Tuesday, July 16, 2013
EXECUTIVE ORDER
ACCELERATING IMPROVEMENTS IN HIV PREVENTION AND CARE IN
THE UNITED STATES THROUGH THE HIV CARE CONTINUUM INITIATIVE
By the authority vested in me as President by the
Constitution and the laws of the United States of America, and in order to
further strengthen the capacity of the Federal Government to effectively
respond to the ongoing domestic HIV epidemic, it is hereby ordered as follows:Section 1. Policy. Addressing the domestic HIV epidemic is a priority of my Administration. In 2010, the White House released the first comprehensive National HIV/AIDS Strategy (Strategy), setting quantitative goals for reducing new HIV infections, improving health outcomes for people living with HIV, and reducing HIV-related health disparities. The Strategy will continue to serve as the blueprint for our national response to the domestic epidemic. It has increased coordination, collaboration, and accountability across executive departments and agencies (agencies) with regard to addressing the epidemic. It has also focused our Nation’s collective efforts on increasing the use of evidence-based approaches to prevention and care among populations and in regions where HIV is most concentrated.
Since the release of the Strategy, additional scientific
discoveries have greatly enhanced our understanding of how to prevent and treat
HIV. Accordingly, further Federal action is appropriate in response to these
new developments. For example, a breakthrough research trial supported by the
National Institutes of Health showed that initiating HIV treatment when the
immune system was relatively healthy reduced HIV transmission by 96 percent. In
addition, evidence suggests that early treatment may reduce HIV-related
complications. These findings highlight the importance of prompt HIV diagnosis,
and because of recent advances in HIV testing technology, HIV can be detected
sooner and more rapidly than ever before.
Based on these and other data, recommendations for HIV
testing and treatment have changed. The U.S. Preventive Services Task Force now
recommends that clinicians screen all individuals ages 15 to 65 years for HIV,
and the Department of Health and Human Services Guidelines for Use of
Antiretroviral Agents now recommends offering treatment to all adolescents and
adults diagnosed with HIV.
Furthermore, ongoing implementation of the Affordable
Care Act provides a historic opportunity for Americans to access affordable,
quality health care. The Act is expanding access to recommended preventive
services with no out-of-pocket costs, including HIV testing, and, beginning in
2014, insurance companies will not be able to deny coverage based on
pre-existing conditions, including HIV. Starting October 1, 2013, Americans can
select the coverage that best suits them through the new Health Insurance
Marketplace, and coverage will begin January 1, 2014.
Despite progress in combating HIV, important work
remains. Since the publication of the Strategy, data released by the Centers
for Disease Control and Prevention show that there are significant gaps along
the HIV care continuum — the sequential stages of care from being diagnosed to
receiving optimal treatment. Nearly one-fifth of the estimated 1.1 million
people living with HIV in the United States are undiagnosed; one-third are not
linked to medical care; nearly two-thirds are not engaged in ongoing care; and
only one-quarter have the virus effectively controlled, which is necessary to
maintain long-term health and reduce risk of transmission to others.
In light of these data, we must further clarify and focus
our national efforts to prevent and treat HIV infection. It is the policy of my
Administration that agencies implementing the Strategy prioritize addressing
the continuum of HIV care, including by accelerating efforts to increase HIV
testing, services, and treatment along the continuum. This acceleration will
enable us to meet the goals of the Strategy and move closer to an AIDS-free
generation.
Sec. 2. Establishment of the HIV Care Continuum
Initiative. There is
established the HIV Care Continuum Initiative (Initiative), to be overseen by
the Director of the Office of National AIDS Policy. The Initiative will
mobilize and coordinate Federal efforts in response to recent advances
regarding how to prevent and treat HIV infection. The Initiative will support
further integration of HIV prevention and care efforts; promote expansion of
successful HIV testing and service delivery models; encourage innovative
approaches to addressing barriers to accessing testing and treatment; and
ensure that Federal resources are appropriately focused on implementing
evidence-based interventions that improve outcomes along the HIV care
continuum.
Sec. 3. Establishment of the HIV Care Continuum Working
Group. There is
established the HIV Care Continuum Working Group (Working Group) to support the
Initiative. The Working Group shall coordinate Federal efforts to improve
outcomes nationally across the HIV care continuum.
(a) Membership. The Working Group shall be
co-chaired by the Director of the Office of National AIDS Policy and the
Secretary of Health and Human Services or designee (Co-Chairs). In addition to
the Co-Chairs, the Working Group shall consist of representatives from:(i) the Department of Justice;
(ii) the Department of Labor;
(iii) the Department of Health and Human Services;
(iv) the Department of Housing and Urban Development;
(v) the Department of Veterans Affairs;
(vi) the Office of Management and Budget; and
(vii) other agencies and offices, as designated by the Co-Chairs.
(b) Consultation. The Working Group shall
consult with the Presidential Advisory Council on HIV/AIDS, as appropriate.
(c) Functions. As part of the Initiative, the
Working Group shall:(i) request and review information from agencies describing efforts to improve testing, care, and treatment outcomes, and determine if there is appropriate emphasis on addressing the HIV care continuum in relation to other work concerning the domestic epidemic;
(ii) review research on improving outcomes along the HIV care continuum;
(iii) obtain input from Federal grantees, affected
communities, and other stakeholders to inform strategies to improve outcomes
along the HIV care continuum;
(iv) identify potential impediments to improving outcomes
along the HIV care continuum, including for populations at greatest risk for
HIV infection, based on the efforts undertaken pursuant to paragraphs (i),
(ii), and (iii) of this subsection;
(v) identify opportunities to address issues identified
pursuant to paragraph (iv) of this subsection, and thereby improve outcomes
along the HIV care continuum;
(vi) recommend ways to integrate efforts to improve
outcomes along the HIV care continuum with other evidence-based strategies to
combat HIV; and
(vii) specify how to better align and coordinate Federal
efforts, both within and across agencies, to improve outcomes along the HIV
care continuum.
(d) Reporting.
(i) Within 180 days of the date of this order, the
Working Group shall provide recommendations to the President on actions that
agencies can take to improve outcomes along the HIV care continuum.
(ii) Thereafter, the Director of the Office of National
AIDS Policy shall include, as part of the annual report to the President
pursuant to section 1(b) of my memorandum of July 13, 2010 (Implementation of
the National HIV/AIDS Strategy), a report prepared by the Working Group on Government-wide progress in implementing this order. This
report shall include a quantification of progress made in improving outcomes
along the HIV care continuum.
Sec. 4. General Provisions. (a) Nothing in this order shall be
construed to impair or otherwise affect:
(i) the authority granted by law to an executive
department, agency, or the head thereof; or
(ii) the functions of the Director of the Office of
Management and Budget relating to budgetary, administrative, or legislative
proposals.
(b) This order shall be implemented consistent with
applicable law and subject to the availability of appropriations.
(c) This order is not intended to, and does not, create
any right or benefit, substantive or procedural, enforceable at law or in
equity by any party against the United States, its departments, agencies, or
entities, its officers, employees, or agents, or any other person.
BARACK OBAMA
Source: http://www.whitehouse.gov/the-press-office/2013/07/15/executive-order-hiv-care-continuum-initiative
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