Project Grant X0955521

ADAP SHORTFALL RELIEF - PUERTO RICO IS A U.S. COMMONWEALTH WITH A TERRITORY OF APPROXIMATELY 4,000 SQUARE MILES AND AN ESTIMATED POPULATION OF 3,203,295 (U. S. CENSUS, DECEMBER 2024). THE ISLAND IS COMPRISED OF 78 MUNICIPALITIES, GROUPED FOR PURPOSES OF PUBLIC HEALTH SERVICES, INTO EIGHT HEALTH REGIONS: AGUADILLA, ARECIBO, BAYAMON, CAGUAS, FAJARDO, MAYAGUEZ, PONCE, AND SAN JUAN. ACCORDING TO THE 2024 U.S CENSUS AN ESTIMATE OF 224,038 PERSONS IN PR DOES NOT HAVE HEALTH INSURANCE. OF THIS NUMBER, 1,152 ARE LIKELY TO BE PWHA. AS OF DECEMBER 31, 2024, A TOTAL OF 16,769 PERSONS WERE LIVING WITH DIAGNOSED HIV INFECTION (PWHA), 75% PERCENT OF PWHA WERE =45 YEARS; HETEROSEXUALS ACCOUNTED FOR THE LARGEST PROPORTION OF PWHA FOLLOWED BY MEN WHO HAVE SEX WITH MEN (MSM), 36.1% AND 34.1%, RESPECTIVELY. PERSONS WHO INJECT DRUGS (PWID) ACCOUNTS FOR 22.4% OF PREVALENT CASES. IN 2022, 59.0% OF THE NEWLY REPORTED DIAGNOSES IN PR WERE ATTRIBUTED TO UNPROTECTED SEX AMONG MSM, FOLLOWED BY 30.1% UNPROTECTED HETEROSEXUAL CONTACT AND 2.8% FOR PWID. ACCORDING TO CDC'S LATEST REPORT, PR IS THE NATION'S 18TH JURISDICTIONS WITH THE HIGHEST HIV DIAGNOSIS RATE (13.5 PER 100,000 POPULATION) AND RANKED 8TH AS ONE OF THE JURISDICTIONS WITH THE HIGHEST HIV PREVALENCE RATE AMONG ADULTS AND ADOLESCENTS = 13 YEARS (534.5 PER 100,000 POPULATION) IN 2023. FROM 2023 TO 2024 THE POPULATION NEWLY DIAGNOSED WITH HIV (INCLUDING AIDS) IN PR DECREASED BY 10%. UP THROUGH MARCH 31, 2025, THE PR-ADAP PROVIDED MEDICATIONS TO 7,512 ELIGIBLE CONSUMERS THROUGH THE ADAP PROVIDERS' NETWORK. THE ONLY PR-ADAP LIMITATION IS A RESTRICTED DRUG FORMULARY. IF GRANTED, FY 2026 ERF FUNDS ARE GOING TO BE USED TO PURCHASE MUCH NEEDED HIV DRUGS TO MEET MEDICATION NEEDS FOR 286 NEW ELIGIBLE PWHA LIVING IN PR. THIS ADAP DRUG ACQUISITION WILL BE CONDUCTED THROUGH A DRUG WHOLESALER VENDOR CONTRACTED BY THE ADAP. PUERTO RICO'S FISCAL AND HEALTH ENVIRONMENT, COMBINED WITH MEDICAID FINANCING UNCERTAINTIES, THE LOSS OF ADAP PROGRAM INCOME AND REDUCTION IN AVAILABLE RESOURCES TO FUND THE ADAP, CREATE AN URGENT NEED FOR FY 2026 ERF ASSISTANCE. WITHOUT ERF SUPPORT, PUERTO RICO ADAP PROJECTS A $23,000,000 FUNDING SHORTFALL IN FY 2026. THE REQUESTED $7,000,000 MILLION WILL: 1) PREVENT THE ESTABLISHMENT OF COST CUTTING MEASURES LIKE DECREASE IN FINANCIAL ELIGIBILITY CRITERIA, ENROLLMENT CAP FOR ELIGIBLE PATIENTS, DRUG SPECIFIC ENROLLMENT CAPS FOR ARVS, AMONG OTHERS, POTENTIAL TREATMENT INTERRUPTION FOR OVER 1,200 CURRENT CLIENTS RECEIVING DRUG ASSISTANCE AND THE CREATION OF A WAITING LIST; 2) MAINTAIN ALIGNMENT WITH THE EHE NATIONAL STRATEGIC PLAN; 3) UPHOLD HRSA HAB PRIORITIES FOR EQUITABLE ACCESS; AND 4) SUSTAIN PROGRAM OPERATIONS THROUGH POLICY TRANSITION. ERF FUNDING IS ESSENTIAL TO ENSURE UNINTERRUPTED MEDICATION ACCESS, PRESERVE VIRAL SUPPRESSION, AND PROTECT THE HEALTH GAINS ACHIEVED AMONG PEOPLE WITH HIV IN PUERTO RICO.