Accelerating Improvements in HIV Prevention and Care in the United States Through the HIV Care Continuum Initiative

Executive Order 13649 of July 15, 2013

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.

    (Presidential Sig.)

THE WHITE HOUSE,

    July 15, 2013.