Announced in 2019, the Ending the HIV Epidemic (EHE) initiative aims to reduce HIV infections by 90% over a span of 10 years. EHE is looking to reduce the number of new HIV infections in the US by 75 percent by 2025, and then by at least 90 percent by 2030. They estimated that 250,000 total HIV infections could be averted by this action.

US federal agencies created a plan to pursue these goals and requested additional resources that were provided by Congress. EHE focuses on four strategies including diagnosing, treating, preventing, and responding to HIV.

EHE provides a targeted approach of new resources and will inject support and resources to 

 that account for more than half of new HIV diagnoses. This includes 48 US counties, San Juan, Puerto Rico, Washington, DC, and 7 states with a substantial rural burden, according to the Centers for Disease Control and Prevention.

With this ambitious public health initiative as the backdrop, Anthony Todd Fojo, MD, MHS, assistant professor, Johns Hopkins University School of Medicine, led a study published in the 

 that looked at ways to prevent further HIV transmission in US cities over 10 years. They did a modeling study that focused on 32 metropolitan statistical areas (MSAs). Within each of these MSAs, they broke down the local populations by age, race, sex, and potential for HIV acquisition according to Fojo. Specifically, they looked at 3 interventions including testing, PrEP usage among those at risk, and viral suppression for those infected with HIV. 

With increases in these aforementioned interventions, there could be significant reductions in HIV, according to Fojo.

“Modest increases in testing (1.25-fold per year), PrEP coverage (5 percentage points), and viral suppression (10 percentage points) across the population could achieve reductions of 34% to 67% by 2030,” Fojo, et al, wrote in their study. “Twenty-five percent PrEP coverage, testing twice a year on average, and 90% viral suppression among young Black and Hispanic men who have sex with men (MSM) achieved similar reductions (13% to 68%). Including all MSM and persons who inject drugs could reduce incidence by 48% to 90%. Thirteen of 32 MSAs could achieve greater than 90% reductions in HIV incidence with large-scale interventions that include heterosexuals.”

Without any further increases in the interventions, the investigators predicted there would be a 19% decrease in HIV incidence across all 32 MSAs.

While Fojo points out it would be difficult to reach the 90% goal, he believes you can still make some significant inroads in reducing HIV incidence. “It is going to be hard to get to 90% reductions…basically to get there you have to do all three of these things: you have to do more testing; you have to do more PrEP coverage; and you have to get more people virally suppressed—and you have to do it for a long time,” Fojo stated. “You can actually get pretty big reductions—not 90% reductions but in the order of 60% reductions over the coming decade.”

 spoke to Fojo who offered further insights about the study.

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In utilizing a modeling study, investigators estimated reductions in HIV incidence rates as well as PrEP usage rates and viral suppression across US cities over 10 years.

Ending the HIV Epidemic Initiative: Can We Get There?

Sepsis remains a difficult condition that needs timely therapeutic intervention in order to reduce mortality. In a large study, investigators reported a significant increase in the probability of death was associated with the delay in the number of hours antibiotics were first administered to inpatients. In fact, after adjusting for sepsis severity, ICU admission source and geographic region, inpatient mortality from the condition increased steadily after 1 hour of time to therapeutic intervention.

“We found that many people that come in with sepsis delayed care,” Chief Medical Officer Kathy Hudson, MD, at Phoebe Putney Memorial Hospital, said. “They may have an infection they are trying to doctor at home.” This delay can be problematic for clinicians as patients may already be close to sepsis.

Hudson’s Phoebe Putney Health System is using a monitoring tool, POC Advisor, to aid in detecting earlier the onset of sepsis which can then provide clinicians the opportunity to deliver interventions sooner in the process. The health system, which is a not-for-profit health system in southwest Georgia, is going to be using it at 3 hospital sites.

The monitoring tool analyzes data in real-time, accounting for more than 4000 comorbidities. It contains evidence-based algorithms that can reduce false positives for conditions that mimic sepsis resulting in higher quality alerts that clinicians trust.

By analyzing a broad cross-section of Phoebe’s electronic health record (EHR) data, including clinical notes using natural language processing, the platform can identify patients at risk of sepsis much earlier than the EHR SIRS-based sepsis alerts.

At Phoebe, clinicians will receive alerts with evidence-based protocols at the point of care. The solution’s dashboards track quality performance metrics to reduce practice variation by identifying gaps in bundle compliance. Additionally, the alert response dashboard will provide a comprehensive view of Phoebe’s clinician actions to promote timely interventions, support continuous improvement, educate staff and increase standardization of sepsis response.

 spoke to Hudson about the importance of identifying and treating sepsis earlier and how they plan to incorporate the POC Advisor into their health system.

1. Ferrer R, Martin-Loeches I, Phillips G, et al. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. 

. 2014;42(8):1749-1755. doi:10.1097/CCM.0000000000000330

A predictive tool, POC Advisor, has been developed to support faster diagnosis and intervention of this dangerous condition. 

Detecting Sepsis Earlier


The burden of the Omicron variant has been very difficult on everyone. The prevalence of it becoming abundant in our greater society is apparent, especially as cases go up and more people need care.

There are ongoing reports that some hospitals and medical centers are being inundated by COVID-19. Facilities are seeing larger numbers of cases and hospital personnel are contracting the more contagious variant of COVID-19, thus in some cases, leaving staff short-handed and exacerbating the problem which can lead to burnout. 

Some providers and caregivers are choosing to leave the medical industry altogether due to this never-ending pandemic. Although no one knows when the pandemic will transition into an endemic, if you take a historical perspective, this virus will eventually evolve to that stage.

In the meantime, providers and caregivers need to try to find a way to balance their work lives with time for themselves.

Ami Multani, MD, medical director of infectious disease, Fenway Health has been thinking about the historical context of the pandemic in the early days of it in 2020 and how we can manage through the continuation of difficult times. She offers some insights into looking at COVID-19 and how it parallels with the early days of the AIDs crisis. She also discusses strategies to help fellow providers to decompress and feel better about the current state of things and the future.

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During a continuation of a difficult time in our history, overwhelmed providers need to take a step back and find time for themselves to unwind and destress from COVID-19.

In Turbulent Times, Taking Care of One’s Self


The emergence of the Omicron variant as the predominant strain of COVID-19 happened in a matter of few weeks, and thus has reminded everyone we are not out of the woods with this virus yet. And even when we do eventually have a handle on this, there is going to be so much to learn from this experience that could inform us for the next potential pandemic.

 is a biomedical research institution that was awarded a $4 million grant by the state of Pennsylvania to study COVID-19including understanding the impact of the virus on certain at-risk populations and supporting the state’s preparation and emergency response planning for future pandemics.

Specifically, Wistar will study vulnerable populations such as seniors, people with an opioid use disorder, and those who are HIV positive. In addition, they will develop clinical trials with the 3 subgroups and 100 people per category.

In the announcement, Pennsylvania Governor Tom Wolf stressed the importance of understanding at-risk populations. “This project will allow us to look more closely at the impacts of this pandemic on those among us who are more vulnerable to the greatest risks of the pandemic, and I am grateful for this partnership that will bolster Pennsylvania’s ability to embed lessons of the last two years in future planning and preparation.”

Luis Montaner, DVM, MSc, DPhil, vice president, Scientific Operations at the Wistar Institute, is leading the operation. One of the areas they are exploring is the ongoing vaccine strategies including boosters. Certainly this can play a big role in the current understanding of the Omicron variant and how much protection today’s vaccines play now.

“The current vaccines, although effective, require a lot of persistent monitoring of what are overall levels of immunity and when we should be revaccinated or reboosted,” Montaner stated. “I think we are all experiencing both the benefits and limitations of the current strategies that we have.” 

In thinking of about vulnerable populations, Montaner points out these people may be experiencing both benefits and challenges during the pandemic. “Perhaps they have higher exposure because of their lifestyle, so from one side you could argue that they could be naturally boosted by what would be a herd immunity type setting based on their demographic and lifestyle or you could also raise the fact they have other comorbidities and other factors that are eroding their immunological competency, and they become more vulnerable and we need to be more proactive to try and manage.”

spoke to Montaner and he provided further insights about the institute’s WINCORE COVID-19 program, the populations they plan to study, and pandemic preparedness.

The award given to the research institute by the state of Pennsylvania looks to delve deep in understanding vulnerable populations and taking some lessons away in addressing future  potential pandemics. 

With Grant, Wistar Institute is Planning to Study COVID-19 in At-Risk Populations

 to discuss several exciting new technologies 

Henn is the chief scientific officer at Seres Therapeutics, and helped launch it in 2012. Seres advances microbiome therapeutics, work Henn describes as addressing “significant, unmet medical needs.”

Seres designs bacteria with specific pharmacological properties to simulate what happens when the human microbiome is disrupted.

“What we saw at Seres was an opportunity to fundamentally transform how we tackle infectious diseases in particular, and antibiotic-resistant infections.”

Henn notes that the best way to treat a bacterial infection is often with antibiotics, but problems arise when bacteria develop resistance to these antibiotics, or the antibiotics trigger other infections, such as 

Seres is looking to target diseases another way. “We can design our drugs to target multiple disease-relevant pathways simultaneously. So what we’re doing in AMR is that we are both designing our drugs to decolonize and/or prevent infection with the bacteria that harbor these antibiotic-resistant genes, and that’s really really important for two reasons.

“One, we can address the infection itself, but we can also decrease the level of these bacteria in a patient, which we hope will then have an impact in reducing transmission events.”

Henn continued that the second thing Seres is doing is repairing the epithelial barrier in the gut to prevent bacteria from crossing into the bloodstream and causing further infection.

Seres believes they have novel technology to transform AMR treatment, which Henn says is vital, echoing other predictions that 

AMR is one of the greatest public health threats.

Henn has conducted microbiological research for over 25 years, and was the director of viral genomics and assistant director of the Genome Sequencing Center for Infectious Diseases at the Broad Institute of MIT and Harvard before joining Seres.

“What’s exciting about this space right now is that we learn something new all the time…The microbiome plays an incredibly important role in human health,” Henn said.

Matt Henn, chief scientific officer at Seres Therapeutics, discusses new ways of targeting infectious diseases and antimicrobial resistant infections. 

Seres Therapeutics Develops Novel Drugs to Address Unmet Medical Needs 

 their Labor-Health and Human Services-Education appropriations bill in October. The bill includes sizable increases for HIV programs, often matching what President Joe Biden proposed in his budget but falling short of the House bill.

In this bill, which is expected to go to the Appropriations Committee for consideration some of the spending for programs includes:

Matching the House and Biden's proposed increase of at least $245 million to domestic HIV programs.

Proposing a $31 million increase to the Ryan White HIV/AIDS program, which serves low-income people living with HIV and primarily serves communities of color. This matches President Biden's request but falls short of the House bill by $100 million.

Proposing a $20 million increase for the HUD's Housing Opportunities for Persons with AIDS. This matches President Biden's budgetary ask but is far less than the $170 million increase requested by the House.

Removing the ban on using federal funding to purchase sterile syringes for needle exchanges, like the House bill before it.

 is an organization involved in HIV and hepatitis advocacy, and they are closely watching the bill and actively working to aid in its passage.

The organization’s Executive Director Carl Schmid sees a lot of positive proposed funding in the bill and is especially excited about the funding for community centers for 

“Right now, the last 2 years they [the community centers] have gotten $100 million to increase PrEP activities, and this bill would increase it by another $50 million to focus on PrEP activities,” Schmid said.

In addition, the Biden Administration is also looking at addressing HIV/PrEP and is ready to release an updated National HIV/AIDS Strategic Plan.

Congress and the Biden administration have a lot on their plates at the moment, and the Build Back Better bill which looks at social safety net programs, appears to be the federal government’s top priority. With that bill front of mind and the impending holidays, it’s not been determined when Congress will circle back around to looking at HIV/PrEP spending.

While the proposed federal spending plans and bills remain paramount, The HIV+ Hepatitis Policy Institute continues to stay involved in other initiatives involving HIV/PrEP. For example, the organization has been looking at PrEP coverage for medical Insurance. Under the Affordable Care Act, some preventive services are supposed to be covered, and this includes PrEP. Under the act, there is not supposed to be shared costs for users, so it makes it free to people who decide to use it.

“We really want to make the use of PrEP very easy for people, and what we are finding is that they [insurance carriers] are putting PrEP on higher tiers, which when you have higher tiers you have cost sharing, and that may turn people away,” Schmid explained.

 spoke to Schmid about his organization, the appropriations bill, the institute’s work on PrEP spot checks regarding insurance carriers, and addressing health equity issues around HIV/PrEP.

The proposed funding will include a number of measures of spending towards HIV and prevention, including community centers for PrEP education.

Federal Appropriations Bill is Marked for HIV, PrEP Spending 

As pathogens develop resistance to antibiotics and other therapies, we must turn to new solutions—or, as Leonard Friedland, MD, puts it, old solutions: vaccines. “The best treatment of a disease is to actually not have to treat it at all but to prevent it, and that’s the role of vaccines. Vaccines are, after 

, the most effective public health tool that’s ever been introduced,” Friedland said.

Leonard Friedland, MD, is the Vice President of Scientific Affairs and Public Health Vaccines at GlaxoSmithKline (GSK). Last week, Friedland gave a presentation entitled, “Vaccines as an essential tool in the fight against AMR” at the 

2021 World Anti-Microbial Resistance Congress

Friedland said both he and GSK are passionate about the development of vaccine to fulfill unmet medical need, describing antimicrobial resistance (AMR) as “a global health security problem” and “the silent pandemic.”

Friedland expressed concerns that if antimicrobial resistance continues, the practice of medicine will be under threat: “If we don’t have ways to treat infections, we won’t be able to do many of the things that are part of modern medicine, such as organ transplants, safe Cesarian section deliveries, the ability to treat common infections.”

Vaccines save lives, but Friedland says they are underappreciated. To ensure they remain at the forefront of preventative healthcare, Friedland follows the development of vaccines at GSK and beyond, encouraging the extension of bacterial and viral vaccines to drive down the use of antibiotics.

Friedland stressed that low- and middle-income countries will be most affected by continued AMR. “We all recognize through the COVID pandemic now how important it is to address access to care, equitably, for people all around the world…as we address this issue we need to make sure we’re thinking globally, not just locally.”

Antimicrobial resistance is “the silent pandemic,” Dr. Leonard Friedland says, and vaccines are how we fight it.

Prevention is the Best Treatment: Vaccines and Antimicrobial Resistance 

Until his mother was diagnosed with and subsequently died of the bacterial infection, Christian John Lillis had never heard of 

 shortly after their mother’s passing in 2010. “We were really determined that her death not be in vain,” Lillis said.

Lillis is the co-founder and executive director of the PLF, and describes its mission of PLF as threefold: educating the public, empowering advocates, and shaping policy.

Many legislators, like Lillis and the general public, are unfamiliar with 

 In 2018, the PLF held what Lillis believes to be the first-ever 

 Lobby Day on Capitol Hill, meeting with legislators to educate and advocate for policy addressing 

Prior to founding PLF, Lillis had 20 years of experience in fundraising, advocacy, and nonprofit management, including extensive work with the National LGBTQ Task Force and NYU Langone Medical Center.

in our bodies, but excessive or unnecessary antibiotics can kill off all other bacteria in the gut microbiome, enabling the 

to flourish with potentially deadly consequences.

Lillis cautioned the public against taking antibiotics without asking their doctor questions to gauge the type of bacteria they have, the necessity of the antibiotic, and whether they have been cultured for it.

We should also stop expecting medications like antibiotics to be the only path to recovery, Lillis pointed out. “It’s unsatisfying to us,” he said, but sometimes taking time to rest and let the body heal on its own really is the best course of action.

Lillis observed that before the outbreak of COVID-19, and with the exception of people at-risk for HIV, the public hard largely forgotten about infectious disease.

and other infectious diseases, Lillis said, “It’s not a personal choice, it’s not lifestyle, it’s not genetic predisposition…these are communicable diseases.” He continued, “We have to understand that we have to take care of each other.”

Christian Lillis, co-founder and executive director of the Peggy Lillis Foundation (PLF) for C diff Education & Advocacy, says that taking care of each other is often the best way to stop the spread of infectious diseases.

Taking Care of Each Other: The Peggy Lillis Foundation for C Diff Education and Advocacy

Welcome to our series, 1 Big Question, which asks 1 question to the medical community and we get their feedback on an important infectious disease topic.

In this episode, our 1 Big Question is: Will PrEP have a prominent role and significant impact in HIV prevention?

We interviewed Gary Spinner, DMSc, PA, MPH, AAHIVS, medical director of the HIV/AIDS Program, Southwest Community Health Center, Randy Matthews, PhD, MD, senior principal scientist, Merck, and Carl Schmid, executive director, HIV+Hepatitis Policy Institute.

Check out our video to hear their insights.

HIV Stakeholders weigh on the future of PrEP. 

The Long-Term Prognosis of PrEP 

7:10 Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP

In this episode, our 1 Big Question is: One of the things that is being reported is that during the first year of the pandemic antibiotics were over prescribed. Do you agree with that assessment and do you think we are seeing a return to normal prescribing practices now?

We interviewed Priya Nori, MD, director, Antibiotic Stewardship, Montefiore Health System, Cornelius (Neil) Clancy, MD, associate professor of Medicine and director of the Mycology Program at the University of Pittsburgh, and Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP assistant professor of Pharmacy Practice at Loma Linda University School of Pharmacy.

As providers were challenged to care for patients with severe COVID-19 In the first year of the pandemic, antibiotic usage increased. Listen to clinicians talk about this specific challenge and how prescribing practices evolved over time.