SAMHSA Leaders: Behavioral Health Patients Key to HIV Reduction Targets

Meeting the ambitious goals of the national Ending the HIV Epidemic initiative will require greater engagement of individuals with substance use and mental health disorders, federal officials said Wednesday at the virtual Rx Drug Abuse & Heroin Summit.

“We can't reach our goals unless we reach our population of interest,” said Neeraj Gandotra, MD, chief medical officer at the Substance Abuse and Mental Health Services Administration (SAMHSA). Gandotra and SAMHSA public health adviser Fred Bamfo, DNP, MPH, offered an overview of the agency's major initiatives at the intersection of opioid use disorder (OUD) and communicable illnesses such as HIV/AIDS and hepatitis C.

Ending the HIV Epidemic has sought to reduce new infections among individuals ages 13 and older by 15% a year for five years between 2016 and 2021, with a longer-term goal of a 90% reduction in new infections by 2030. Also by 2030, the government wants to see that 90% of individuals diagnosed with HIV have been linked to care and are virally suppressed.

The Department of Health and Human Services' (HHS's) Minority HIV/AIDS Fund has allocated around $29 million to support the Ending the HIV Epidemic initiative. Bamfo outlined many of SAMHSA's grantmaking efforts in this area, stating that around 70% of all Minority AIDS grants have gone to geographic “hotspots” targeted in the Ending the HIV Epidemic initiative.

Gandotra said that by the end of this year, SAMHSA will issue a guide to prevention and treatment of HIV for individuals with behavioral health disorders, with sections devoted to topics such as the role of syringe services programs and the importance of behavioral health clinical strategies such as cognitive-behavioral approaches and contingency management.

COVID-19 impact

Gandotra, who emphasized in his remarks the treatment gold standard of medication therapies for OUD, listed the currently loosened restrictions on medication-assisted treatment (MAT) as among the government's most impactful responses to the COVID-19 crisis. These moves have included waiving the requirement of an initial face-to-face encounter before starting a patient on buprenorphine, and relaxing limits on take-home dosing of OUD medication, he said.

He added that expansion of telehealth also has been crucial, and suggested after the conference session that telehealth's suddenly greater presence in behavioral healthcare is likely to be long-lasting.