In addition to Medicare physician payments, Medicare funding for graduate medical education will be reduced by 2 percent. Other federal health care spending will undergo cuts of about 5 percent. Among the areas hit are research and public health programs of the National Institutes of Health, the Centers for Disease Control and Prevention, and the Substance Abuse and Mental Health Services Administration.

Clinicians Urged to Use Continued Vigilance for Fungal Infections among Patients Who Received Contaminated Steroid Injections

• Information about the current status of the outbreak;
• Recommendations for clinical management and follow-up of exposed patients;
• Information about new revisions to web-based interim clinical guidance; and
• Notice of an upcoming CDC conference call to provide clinicians with additional diagnostic and treatment information.

    This week, the National Institutes of Health released results of an HIV clinical trial that evaluated two oral antiretroviral prophylaxis regimens and a vaginal microbicide among sexually active women. Compared to placebo arms, the intervention arms provided no protection. These results likely occurred because women were not taking the drugs consistently as directed. Less than one- third of participants assigned to all study arms evaluated had any study drug detected.

   The Vaginal and Oral Interventions to Control the Epidemic (VOICE) trial was designed to evaluate safety and efficacy of two daily oral regimens - TDF (tenofovir) or TDF/FTC (brand nameTruvada®) -and one daily vaginal TDF gel. The gel and daily oral TDF arms were found safe but were stopped last year because neither was found to be effective in preventing HIV in this population.  Today's results indicate that oral TDF/FTC was also safe, but did not provide protection to women in this study, and adherence data from all three arms indicate low levels of product use.

   There is strong evidence from previously completed trials that daily oral pre-exposure prophylaxis (PrEP) is safe and effective in reducing the risk of sexual HIV acquisition among multiple high risk populations including men who have sex with men (MSM) and heterosexual women and men, if taken consistently. On the basis of those previous trials, the Food and Drug Administration (FDA) approved the use of Truvada® to reduce the risk of sexual HIV infection. To help ensure the safe and effective use of PrEP among adults, CDC issued  interim clinical guidance. Today's results reinforce the need for clinicians to closely follow that guidance and counsel patients about the need for high levels of medication adherence.