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Au M, Coombs E, Jones A, Carley F, Talwar-Hebert M, Addison W, Mills RJ, Cohen SM, Klein PW, Cheever L, Gilman B. Coordinating Care for People With HIV Who Have Lower Incomes and Alternative Sources of Health Care Coverage. J Assoc Nurses AIDS Care 2023; 34:280-291. [PMID: 37098817 DOI: 10.1097/jnc.0000000000000408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
ABSTRACT As people with HIV increasingly access affordable health care coverage-enabling them to obtain medical care from private providers-understanding how they use the Ryan White HIV/AIDS Program (RWHAP), and their unmet health care needs, can enhance their overall care. We analyzed RWHAP client-level data and interviewed staff and clients at 29 provider organizations to identify trends in health care coverage and service use for clients who received medical care from private providers. The RWHAP helps cover the cost of premiums and copays for these clients and provides medical and support services that help them stay engaged in care and virally suppressed. The RWHAP plays an important role in HIV care and treatment for clients with health care coverage. The growing number of people who receive a combination of services from RWHAP providers and private providers offers opportunities for greater care coordination through communication and data sharing between these settings.
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Affiliation(s)
- Melanie Au
- Melanie Au, MPP, is Health Researcher, Mathematica, Princeton, New Jersey, USA. Ellie Coombs, MPP, is Managing Associate, Mission Analytics, Inc., San Francisco, California, USA. Andrew Jones, MA, is Research and Informatics Specialist, Mission Analytics, Inc., San Francisco, California, USA. Francis Carley, MPP, is Deputy Director of Strategic Initiatives, Oakland Community Health Network, Troy, Michigan, USA. Maya Talwar-Hebert was Health Associate, Mathematica, Princeton, New Jersey, USA. West Addison is Chief of Statistical Programming, Mission Analytics, Inc., San Francisco, California, USA. Robert Mills, PhD, is Senior Health Statistician, Division of Policy and Data, HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, USA. Stacy Cohen, MPH, is Chief, Evaluation, Analysis, Dissemination Branch, HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, USA. Pamela Klein, PhD, is Senior Health Scientist, HIV/AIDS Bureau, Division of Policy and Data, Health Resources and Services Administration, Rockville, Maryland, USA. Laura Cheever, MD, ScM, is Associate Administrator, HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, USA. Boyd Gilman, PhD, is Principal Researcher, Mathematica, Princeton, New Jersey, USA
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Weiser J, Dempsey A, Mandsager P, Shouse RL. Documenting Successes 30 Years After Passage of the Ryan White CARE Act: To the Editor. J Assoc Nurses AIDS Care 2021; 32:138-139. [PMID: 33427768 PMCID: PMC7914155 DOI: 10.1097/jnc.0000000000000224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- John Weiser
- Medical Epidemiologist, U.S., Department of Health and Human Services, Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia, USA
| | - Antigone Dempsey
- Director of Policy and Data, U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, USA
| | - Paul Mandsager
- Health Scientist, U.S., Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, USA
| | - R. Luke Shouse
- Medical Epidemiologist, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia, USA
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Goyal R, Luca D, Klein PW, Morris E, Mandsager P, Cohen SM, Hu C, Hotchkiss J, Gao J, Jones A, Addison W, O'Brien-Strain M, Cheever LW, Gilman B. Cost-Effectiveness of HRSA's Ryan White HIV/AIDS Program? J Acquir Immune Defic Syndr 2021; 86:174-181. [PMID: 33093330 DOI: 10.1097/qai.0000000000002547] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND With an annual budget of more than $2 billion, the Health Resources and Services Administration's Ryan White HIV/AIDS Program (RWHAP) is the third largest source of public funding for HIV care and treatment in the United States, yet little analysis has been done to quantify the long-term public health and economic impacts of the federal program. METHODS Using an agent-based, stochastic model, we estimated health care costs and outcomes over a 50-year period in the presence of the RWHAP relative to those expected to prevail if the comprehensive and integrated system of medical and support services funded by the RWHAP were not available. We made a conservative assumption that, in the absence of the RWHAP, only uninsured clients would lose access to these medical and support services. RESULTS The model predicts that the proportion of people with HIV who are virally suppressed would be 25.2 percentage points higher in the presence of the RWHAP (82.6 percent versus 57.4 percent without the RWHAP). The number of new HIV infections would be 18 percent (190,197) lower, the number of deaths among people with HIV would be 31 percent (267,886) lower, the number of quality-adjusted life years would be 2.7 percent (5.6 million) higher, and the cumulative health care costs would be 25 percent ($165 billion) higher in the presence of the RWHAP relative to the counterfactual. Based on these results, the RWHAP has an incremental cost-effectiveness ratio of $29,573 per quality-adjusted life year gained compared with the non-RWHAP scenario. Sensitivity analysis indicates that the probability of transmitting HIV via male-to-male sexual contact and the cost of antiretroviral medications have the largest effect on the cost-effectiveness of the program. CONCLUSIONS The RWHAP would be considered very cost-effective when using standard guidelines of less than the per capita gross domestic product of the United States. The results suggest that the RWHAP plays a critical and cost-effective role in the United States' public health response to the HIV epidemic.
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Affiliation(s)
| | | | - Pamela W Klein
- HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services; and
| | | | - Paul Mandsager
- HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services; and
| | - Stacy M Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services; and
| | | | | | | | | | | | | | - Laura W Cheever
- HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services; and
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Farias ODO, Guedes DDS, Freitas PCAD, Galvão MTG, Cunha GHD, Lima ICVD. Analysis of the needs for help of men who have sex with men and live with HIV. Rev Esc Enferm USP 2020; 54:e03650. [PMID: 33295530 DOI: 10.1590/s1980-220x2019010303650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 02/17/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To understand the needs for help of men who have sex with men and live with HIV in the light of a Prescriptive Theory. METHOD Descriptive and qualitative study, conducted with men who have sex with men and live with HIV who were treated in a Specialized Outpatient Service in a capital in Northeastearn Brazil, between the months of November 2017 and May 2018. The study used the analysis of the discourse of the collective subject. RESULTS 49 men with HIV who self-identified as men who have sex with men participated in the study. Help was described as support, welcoming, psychosocial and family support. The desire to receive assistance was related to accepting and forgetting the diagnosis. The problems experienced were related to the acceptance of the diagnosis, fear and prejudice. Professionals and family members stood out as sources of support. Nursing care was cited as significant and the main help required was psychological. CONCLUSION The needs for help identified were mainly related to psychological support coming from health professionals and family members. Participants were willing to receive help, especially to cope with the diagnosis.
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Affiliation(s)
- Odaleia de Oliveira Farias
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e Enfermagem, Departamento de Enfermagem, Fortaleza, CE, Brasil
| | - Dayse da Silva Guedes
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e Enfermagem, Departamento de Enfermagem, Fortaleza, CE, Brasil
| | | | - Marli Teresinha Gimeniz Galvão
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e Enfermagem, Departamento de Enfermagem, Fortaleza, CE, Brasil
| | - Gilmara Holanda da Cunha
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e Enfermagem, Departamento de Enfermagem, Fortaleza, CE, Brasil
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Muiruri C, Sico IP, Schexnayder J, Webel AR, Okeke NL, Longenecker CT, Gonzalez JM, Jones KA, Gonzales SE, Bosworth HB. Why Do People Living with HIV Adhere to Antiretroviral Therapy and Not Comorbid Cardiovascular Disease Medications? A Qualitative Inquiry. Patient Prefer Adherence 2020; 14:985-994. [PMID: 32669837 PMCID: PMC7337208 DOI: 10.2147/ppa.s254882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/19/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND After achieving viral suppression, it is critical for persons living with HIV (PLWH) to focus on prevention of non-AIDS comorbidities such as cardiovascular disease (CVD) in order to enhance their quality of life and longevity of life. Despite PLWH elevated risk of developing CVD compared to individuals without HIV, PLWH do not often meet evidence-based treatment goals for CVD prevention; the reasons for PLWH not meeting guideline recommendations are poorly understood. The objective of this study was to identify the factors associated with adherence to CVD medications for PLWH who have achieved viral suppression. METHODS Qualitative data were obtained from formative research conducted to inform the adaptation of a nurse-led intervention trial to improve cardiovascular health at three large academic medical centers in the United States. Transcripts were analyzed using content analysis guided by principles drawn from grounded theory. RESULTS Fifty-one individuals who had achieved viral suppression (<200 copies/mL) participated: 37 in 6 focus groups and 14 in individual semi-structured interviews. Mean age was 57 years (SD: 7.8); most were African Americans (n=31) and majority were male (n=34). Three main themes were observed. First, participants reported discordance between their healthcare providers' recommendations and their own preferred strategies to reduce CVD risk. Second, participants intentionally modified frequency of CVD medication taking which appeared to be related to low CVD risk perception and perceived or experienced side effects with treatment. Finally, participants discussed the impact of long-term experience with HIV care on adherence to CVD medication and motivational factors that enhanced adherence to heart healthy behaviors. CONCLUSION Findings suggest that future research should focus on developing interventions to enhance patient-provider communication in order to elicit beliefs, concerns and preferences for CVD prevention strategies. Future research should seek to leverage and adapt established evidence-based practices in HIV care to support CVD medication adherence.
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Affiliation(s)
- Charles Muiruri
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Correspondence: Charles Muiruri Email
| | - Isabelle P Sico
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Julie Schexnayder
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Juan Marcos Gonzalez
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Sarah E Gonzales
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Hayden B Bosworth
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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Youn B, Shireman TI, Lee Y, Galárraga O, Wilson IB. Trends in medication adherence in HIV patients in the US, 2001 to 2012: an observational cohort study. J Int AIDS Soc 2019; 22:e25382. [PMID: 31441221 PMCID: PMC6706701 DOI: 10.1002/jia2.25382] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 07/31/2019] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Adherence to antiretroviral therapy (ART) is essential to reduce HIV-related morbidity and mortality as well as the risk of virological failure and HIV transmission. We determined the trends in ART adherence during the periods of therapeutic advances, wider use of ART and greater attention to ART adherence. To understand the general trends in medication adherence, we compared ART adherence with medications for other common chronic conditions. METHODS A retrospective cohort study using Medicaid claims between 2001 and 2012 from 14 US states with the highest HIV prevalence. Medicaid is the largest source of care for HIV patients in the US. We identified Medicaid beneficiaries with HIV who initiated ART between 2001 and 2010 (n=23,343). Comparison groups included (1) HIV- persons who initiated a statin, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB), or metformin and (2) HIV+ persons who initiated these control medications while on and not on ART. We estimated adjusted odds of >90% medication implementation during the two years following initiation. RESULTS The proportion of HIV+ persons with >90% ART implementation increased from 33.5% in those who initiated in 2001 to 46.4% in 2005 and 52.4% in 2010. ART initiators in 2007 to 2010 had 53% increased odds of >90% implementation compared to those in 2001 to 2003 (adjusted OR 1.53, 99% CI: 1.34 to 1.75). Older age, male, White race, newer ART regimens and absence of substance use indicators were also associated with increased odds of >90% ART implementation. No or minimal improvements were found in the implementation of control medications in HIV- persons. For HIV- persons, the adjusted ORs comparing 2007-2010 to 2001-2003 were 1.06, 1.01 and 1.19 for statins, ACEI/ARB, metformin respectively. HIV+ persons who were on ART had, on average, 15.0 (SD: 4.2) and 16.1 (SD: 3.4) percentage points higher >90% implementation rates of concurrent statins, ACEI/ARB or metformin compared to HIV- persons and HIV+ persons who were not on ART respectively. CONCLUSIONS Adherence to ART substantially improved between 2001 and 2012. Nevertheless, the absolute rates of >90% implementation were low for all groups examined. Substantial disparities by age, sex and race were present, drawing attention to the need to continue to enhance medication adherence. Further studies are required to examine whether these trends and disparities persist in the most recent period.
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Affiliation(s)
- Bora Youn
- Department of Health Services, Policy & PracticeBrown University School of Public HealthProvidenceRIUSA
| | - Theresa I Shireman
- Department of Health Services, Policy & PracticeBrown University School of Public HealthProvidenceRIUSA
| | - Yoojin Lee
- Department of Health Services, Policy & PracticeBrown University School of Public HealthProvidenceRIUSA
| | - Omar Galárraga
- Department of Health Services, Policy & PracticeBrown University School of Public HealthProvidenceRIUSA
| | - Ira B Wilson
- Department of Health Services, Policy & PracticeBrown University School of Public HealthProvidenceRIUSA
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Weiser J, Chen G, Beer L, Boccher-Lattimore D, Armstrong W, Kurth A, Shouse RL. Sustaining the HIV care provider workforce: Medical Monitoring Project HIV Provider Survey, 2013-2014. Health Serv Res 2019; 54:1065-1074. [PMID: 31264205 DOI: 10.1111/1475-6773.13192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To describe delivery of recommended HIV care and work satisfaction among infectious disease (ID) physicians, non-ID physicians, nurse practitioners (NPs), and physician assistants (PAs). DATA SOURCES Medical Monitoring Project 2013-2014 HIV Provider Survey. STUDY DESIGN Population-based complex sample survey. DATA COLLECTION/ANALYSIS METHODS We surveyed 2208 HIV care providers at 505 US HIV care facilities and computed weighted percentages of provider characteristics, stratified by provider type. Rao-Scott chi-square tests and logistic regression used to compare characteristics of ID physicians with each other provider type. PRINCIPAL FINDINGS The adjusted provider response rate was 64 percent. Among US HIV care providers, 45 percent were ID physicians, 35 percent non-ID physicians, 15 percent NPs, and 5 percent PAs. Satisfaction with administrative burden was lowest among non-ID physicians (27 percent). Compared with ID physicians, satisfaction with remuneration was lower among non-ID physicians and higher among NPs (37, 28, and 51 percent, respectively). NPs were more likely than ID physicians to report performing four of six services that are key to providing comprehensive HIV care, but more NPs planned to leave clinical practice within 5 years (19 vs 7 percent). CONCLUSION Addressing physician dissatisfaction with remuneration and administrative burden could help prevent a provider shortage. Strengthening the role of NPs may help sustain a high-quality workforce.
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Affiliation(s)
- John Weiser
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Linda Beer
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Wendy Armstrong
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Ann Kurth
- Yale School of Nursing, Yale University, Orange, Connecticut
| | - R Luke Shouse
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Byrd KK, Hardnett F, Clay PG, Delpino A, Hazen R, Shankle MD, Camp NM, Suzuki S, Weidle PJ, Aguirre M, Akinbosoye O, Bamberger DM, Bluml B, Bullock K, Burrell DC, Bush T, Bush C, Cadwell C, Cardarelli R, Clark T, Crim A, Cure A, Darin K, Dean T, DeMayo M, Elrod S, Eschmann AL, Farmer D, Farnan R, Free H, Gudzelak A, Halbur A, Hardnett F, Hazen R, Hilker H, Hou J, Hujdich B, Johnson L, Kirkham H, Lecounte J, Lio S, Lo G, Middleton S, Mills B, Nguyen CM, Ortiz L, Pietrandoni G, Scarsi K, Schommer J, Shrestha R, Smith D, Taitel MS, Teferi GN, Tomer V, Terres L, Whitfield C, Willman JE. Retention in HIV Care Among Participants in the Patient-Centered HIV Care Model: A Collaboration Between Community-Based Pharmacists and Primary Medical Providers. AIDS Patient Care STDS 2019; 33:58-66. [PMID: 30648888 DOI: 10.1089/apc.2018.0216] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Poor retention in HIV care is associated with higher morbidity and mortality and greater risk of HIV transmission. The Patient-Centered HIV Care Model (PCHCM) integrated community-based pharmacists with medical providers. The model required sharing of patient clinical information and collaborative therapy-related action planning. The proportion of persons retained in care (≥1 medical visit in each 6-month period of a 12-month measurement period with ≥60 days between visits), pre- and post-PCHCM implementation, was modeled using log binomial regression. Factors associated with post-implementation retention were determined using multi-variable regression. Of 765 enrolled persons, the plurality were male (n = 555) and non-Hispanic black (n = 331), with a median age of 48 years (interquartile range = 38-55); 680 and 625 persons were included in the pre- and post-implementation analyses, respectively. Overall, retention improved 12.9% (60.7-68.5%, p = 0.002). The largest improvement was seen among non-Hispanic black persons, 22.6% increase (59.7-73.2%, p < 0.001). Persons who were non-Hispanic black [adjusted risk ratio (ARR) 1.27, 95% confidence interval (CI) 1.08-1.48] received one or more pharmacist-clinic developed action plan (ARR 1.51, 95% CI 1.18-1.93), had three or more pharmacist encounters (ARR 1.17, 95% CI 1.05-1.30), were more likely to be retained post-implementation. In the final multi-variable models, only race/ethnicity [non-Hispanic black (ARR 1.27, 95% CI 1.09-1.48) and "other or unknown" race/ethnicity (ARR 1.36, 95% CI 1.14-1.63)] showed an association with post-implementation retention. PCHCM demonstrated how collaborations between community-based pharmacists and primary medical providers can improve retention in HIV care. This care model may be particularly useful for non-Hispanic black persons who often are less likely to be retained in care.
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Affiliation(s)
- Kathy K. Byrd
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Felicia Hardnett
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Patrick G. Clay
- University of North Texas Health Science System College of Pharmacy, Fort Worth, Texas
| | | | | | | | | | - Sumihiro Suzuki
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, Texas
| | - Paul J. Weidle
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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