Project Summary Abstract HIV remains a major public health concern in the United States (US) with a disproportionate burden of disease in the US South, including Tennessee. The proportion of people with HIV (PWH) in Tennessee in 2019 who knew their HIV status (85%), were linked to care (61%), were retained in clinical care (59%), and had suppressed viral loads (65%), were well below US Ending the HIV epidemic goals (90%). People residing in rural areas, men who have sex with men (MSM), and Black and Hispanic people continue to bear the highest burden of HIV disease and have poor HIV continuum of care outcomes in Tennessee. These statewide disparities are more starkly mirrored in Memphis/Shelby County, a Phase 1 EHE Priority Jurisdiction and a Metropolitan Statistical Area (MSA) that ranks 3rd in the US for HIV incidence. In this public health context, the state of Tennessee has decided to reject ~$9 million dollars in federal funding for HIV testing and prevention effective June 1, 2023. The public health impact of rejecting federal funding for community-based HIV services is likely to be profound given the years of experience, deep institutional knowledge, and community trust these organizations have built. Further, the state has enunciated new “priority populations” responsible for only a handful of HIV cases in Tennessee in the past decade (i.e., first responders, victims of human trafficking, and pregnant women and children), in addition to the key populations known to have a high risk of HIV and high need for these services (i.e., rural residents, MSM, and Black and Hispanic people). These changes represent an urgent quasi-experimental event that requires evaluation to assess changes in HIV prevention and care outcomes related to this policy shift. Thus, our overarching goal is to provide a near-real-time evaluation of whether and how policy changes to funding HIV testing and prevention in Tennessee will affect HIV outcomes, particularly among populations highly vulnerable to HIV. We are uniquely positioned to perform the work in this proposal as our study team has complementary expertise in Tennessee clinical HIV testing and prevention, HIV modeling, health policy analysis, and qualitative research to ensure the timely initiation of the project with minimum delay. Our findings will provide clear, rigorous evidence in a near-real-time evaluation of whether and how policy changes to funding HIV prevention and care in Tennessee affect HIV outcomes, particularly among populations highly vulnerable to HIV. Although focused on Tennessee, results are relevant to broader policy discussions around the direction of federal funding to community-based organizations for public health programs already emerging across the US South. Importantly, our work will support Tennessee communities in reaching their Ending the HIV Epidemic (EHE) goals through the leveraging of our unique academic and community-based partnerships.

Project Narrative The public health impact of rejecting federal funding for community-based HIV services in Tennessee is likely to be profound, with the potential to widen disparities in HIV testing and prevention services for racial, sexual/gender, and rural residential minorities. Thus, our overarching goal is to provide a near-real-time evaluation of whether and how policy changes to funding HIV testing and prevention in Tennessee will affect HIV outcomes, particularly among populations highly vulnerable to HIV. Although focused on Tennessee, results are relevant to broader policy discussions around the direction of federal funding to community-based organizations for public health programs already emerging across the US South.