HIV prevention and treatment efforts are significantly influenced by policies and regulations at the local, state, and federal levels. Some policy decisions are highly specific to HIV (e.g., funding decisions, laws criminalizing nondisclosure of HIV status, and policies delineating sexual education requirements). Other policy decisions are untargeted but likely to have a disproportionate effect on the health and behaviors of people living with or at risk of HIV (e.g., denial-of-service laws and Medicaid expansion). However, health policy researchers and policy analysis methods are not well integrated into HIV research.

Before 2023, the Tennessee CFAR had a limited record of research and impact in the HIV policy space. Work by Dr. Peter Rebeiro on the effects of health policy on HIV led to a high-impact CFAR study that was a key factor in changing Tennessee law legalizing needle exchange. However, this work remained somewhat siloed until significant changes to HIV prevention funding at the state level occurred in 2023 when the Governor of Tennessee announced that the state would forgo nearly $9 million in federal funding for HIV testing, prevention, and surveillance. 1 This seismic announcement sent shockwaves through the CFAR, quickly mobilizing CFAR members. Multiple faculty members at the CFAR institutions collaborated on op-eds and perspective pieces in response to the decision. 2,3 CFAR members also successfully applied for an R61/R33 (R61HD019323; PI Pettit; MPI McKay), a time-sensitive research mechanism, to track clinical, economic, and social effects of this decision on HIV continuum of care outcomes. Microsimulation models, in collaboration with the Harvard CFAR, estimate that Tennessee’s HIV funding reallocation will contribute to 190 excess HIV deaths and increase cost per death averted by nearly 1500% over the next 10 years.

The primary goal of this new Scientific Working Group on Health Policy and HIV is to organize and expand health policy expertise within the CFAR by fostering new connections between HIV investigators and Health Policy investigators, and catalyzing research to understand how HIV-related policies on prevention, transmission, and treatment impact HIV continuum of care outcomes. This SWG leverages 1) the longstanding and productive CFAR partnership between Vanderbilt, Meharry, the Tennessee Department of Health (TDH), and Nashville CARES, 2) new health policy expertise in the nationally recognized Department of Health Policy at Vanderbilt University Medical Center that has had significant impacts on state and federal health policy but has limited work in HIV, and 3) the newly-established School of Global Health at Meharry led by Daniel Dawes, JD, National Academy of Medicine inductee recognized for reframing the conversation on differential health outcomes through actionable policy solutions using the political factors impacting health framework. Building on a prior, highly successful Disparities and HIV SWG, which recruited new CFAR members from HIV community organizations and from Memphis/Shelby County, a designated Phase 1 EHE Priority Jurisdiction, we will further expand community engagement via Health Policy and HIV SWG activities.

Tennessee is a critical location to conduct this work. Both targeted and untargeted policy decisions are likely to have disproportionate effects on populations affected by HIV. Memphis/Shelby County is a designated Phase 1 EHE Priority Jurisdiction and a Metropolitan Statistical Area (MSA) that ranks 2nd in the US for HIV incidence. Rural residents are at higher risk for late HIV diagnosis in Tennessee compared to urban residents.

• SPECIFIC AIM 1: To engage new members, build research capacity, and foster new connections between CFAR clinical investigators, community-based organizations, public health practitioners, and health policy investigators in the area of health policy impacts on HIV outcomes. 

• SPECIFIC AIM 2: To catalyze new clinical, community, and translational research to assess the potential impact of policy on HIV outcomes and HIV disparities in Tennessee

• Regularly scheduled SWG meetings to engage CFAR members/partners and identify research gaps, healthpolicy issues, overlapping interests, and ways to fill gaps in resources and expertise.
• Support for collection and analysis of HIV and policy data in local, state, and U.S. contexts.
• Publishing high-impact manuscripts and submitting grant applications to NIH and other agencies to supportresearch on the effects of local, state, and federal policies on HIV.
• Recruiting and mentoring early-stage investigators interested in health policy and HIV as well as establishedinvestigators with policy expertise who are new to HIV