1. 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

2. 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

3. 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

4. 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

5. HIV Prevalence and New Infections 1980-2011 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

6. 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

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

8. 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)

9. 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

10. Cost Effectiveness of Prevention HIVViral HepatitisTBSTDsSchool Health 1991-2006, averted 350,000 HIV infections; saved ≥$125 billion Screening of persons born 1945-1965 reduces HCV- related deaths by 121,000 at $35,700 per quality- adjusted life year gained (QALY) Est. 200,000 TB cases prevented since 1993. Saved $3.4 billion Reductions in gonorrhea and syphilis1990- 2003 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

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

12. 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

13. 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

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

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

16. Thank you National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention Centers for Disease Control and Prevention Website: www.cdc.gov/nchhstpwww.cdc.gov/nchhstp