RWHAP Considerations and Resources
As jurisdictions continue to recommend isolation, quarantine, and physical distancing protocols, RWHAP grantees – and ADAPs in particular – have been implementing policies to ensure continued access to medications and health care services for clients. In support of these efforts, HRSA’s HIV/AIDS Bureau (HAB) maintains a Frequently Asked Question (FAQ) webpage on the HAB website. Included on the website is information regarding new funding for RWHAP grantees for COVID-19 activities for people living with HIV. HRSA/HAB released 581 awards funded through the CARES Act that will allow grantees to focus on a number of activities around prevention, preparedness, and response activities.
Many ADAPs already have plans in place to ensure access to medications during times of disrupted access (e.g., a natural disaster). ADAPs should work with their PBMs and pharmacy networks to review and deploy existing policies aimed at easing access barriers. See the following resource for a summary of existing policies and flexibilities: AIDS Drug Assistance Program (ADAP) Emergency Preparedness Resource Guide.
Here are some additional considerations for health departments as they work to ensure the continued health and safety of people living with HIV:
- Early refill and dispensing limit overrides: ADAPs have discretion to allow for early refill overrides as well as extend fills to 60-days. ADAPs should work with their PBMs and/or pharmacy networks to implement these policies.
- Streamlined recertification and annual renewal policies: RWHAP Part B programs and ADAPs have discretion to streamline the recertification process, including utilizing self-attestation that there have been no changes in financial eligibility, residence, and third-party coverage for one of the two required recertifications per year (see HRSA/HAB PCN 13-02). Clients may “sign” the self-attestation virtually or at their next provider visit. In some cases, RWHAP Part B programs/ADAPs are setting up virtual signature or phone-based options via case management agencies). Though it is not required by HRSA/HAB, many RWHAP Part B programs/ADAPs collect viral load and/or CD4 labs at either annual or six-month recertification. Because social distancing may delay clients’ ability to access these labs currently, programs may waive or delay collection of that information.
- Network exceptions: ADAPs may be able to work with PBMs and pharmacy networks to approve limited pharmacy network exceptions for individuals who may not have access to their regular pharmacy.
- Testing: RWHAP Part B funds can also be used to cover COVID-19 testing for eligible clients via the Outpatient/Ambulatory Health Services category (or primary insurance cost sharing associated with COVID-19 testing via the Health Insurance Premium and Cost Sharing Assistance for Low-Income Individuals category).
HRSA has also released a COVID-19 resource page for 340B Drug Pricing Program participants and stakeholders.
Viral Hepatitis Program Resources
There has been little research on the intersection of COVID-19 and viral hepatitis. Some of the resources below suggest that people with hepatitis B or hepatitis C are at increased risk of illness with COVID-19 if they have extensive liver damage or other underlying conditions, such as kidney injury, cardiovascular disease, and diabetes:
- What to Know About Liver Disease and COVID-19 (CDC, May 5) – The U.S. Centers for Disease Control and Prevention (CDC) developed this FAQ to address concerns related to COVID-19 and viral hepatitis, highlighting what people living with hepatitis B and/or hepatitis C infection can do to protect themselves and maintain their health. It also provides guidance for protecting people at risk for hepatitis A virus infection from the ongoing multi-state hepatitis A outbreaks.
- Information about COVID-19 for people living with chronic HBV and HCV (Hepatitis Australia, updated March 20) – This fact sheet provides practical advice on how to protect yourself against COVID-19 while there is limited information about the effect of the virus on people living with viral hepatitis.
- Clinical Insights for Hepatology and Liver Transplant Providers During the COVID-19 Pandemic (AASLD, March 23) – The American Association for the Study of Liver Diseases (AASLD) created this document to provide data and insights on COVID-19 and how it may affect hepatologists and liver transplant providers and their patients.
- Blog: Can a Transplant and Other Immune Suppressed be Cured of COVID-19 (I Help C, March 20)
NASTAD will update and add resources on COVID’s impact on people living with hepatitis as they become available.
- Dr. Saab Coronavirus and the Liver Overview (ALF, YouTube, March 20) – In this video, Dr. Sammy Saab from David Geffen School of Medicine at UCLA gives an overview of COVID-19 (Coronavirus) and answers your questions in the first of the American Liver Foundation Coronavirus series.
- COVID-19: A Message to the Community (NVHR, Vimeo, March 18) – Michael Ninburg, Executive Director, Hepatitis Education Project
- Viral Hepatitis: COVID-19 Considerations (NVHR, Vimeo, March 18) – Robert G. Gish, MD
- National Viral Hepatitis Roundtable: COVID-19 Resources
- American Association for the Study of Liver Diseases (AASLD): COVID-19 Resources
- Association of Asian Pacific Community Health Organizations (AAPCHO): COVID-19 Resources
- National Viral Hepatitis Roundtable: COVID-19 Alerts
- World Hepatitis Alliance: Guidance for people living with viral hepatitis or other liver diseases
Syringe Services Programs (SSPs) and Drug User Health Resources
In response to the global COVID-19 pandemic, health departments and community-based syringe services programs (SSPs) have requested recommendations for supporting syringe access and, in turn, people who use drugs (PWUD).
Several harm reduction and public health partners have developed resources for drug user health response that recognize the additional burdens of housing insecurity, treatment adherence, reduced income (including sex work and other types of labor), chronic and compounding illness, including mental health conditions, and inadequate insurance coverage faced by many SSP participants and other people who use drugs.
NASTAD’s COVID-19: Suggested Health Department Actions to Support Syringe Services Programs (SSPs), released April 8, 2020, consolidates many of these recommendations and includes promising strategies and important considerations for health departments working with SSPs that were raised during a March 2020 NASTAD call with health department and community partners to discuss COVID-19 response.
Additionally, the following resources have been created by federal, state, and local agencies and community-based and non-profit partner groups and might be useful to health departments. Please feel free to send additional resources to NASTAD’s Drug User Health team.
- Vital Strategies – Practicing Harm Reduction in the COVID-19 Outbreak
- SAMHSA’s COVID-19 Guidance for Opioid Treatment Programs
- Drug Enforcement Administration’s guidelines on Use of Telemedicine While Providing Medication Assisted Treatment (MAT)
- Drug Enforcement Administration’s exception for medication delivery by narcotic treatment programs
- CDC Guidance on COVID and Homeless Service Providers
- United States Interagency Council on Homelessness COVID Resource Page
- American Medical Association: Policy recommendations to help patients with OUD, pain and harm reduction efforts
- American Society of Addiction Medicine COVID-19 – Supporting Access to Buprenorphine
- The Network for Public Health Law: 2019 Novel Coronavirus: Legal Preparedness and Public Health Response Efforts
- Health Department Responses to COVID-19: Supporting SSPs and Harm Reduction Programs Webinar
- The Impact of COVID‑19 on Syringe Services Programs in the United States – Notes from the Field
- The Impact of COVID‑19 on Syringe Services Programs in the United States – Graphic
Prevention Program Resources
In the midst of addressing the global COVID-19 pandemic, health departments and community-based organizations are continuing to address HIV prevention strategies and respond to the national HIV epidemic. Several national partners have developed resources on HIV + COVID-19, safer sex strategies during COVID-19, and testing and treatment options.
NASTAD will update and add resources on COVID’s impact on HIV prevention as they become available.
- Centers for Disease Control and Prevention- PrEP During COVID-19
- Centers for Disease Control and Prevention- HIV Self Testing Guidelines
- NYC Department of Health and Mental Hygiene- Sex and COVID-19 Fact Sheet
- Oregon Health Authority
- Sex in the time of COVID-19 Infographic (English)
- Sex in the time of COVID-19 Infographic (Spanish)
National Partner Resources:
- Greater than AIDS- HIV and COVID-19
- National Coalition of STD Directors- COVID-19 Command Center for STD Programs
- Planned Parenthood- COVID-19 and You Sexual Health