Attachment A - 2020 Ending the Epidemic and Fast Track Cities.pdf

Ending the Epidemic and Fast Track Cities Initiatives 
National and local policy leaders have taken bold steps to end the HIV epidemic by 2030. With your 
participation this goal can become a reality. The federal government is now implementing the Ending 
the Epidemic plan, which will send resources to targeted regions in the United States with the highest 
incidence of HIV infection; Maricopa County is among them. The City of Phoenix has joined a global 
initiative established by The Joint United Nations Programme on HIV/AIDS (UNAIDS) by becoming a 
Fast Track City in 2017.  The City of Phoenix Fast Track Cities Initiative has been making steady 
progress toward three benchmark prevention and treatment goals referred to as 90-90-90. 
The City of Phoenix Fast Track Cities Initiative is committed to ending HIV and playing their role in the 
Ending the Epidemic Initiative.  The undersigned members call upon medical providers, emergency 
departments, medical systems, and private and government insurance programs to play their role in 
helping to establish the following three policies to join in our effort to end HIV! 
Ninety Percent of All Persons Living with HIV Tested and Identified 
It is estimated that 15% of all persons living with HIV in Arizona are undiagnosed.  It has also been 
shown that these undiagnosed persons account for 38% of all new transmissions in the United States.  
The Phoenix Fast Track Cities Initiative Ad Hoc Committee calls upon primary care physicians 
and emergency departments to implement opt-out HIV testing, where all adult patients are 
routinely screened for HIV unless they specifically opt-out of screening, in order to better 
identify HIV-positive individuals and link them to appropriate medical care. 
Ninety Percent of All Persons Identified as HIV Positive in Medical Care and On Treatment 
About 40% of all persons identified as living with HIV are not retained in consistent medical care. 
These individuals account for 43% of new HIV infections.  Social determinants of health most 
commonly prevent consistent medical care, but HIV stigma plays a part as well.  Phoenix-based HIV 
service organizations have robust programs to link patients to medical care and have implemented a 
rapid start protocol to connect patients to medical care within five days of diagnosis.  This rapid start 
protocol has been shown to help patients become virally undetectable as quickly as possible, which in 
turn prevents them from transmitting HIV to others. 
The Phoenix Fast Track Cities Initiative Ad Hoc Committee calls upon medical providers and 
systems (integrated delivery networks) to better educate its medical teams about Ryan White 
programs and implement Phoenix’s rapid start protocol as part of their patient care systems.  
Ryan White programs ensure that any person who is living with HIV has access to medical, 
pharmaceutical, and support services.  Phoenix’s rapid start protocol calls for the 
implementation of immediate treatment for newly diagnosed patients, in accordance with U.S. 
Department of Health and Human Services Guidelines.  In addition, better education about HIV 
in medical settings can help to eliminate provider stigma about HIV risk, transmission, and 
treatment. 
Attachment A

Ninety Percent of All Persons on Treatment With an Undetectable Viral Load 
 
HIV treatment today is powerful, and treatment is prevention.  The CDC has acknowledged that HIV-
positive patients on treatment, and with an undetectable viral load, cannot transmit HIV to others.  
This medical science that is referred to as undetectable = untransmittable, or U=U, heralds a new day 
in HIV treatment and prevention, as it pertains to HIV and sexual transmission.  If we can get every 
HIV-positive individual on treatment and virally undetectable, then we can stop new transmissions. 
 
Single-tablet regimens are the most powerful tool available to achieve viral suppression in patients. 
Research has proven that patient adherence and time to viral suppression on a single-tablet regimen 
is significantly better with the use of single-tablet therapies.  U.S. Department of Health and Human 
Services  guidelines for treatment-naïve patients call for immediate prescription of a limited number of  
regimens, and medical providers need all available medications at their disposal to treat HIV.  HIV is a 
unique condition where the virus often mutates and develops resistance to medications.  In addition, 
many patients have co-morbidities that require specific treatment therapies.  One size does not fit all 
with HIV treatment.  All Federal Drug Administration (FDA)-approved therapies are included on the 
Medicare Part D formulary, and Ryan White programs similarly include all therapies on its formulary.  
It is critically important that private insurers and Arizona’s Medicaid Program, AHCCCS, follow suit 
and include all HIV therapies on their formularies. 
 
In addition to the current HIV therapies that need formulary approval, it is equally critical that private 
insurance and AHCCCS quickly approve new therapies on their formularies.  Soon there will be a 
monthly injection that is FDA approved for treatment, and for many populations this will be a potent 
and effective treatment to help them achieve an undetectable viral load. 
 
The Phoenix Fast Track Cities Initiative Ad Hoc Committee calls upon Private Insurers and 
Arizona’s Medicaid Program, AHCCCS, to establish policies of open access to HIV therapies to 
give medical providers every tool at their disposal to treat HIV. 
 
The City of Phoenix Fast Track Cities Initiative is committed to ending HIV and playing their role in the 
Ending the Epidemic Initiative.  The undersigned members call upon medical providers, emergency 
departments, medical systems, and private and government insurance programs to play their role in 
helping to establish the above three policies to join in our effort to end HIV! 
 
 
SIGNATORIES