Ensuring Access to Treatment for HIV Infection
ABSTRACT The recent recommendations of the Centers for Disease Control and Prevention for opt-out testing are intended to address the evolving human immunodeficiency virus (HIV) epidemic in the United States by bringing more HIV-infected individuals into medical care. This is an important step to better control the epidemic but brings with it the challenges of adequately caring for more individuals infected with HIV and of funding medications and medical care for these additional patients. With more patients being offered HIV testing, there will be a surge in the need for testing and counseling services, which must keep pace with patient demand. This article describes the current status of HIV screening and care from 4 perspectives: the Ryan White Program (previously known as the Ryan White Comprehensive AIDS Resources Emergency Act), Medicaid and Medicare reimbursement for HIV screening, a managed care organization, and community health centers. The mandate for routine HIV screening challenges each of these health care entities, but all will need to overcome these challenges if routine HIV screening is to become a reality.
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ABSTRACT: A substantial number of people living with human immunodeficiency virus (HIV) have never received HIV medical care despite the benefits of early entry to care. The United States has no population-based system that can be used to estimate the number of people who have never received HIV care or to monitor the reasons that care is delayed. Although local efforts to describe unmet need and barriers to care have been informative, nationally representative data are needed to increase the number of people who enter care soon after diagnosis. Legal requirements to report all CD4 counts and all HIV viral load levels (indicators of HIV care) in most states now make national estimates of both care entry and non-entry feasible. The Centers for Disease Control and Prevention (CDC) and five state and local health department jurisdictions are testing and evaluating methods for a standardized supplemental HIV surveillance system to characterize HIV-infected people across the U.S. who have not entered HIV care after their diagnosis. This article reviews the context, rationale, and potential contributions of a nationally representative surveillance system to monitor delays in receiving HIV care, and provides data from the formative phase of the CDC pilot project.Public Health Reports 01/2010; 125(4):520-7. DOI:10.2307/41435276 · 1.64 Impact Factor
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ABSTRACT: In the United States, the publically supported national HIV medical care system is designed to provide HIV medical care to those who would otherwise not receive such care. Nevertheless, many HIV-infected persons are not receiving medical care. Limited information is available from HIV-infected persons not currently in care about the reasons they are not receiving care. From November 2006 to February 2007, we conducted five focus groups at community-based organizations and health departments in five U.S. cities to elicit qualitative information about barriers to entering HIV care. The 37 participants were mostly male (n = 29), over the age of 30 (n = 34), and all but one had not received HIV medical care in the previous 6 months. The focus group discussions revealed health belief-related barriers that have often been overlooked by studies of access to care. Three key themes emerged: avoidance and disbelief of HIV serostatus, conceptions of illness and appropriate health care, and negative experiences with, and distrust of, health care. Our findings point to the potentially important influence of these health-related beliefs on individual decisions about whether to access HIV medical care. We also discuss the implications of these beliefs for provider-patient communication, and suggest that providers frame their communications with patients such that they are attentive to the issues identified by our respondents, to better engage patients as partners in the treatment process.AIDS patient care and STDs 09/2009; 23(9):785-92. DOI:10.1089/apc.2009.0032 · 3.58 Impact Factor
- Journal of General Internal Medicine 10/2009; 24(12):1338-40. DOI:10.1007/s11606-009-1156-9 · 3.42 Impact Factor