Introduction to NCHHSTP National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Office of the Director Jonathan Mermin, MD, MPH National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Centers for Disease Control and Prevention 2015 CDC New Health Official Orientation May 14, 2015

About NCHHSTP  Mission: Save lives, protect people, and reduce health disparities associated with HIV, viral hepatitis, STDs, and TB  Goals:  Decrease incidence of infection  Decrease morbidity and mortality  Decrease health disparities  Guiding principle—High Impact Prevention:  Maximize impact through efficient implementation of cost effective and feasible interventions, policy, and research

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Divisions Office of the Director Division of HIV/AIDS Division of Adolescent and School Health Division of Viral Hepatitis Division of STD Prevention Division of Tuberculosis Elimination

NCHHSTP FY 2015 Appropriation, By Division Total: $1.12 billion Div. of STD Prevention Division of Adolescent and School Health Div. of Viral Hepatitis Div. of TB Elimination Division of HIV/AIDS Prevention

HIV Prevalence and New Infections Number of people living with HIV has grown because incidence is relatively stable and survival has increased Hall HI et al. JAMA 2008 Aug 6;300(5):520-9; Prejean J et al PLoS One 2011;6(8):e17502; MMWR 2012 Mar 2;61(8):133-8

Burden of Viral Hepatitis  Viral hepatitis is the most common blood-borne infection in the U.S. – and the leading cause of liver cancer  An estimated 3.5 million to 5.3 million Americans live with hepatitis B and hepatitis C infection  At least 18,500 Americans die from viral hepatitis B and C each year

Estimated Incidence of Sexually Transmitted Infections and HIV, United States, 2008

TB in United States, 2014  9,412 new cases of TB reported in 2014  Rate of 3 cases per 100,000  30 times greater than elimination target of one case per million (300 cases total)  About 75% of new cases resulted from reactivated latent TB infection (LTBI)

Youth Health Risks, 2013  41% of 9-12 grade students surveyed had texted or e- mailed while driving in past 30 days  22% of students reported current tobacco use  62% of students reported ever drinking alcohol  21% of students reported drinking 5 or more alcoholic drinks in a row in past 30 days  47% of students had ever had sexual intercourse  59% of sexually active students reported using condoms  14% of students were obese  15% of students had been electronically bullied in last 12 months  8% had attempted suicide in last 12 months Youth Risk Behavior Surveillance — United States, 2013

Cost Effectiveness of Prevention HIVViral HepatitisTBSTDsSchool Health , averted 350,000 HIV infections; saved ≥$125 billion Screening of persons born reduces HCV- related deaths by 121,000 at $35,700 per quality- adjusted life year gained (QALY) Est. 200,000 TB cases prevented since Saved $3.4 billion Reductions in gonorrhea and syphilis resulted in $6.5 billion in estimated savings. Every dollar invested in school-based HIV, STI, and pregnancy prevention saves $2.65 in medical and social costs Single case of HIV infection costs $402,000 in care Hepatitis B virus screening of persons at increased risk is cost effective at $29,230 per QALY Costs of treatment for multi-drug resistant TB is $134,000 per case; and for XDR-TB, $430,000 per case Chlamydia screening in sexually active young women costs from $2,500–$37,000 per QALY

HIV Prevention Key Issues  Treatment saves lives and prevents transmission  Data to care  Preexposure prophylaxis (PrEP)

Hepatitis C Prevention Key Issues  New treatments much more effective  Expensive, but cost effective over time  Increase in new cases, especially among young people who inject drugs  Public health opportunity

Tuberculosis Key Issues  Addressing LTBI will hasten progress toward TB elimination in United States  LTBI last vestige of TB in United States  New blood test screening available for LTBI  New, shorter treatment available for LTBI  Rifapentine and INH once a week for 12 weeks

STDs Key Issues  Drug resistant gonorrhea  Syphilis increasing among men who have sex with men  Need for new STD prevention messaging

Adolescent and School Health Key Issues  LGBT youth  Linkage to health services  Health education along the life course

Thank you National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention Website: