1. Viral load suppression and ART. A viral load measurement is the amount of a virus in an organism, typically in the bloodstream, usually stated in virus particles per milliliter. Related to HIV, Viral load suppression (VLS) occurs when an individual's viral load is undetectable. Successful Antiretroviral Therapy (ART) reduces a person's viral load to an undetectable level. Viral suppression does not mean a person is cured; HIV still remains in the body. If ART is discontinued, the person's viral load will likely return to a detectable level. The primary purpose of ART is to keep people living with HIV in good health. In the large majority of people living with HIV, ART can be chosen that reduce the amount of HIV in the blood to levels that are undetectable by standard laboratory tests.
2. AIDS Drug Assistance Program (ADAP). ADAP is a program administered by DPH that provides access to life-saving medications for eligible California residents living with HIV, and assistance with covering costs related to HIV pre-exposure prophylaxis (PrEP) for clients at risk for acquiring HIV. The number of ADAP clients experienced a downward trend from fiscal year (FY) 2009-10 to FY 2015-16, but has been on a steady climb since then reflecting an increase in new HIV infections in California.

ViiV Healthcare (ViiV) and GlaxoSmithKline (GSK) write in support that this resolution recognizes the critical role VLS plays in treating HIV and reducing new transmissions. ViiV and GSK state treating to VLS saves state Medicaid programs an estimated $1 million per treated patient by preventing an average of 2.65 transmissions over 50 years. This can only occur, however, if people living with HIV are diagnosed, have access to medical care, receive treatment, and remain adherent to their prescribed therapy. Supporters state that there is more to be done as approximately 1.2 million people in the United States have HIV, and 13% are unaware that they are infected. The transparency required by this resolution will provide the information and data required to enhance collaboration among public and private stakeholders committed to ending the HIV epidemic; and implement performance improvement projects to address gaps along the HIV care continuum.

There is no known opposition to this resolution.

Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097 FN: 0002642

Date of Hearing: March 20, 2018

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

SBPCA Bill Id:SCR 74

Author:(Wiener) – As Amended Ver:August 28, 2017

SENATE VOTE: 38-0

SUBJECT: HIV viral load suppression.

SUMMARY: Recognizes the critical importance that viral load suppression (VLS) plays in improving health outcomes and reducing human immunodeficiency virus (HIV) transmissions on a population level in this state and encourages stakeholders in the HIV/acquired immunodeficiency syndrome (AIDS) community, and all Californians, to carefully examine the Office of AIDS findings and conclusions relating to the HIV Health Improvement Affinity Group (HHIAG) when the Office of AIDS completes its findings and generates any related data. Specifically, this resolution makes legislative findings and declarations related to HIV viral load suppression, including:

1. More than 1.2 million people living in the United States are infected with HIV, and one in eight is unaware of the infection.
2. In 2014, five states, including California, made up almost one-half of all new HIV diagnoses in the United States.
3. California has made significant progress through its “Laying a Foundation for Getting to Zero, California’s Integrated HIV Surveillance, Prevention and Care Plan” — committed to zero new HIV infections, zero AIDS-related deaths, and zero stigma and discrimination against people living with HIV.
4. Significant advances in antiretroviral therapy (ART) for HIV have made it possible to reduce transmission rates, avoid over 862,000 premature deaths, gain over 27 million life-years, and gain $615 billion in economic value over the cost of HIV treatment in the United States alone.
5. A 2011 clinical study from the National Institutes of Health found that treating HIV-positive people with ART reduces the risk of transmitting the virus to HIV-negative sexual partners by 96% from the start of treatment.
6. Viral load suppression saves state Medicaid programs an estimated $1 million per treated patient by preventing transmissions.
7. The HIV Health Improvement Affinity Group (HHIAG) — a joint initiative between the Centers for Medicare and Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), and the Health Resources and Services Administration — offers federal support for state-level efforts to improve rates of sustained viral load suppression among Medicaid and Children’s Health Insurance Program enrollees who are living with HIV.
8. States, including California, that participate in the HHIAG benefit from direct technical assistance to develop and implement a viral load suppression improvement plan and leverage best practices to improve state viral load suppression rates.
9. As a result of HHIAG, the Office of AIDS has committed to sharing its findings and data with the Department of Health Care Services (DHCS) in order to assess and increase viral load suppression rates among Medicaid recipients living with HIV; and other related findings and declarations.

FISCAL EFFECT: None

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, while several legislators of both parties have pursued regular exchanges with the Department of Public Health (DPH) regarding the benefits and outcomes of its participation in the HIV HIAG, these letters, though thorough, are no substitute for uniform and transparent information for all interested parties. This resolution will highlight this aspect of the DPH's efforts at productive collaboration, currently ongoing and expected to produce a round of informative results later in 2018.

SCR 74 is both consistent with and promotional of the critical goals expressed in DPH’s “Laying a Foundation for Getting to Zero: California’s Integrated HIV Surveillance, Prevention, and Care Plan” to: a) increase the percentage of Californians newly diagnosed with HIV who are virally suppressed within six months of diagnosis to at least 75%, b) increase the percentage of Californians with diagnosed HIV infection who are virally suppressed to at least 80%; and, c) increase the percentage of Californians with diagnosed HIV infection who are in HIV medical care (at least one visit per year) to at least 90%.

1. BACKGROUND. According to information from the CDC, there are 119,589 Californians living with diagnosed HIV in 2014, with 4,720 new HIV diagnoses in 2015. In California, gay, bisexual, and other men who have sex with men represent the majority of those living with HIV, as well as those newly infected with the virus. Persons who inject drugs, transgender women, and other high-risk heterosexuals, including sex workers and persons with HIV-positive sex partners, represent smaller but significant HIV-infected populations.
   1. Viral load suppression and ART. A viral load measurement is the amount of a virus in an organism, typically in the bloodstream, usually stated in virus particles per milliliter. Related to HIV, VLS occurs when an individual's viral load is undetectable. Successful ART reduce a person’s viral load to an undetectable level. Viral suppression does not mean a person is cured; HIV still remains in the body. If ART is discontinued, the person’s viral load will likely return to a detectable level. The primary purpose of ART is to keep people living with HIV in good health. In the large majority of people living with HIV, ART can be chosen that reduce the amount of HIV in the blood to levels that are undetectable by standard laboratory tests.
   2. Laying a Foundation for Getting to Zero: California’s Integrated HIV Surveillance, Prevention, and Care Plan. According to DPH, the California Integrated HIV Surveillance, Prevention and Care Plan outlines the strategies and objectives to be implemented in order to enable California to “Get to Zero.” Getting to zero means getting to a time when there are no new HIV infections, no AIDS-related deaths, and no stigma and discrimination against people living with HIV (PLWH). The Integrated Plan was developed by DPH, the Center for Infectious Diseases, Office of AIDS in collaboration with local health jurisdictions and HIV planning bodies throughout California, other state programs that serve PLWH including Medi-Cal, Covered California, and the California Department of Corrections and Rehabilitation, and key stakeholders in the private sector, with input and review by a broad array of community stakeholders. The Integrated Plan establishes a blueprint to guide the work of the state and local health departments from 2017 to 2021 as we strive to finally get to zero. The four goals of California’s Integrated HIV Surveillance, Prevention, and Care Plan align closely with the goals of the National HIV/AIDS Strategy. Those goals are as follows:
      1. Reduce new HIV infections in California;
      2. Increase access to care and improve health outcomes for PLWH in California;
      3. Reduce HIV-related disparities and health inequities in California; and,
      4. Achieve a more coordinated statewide response to the HIV epidemic.

The Integrated Plan is meant to give a voice to all Californians at risk for and living with HIV, and to implement strategies that recognize the interplay between biological, behavioral, psychosocial, and structural factors that affect the health and well-being of those most profoundly affected by the epidemic. To ensure that communities disproportionately affected by HIV are addressed in the Integrated Plan, the Integrated Plan describes the relationship between social and health inequities and defines specific sub-objectives to be achieved to address health disparities.

• 1. The HIV Health Improvement Affinity Group. According to the Federal Department of Health and Human Services, HHIAG offers federal support for state-level efforts to improve rates of sustained virologic suppression among Medicaid and Children’s Health Insurance Program (CHIP) enrollees who are living with HIV. Those efforts are guided by teams made up of state public health and Medicaid/CHIP agencies, who collaborate to develop and implement performance improvement projects that address gaps along the HIV care continuum for Medicaid/CHIP enrollees.

The HHIAG is a joint initiative between CMS, CDC, and the Health Resources and Services Administration (HRSA), in collaboration with the HHS Office of HIV/AIDS and Infectious Disease Policy, and in partnership with the National Academy for State Health Policy. Participating states benefit from direct technical assistance as they develop and implement a viral suppression improvement plan for their state. Opportunities for state-to-state learning and sharing of best and promising approaches to improve VLS among enrollees who are living with HIV and stronger collaborative relationships among state Medicaid/CHIP programs, state public health departments, and federal and other partners. In addition to these direct benefits to the states, HHS expects to learn valuable lessons that will be useful to other states that want to improve VLS rates and may identify additional opportunities to improve HIV and other health outcomes.

• 1. AIDS Drug Assistance Program (ADAP). ADAP is a program administered by DPH that provides access to life-saving medications for eligible California residents living with HIV, and assistance with covering costs related to HIV pre-exposure prophylaxis (PrEP) for clients at risk for acquiring HIV. ADAP services, including support for medications, health insurance premiums, and medical out-of-pocket costs, are provided to PLWH who do not have private insurance and are not enrolled in Medi-Cal or Medicare, PLWH enrolled in Medi-Cal who have a share of cost for Medi-Cal services, PLWH who have some form of health insurance, but still require assistance with out of pocket costs associated with HIV, PLWH who are enrolled in Medicare and have purchased Medicare Part D plans for medication coverage, and PrEP clients who are at risk for, but not infected with HIV, and have chosen to take PrEP as a way to prevent infection. The number of ADAP clients experienced a downward trend from fiscal year (FY) 2009-10 to FY 2015-16, but has been on a steady climb since then reflecting an increase in new HIV infections in California.

1. SUPPORT. ViiV Healthcare (ViiV) and GlaxoSmithKline (GSK) write in support that this resolution recognizes the critical role VLS plays in treating HIV and reducing new transmissions. ViiV and GSK state treating to VLS saves state Medicaid programs an estimated $1 million per treated patient by preventing an average of 2.65 transmissions over 50 years. This can only occur, however, if people living with HIV are diagnosed, have access to medical care, receive treatment, and remain adherent to their prescribed therapy. Supporters state that there is more to be done as approximately 1.2 million people in the U.S. have HIV, and 13% are unaware that they are infected. According to the CDC, only 33% of people living with HIV are on ART, and only 25% are virally suppressed. Despite groundbreaking treatments that have slowed the progression and disease burden, the pace of new infections continues to grow, especially among certain minority and geographic groups. Supporters note that this resolution encourages the California’s Office of AIDS to submit a full report to the Assembly and Senate of its final findings and data shared with the DHCS as a part of the state’s participation in the HHIAG and make this information publicly available so it may inform state-level quality improvement opportunities to increase rates of sustained viral load suppression among Medicaid enrollees living with HIV. The transparency required by this resolution will provide the information and data required to enhance collaboration among public and private stakeholders committed to ending the HIV epidemic; and implement performance improvement projects to address gaps along the HIV care continuum.

REGISTERED SUPPORT / OPPOSITION:

Support

GlaxoSmithKline (cosponsor)

ViiV Healthcare (cosponsor)

California Chronic Care Coalition

Opposition

None on file.

Analysis Prepared by: Paula Villescaz / HEALTH / (916) 319-2097

 THIRD READING 

Bill No: SCR 74

Author: Wiener (D), et al.

Amended: 8/28/17

Vote: 21

SUBJECT: HIV viral load suppression

SOURCE: Author

DIGEST:

This resolution recognizes the importance that viral load suppression plays in improving health outcomes and reducing HIV transmission in the state, and encourages stakeholders in the HIV/AIDS community, and all Californians, to carefully examine the Office of AIDS findings and conclusions relating to a specified program on HIV when the office completes its findings and generates data related to that program.

ANALYSIS: This resolution makes the following legislative findings:

1. More than 1.2 million people living in the United States are infected with HIV, and 1 in 8 is unaware of the infection.
2. California has made significant progress through its “Laying a Foundation for Getting to Zero, California’s Integrated HIV Surveillance, Prevention and Care Plan” — committed to zero new HIV infections, zero AIDS-related deaths, and zero stigma and discrimination against people living with HIV.
3. Significant advances in antiretroviral therapy (ART) for HIV have made it possible to reduce transmission rates, avoid over 862,000 premature deaths, gain over 27 million life-years, and gain $615 billion in economic value over the cost of HIV treatment in the United States alone.
4. The Centers for Disease Control and Prevention estimated that 126,241 people were diagnosed and living with HIV in California in 2014; however, only 52 percent (71,683 persons) achieved viral suppression, meaning that antiretroviral therapy has reduced a person’s viral load to an undetectable level.
5. Viral load suppression saves state Medicaid programs an estimated $1 million per treated patient by preventing transmissions.
6. In its Clinical Quality Management Plan, HIV Care Program, AIDS Drug Assistance Program, the Office of AIDS report released May 2015, the State Department of Public Health, Office of AIDS expressed a vision that “All people living with HIV/AIDS in California are virally suppressed and in care,” and declared that “viral load suppression not only improves individual health, but it also reduces HIV transmission on a population level.”
7. The HIV Health Improvement Affinity Group (HHIAG) — a joint initiative between the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, and the Health Resources and Services Administration — offers federal support for state-level efforts to improve rates of sustained viral load suppression among Medicaid and Children’s Health Insurance Program enrollees who are living with HIV. States, including California, that participate in the HHIAG benefit from direct technical assistance to develop and implement a viral load suppression improvement plan and leverage best practices to improve state viral load suppression rates.
8. As a result of HHIAG, the Office of AIDS has committed to sharing its findings and data with the State Department of Health Care Services in order to assess and increase viral load suppression rates among Medicaid recipients living with HIV.

This resolution:

1. Recognizes the critical importance that viral load suppression plays in improving health outcomes and reducing HIV transmission on a population level in this state.
2. Encourages stakeholders in the HIV/AIDS community, and all Californians, to carefully examine the Office of AIDS findings and conclusions of relating to the HHIAG when the office completes its findings and generates any related data.

Background

The HIV Health Improvement Affinity Group (HHIAG). The HIV Health Improvement Affinity Group (HHIAG) offers federal support for state-level efforts to improve rates of sustained virologic suppression among Medicaid and Children's Health Insurance Program (CHIP) enrollees who are living with HIV. Those efforts are guided by teams made up of state public health and Medicaid/CHIP agencies, who will collaborate to develop and implement performance improvement projects that address gaps along the HIV care continuum for Medicaid/CHIP enrollees.

The HHIAG is a joint initiative between the Centers for Medicare and Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), and the Health Resources and Services Administration (HRSA), in collaboration with the HHS Office of HIV/AIDS and Infectious Disease Policy, and in partnership with the National Academy for State Health Policy.

Group members began their work via webinar in October 2016, and at an in-person meeting in Washington, DC, on December 6-7, 2016. For a 12-month period, they will participate in monthly state team calls with CMS, CDC, and HRSA, and in monthly HHIAG virtual meetings with other states and quality-improvement experts. CDC, CMS, and HRSA staff, as well as other state and local partners, will also provide technical assistance to the state teams.

Comments

According to the author:

SCR 74 would highlight the important role viral load suppression treatments play in combatting HIV/AIDS and in particular note the California Dept. of Public Health’s participation in the promising and innovative HIV Health Improvement Affinity Group, a partnership between federal agencies such as the Centers for Disease Control and Prevention and state health agencies. While states such as Louisiana have used Affinity Group resources to pioneer new data-sharing techniques and improve health outcomes, there remain over 1.2 million people in the United States living with HIV/AIDS and much works remains to be done. This important resolution would ensure California’s legislature joins health and advocacy organizations in recognizing the critical role viral load suppression treatments play in our fight against HIV/AIDS.

FISCAL EFFECT: Appropriation: No Fiscal Com.: No Local: No

SUPPORT: (Verified 9/6/17)

APLA Health

GlaxoSmithKline

San Francisco AIDS Foundation

ViiV Healthcare

OPPOSITION: (Verified 9/6/17)

None received

ARGUMENTS IN SUPPORT: In support, APLA Health and GlaxoSmithKline state:

SCR 74 would encourage the California’s Office of AIDS to submit a full report to the Assembly and Senate of its final findings and data shared with the California Department of Health Care Services as a part of the state’s participation in the HIV Health Improvement Affinity Group and make this information publicly available so it may inform state-level quality improvement opportunities to increase rates of sustained viral load suppression among Medicaid enrollees living with HIV. The transparency required by SCR 74 will provide the information and data required to enhance collaboration among public and private stakeholders committed to ending the HIV epidemic; and implement performance improvement projects to address gaps along the HIV care continuum.

Prepared by: Jonas Austin / SFA / (916) 651-1520

9/12/17 9:34:34

**** END ****