Sunday, March 8, 2009

Had my first entry into interactions with the new Administration. Background is that there have been recent reports of the terrible situation in Washington, D.C. regarding prevalence of HIV/AIDS with 3% of the population infected and 6.5% of black men. This is worse than 22 countries in sub-Saharan Africa. We at NIAID and NIH (Fauci, Dieffenbach, and Henry Masur) have been putting together a collaborative program with DC Department of Health (Shannon Hader) to address this issue with a combined research-care program that also involves the recently promoted “test and treat” concept. This model (appeared in Lancet on Nov. 27, 2008) suggests that if you test everyone 1X per year and treat people immediately regardless of their CD4+ T cell count or viral load, you could decrease the level of virus in the community so that you could conceivably get the Ro to <1, which would in essence shut off the AIDS epidemic. Such a concept would require the answering of questions of safety, efficacy, adherence, access to people for testing, benefit to individual versus community, cost effectiveness, etc. We could help to district by making this “test and treat” research agenda a part of our collaborative effort with the District. While this is going on, Zeke Emanuel is now detailed to OMB as an assistant to OMB Director Peter Orzag to handle health related issues. Zeke heard about the initiative and feels that it would be a good idea to get the WH and the POTUS involved in an announcement of such a program for the District. Thus, I was called down to the OMB in Room 263 in EEOB to present the program. Zeke was present as was Jeff Crowley, the new WH AIDS Coordinator and Director of the Office of National AIDS Policy. Connected by phone was Jenny Backus (HHS Public Affairs Director), Dora Hughes (General Counsel to the Secretary, HHS), Nick ?. I presented the proposal and they asked good questions and were very excited about it. We will proceed with rolling it out after nailing down a few details. While at the EEOB, I ran into Peter Orzag who greeted me as if we were friends. He clearly knew who I was from seeing me down the hall. Good news that this WH at least is up on what is going on in AIDS and health in general. Let us see how things evolve.