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.

Exploring the Medical Home in Ryan White HIV Care Settings: A Pilot Study

“…The development of personal providers and multidisciplinary care teams are crucial elements of the RWP model of care. One study demonstrated that a successful multi-disciplinary HIV care team needed to include an HIV specialty provider, care coordinator, medication support staff, benefits and insurance coordinator, social worker, and services such as behavioral health support and health education (Cheever, Lubinski, Horberg, & Steinberg, 2007). This team-based model has gained favor for effective management of HIV and other chronic diseases (Rodriguez, Marsden, Landon, Wilson, & Cleary, 2008) and is a core feature of medical homes.…”

The Role of Jails in Engaging PLWHA in Care: From Jail to Community

“…Numerous measures—receiving results from a rapid test, having initial blood work conducted, full intake at a clinic, and actually meeting with a physician at a clinic [9–11]—have been used to define linkage in research studies. A more expansive view also includes the quality of a successful linkage, having a health care worker’s presence at the post-testing counseling meeting, referral to a multidisciplinary agency that includes both medical and social services, an individualized match between individual and primary care provider, expedited care provided for substance abuse and psychiatric problems and frequent appointment reminders [11].…”

Routine HIV Testing Hits the Primary Care Clinic

“…Although more private insurers are covering routine HIV testing, very few Medicaid programs have adopted coverage, 15 and uninsured patients would have to pay for the test themselves. The resulting uncertainty about reimbursement for testing is a major barrier that should be addressed.…”