Short Takes On News & Events

New Report Identifies Barriers To HIV Care In U.S.

By Shefali S. Kulkarni

March 15th, 2012, 1:27 PM

In July 2010 the White House created the National HIV/AIDS Strategy (NHAS) that set out to decrease HIV-related health disparities, to increase access to care for the disease and to improve health outcomes for HIV patients.

But in order to effectively measure the success of this plan, the Office of National AIDS Policy (ONAP) commissioned the Institute of Medicine (IOM) to identify what indicators and data systems should be used to measure HIV care and access to support services like public housing. The IOM committee was also tasked to monitor how HIV care will be affected by the health reform law — which could newly insure a number of now-uninsured HIV patients.

President Obama marks World AIDS Day on Dec. 1, 2011 with a speech on the national agenda to combat AIDS (White House photo).

On Thursday, the IOM released their recommendations in a 259-page report highlighting barriers to HIV care such as delayed diagnosis, sporadic use of antiretroviral therapy and untreated mental health problems.

“So now the issue is: There are all these things from the national strategy that we propose to do. How are we going to measure them? In other words, how are we going to know that we got there, and when can we say ‘Mission Accomplished?’” said Dr. Carlos del Rio, a member of the IOM committee and chair of the Hubert Department of Global Health at Emory University.

Keeping the barriers to HIV care in mind, the report notes that core indicators for continuous, good HIV care “include measures of clinical HIV care, access to treatment for substance abuse and mental health disorders, and access to supportive services, such as housing, transportation, and food assistance, all of which have been shown to influence the overall health of people with HIV.”

The report also identified 12 different data systems — from the U.S. Department of Veteran Affairs’ clinical case registry to Medicare and Medicaid claim systems — that will help to show the effects that the health reform law and the White House strategy have on HIV care in the U.S.

“Basically, at the end of the day, what we are recommending is that existing monitoring systems — for example the CDC’s Medical Monitoring Project and some other projects that exist out there — be strengthened,” Del Rio said.

He said monitoring HIV care is going to be vital, especially after the implementation of the health reform law. “There’s a lot of concern right now that HIV care, like any other care, is going to be significantly affected by [the health reform law]. So how are we going to know if things got better or worse? And having the right monitoring systems are going to be critical to do that.”

In addition to the IOM recommendations, the White House tapped Dr. Grant Colfax as the new director for ONAP on Wednesday. Colfax, the former president of the San Francisco AIDS Foundation, is known for his work tracking HIV viral loads throughout that city as well as for improving HIV prevention and care.

Del Rio says the report “will likely be the first thing on Colfax’s new desk.”

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