|
 Compared to other outpatient HIV treatment facilities, those funded
by the federal Ryan White HIV/AIDS Program (RWHAP) offer more case
management, mental health and substance abuse support services, and
those services make a difference in patient outcomes, according to
researchers from Centers for Disease Control and Prevention (CDC).
Facilities that applied for and received funding through the RWHAP
have served more vulnerable populations, including the poor or
recently homeless or incarcerated, said lead author Dr. John Weiser
of the CDC’s Division of HIV/AIDS Prevention in Atlanta, Georgia.
“As expected, patients receiving care at RWHAP-funded facilities,
because they were more likely to experience life challenges, were
less likely overall to achieve viral suppression than those
receiving care at non-RWHAP-funded facilities,” Weiser told Reuters
Health by email.
“However, after taking those differences into consideration, poor
patients were more likely to achieve viral suppression if they
received care at RWHAP-funded facilities,” he said.
Achieving viral suppression by taking HIV medication means that
levels of the virus in the body are so low that people have a nearly
average life expectancy and are less likely to transmit the disease,
according to the CDC.
In 1990, the RWHAP was established to fund states, metropolitan
areas and clinics to increase access to high-quality HIV care and
treatment for low-income, uninsured and underinsured individuals and
families.
Currently reaching 500,000 people with HIV – more than half of those
in the U.S. living with the disease – the RWHAP is a “payer of last
resort” for core medical services like medication that a facility
could otherwise not afford, and also for support services like food,
housing and transportation or counseling services.
As the Affordable Care Act and Medicaid expansion increase access to
HIV treatment for many Americans, the supportive services that the
RWHAP funds are still often not covered by Medicaid and commercial
insurance, Weiser said. So facilities without RWHAP funding would
need to find another way to pay for them, he noted.
[to top of second column] |
For the new study, published in JAMA Internal Medicine, Weiser’s
team looked at data from 2009 and 2011 covering a sample of 8,038
HIV-infected adults receiving medical care at 989 outpatient health
care facilities across the U.S.
They found that 34 percent of facilities received RWHAP funding and
72.8 percent of patients were treated at one of these facilities.
Patients getting care at RWHAP-funded facilities were more likely to
be young, female and black or Hispanic, to have less than a high
school education, be at or below the poverty level and to lack
health insurance.
Nonetheless, almost 75 percent of patients at RWHAP funded
facilities achieved viral suppression, only slightly less than the
79 percent at other facilities.
“If we’re going to have an increase in the number of cases, we’re
going to have to increase the proportion of people who are virally
suppressed,” said commentary author Stephen F. Morin of the
University of California, San Francisco, who worked on the
authorization of the Ryan White program as part of congresswoman
Nancy Pelosi’s staff in the 1980s.
Ryan White-funded programs are “stretched to the limit” in states
that did not expand Medicaid, like Alabama, Morin told Reuters
Health.
Many states are having trouble financing important case management
services, he said.
Ryan White died in 1990 at age 18, just months before Congress
passed the Ryan White Comprehensive AIDS Resources Emergency (CARE)
Act.
SOURCE: http://bit.ly/1N36uXJ and http://bit.ly/1JNOA5Q JAMA
Internal Medicine, online August 31, 2015.
[© 2015 Thomson Reuters. All rights
reserved.] Copyright 2015 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
 |
