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Challenges Remain in HIV Care: Public Health Watch Report

Which puts a recent analysis released by the Centers for Disease Control and Prevention (CDC) in an interesting light. In assessing their HIV testing initiative, which financed testing and treatment referral programs at local clinics, the agency still found issues regarding access to care and treatment compliance, despite significant improvements. Indeed, among the nearly 3,000 youths who received a new diagnosis of HIV infection as part of the agency’s testing program, only 66% were linked to HIV medical care within 90 days of diagnosis, and only 63% were interviewed for partner services—still well short of the national goal for 2020, which seeks to have “at least 85% of HIV-positive persons [referred] to medical care within 30 days of diagnosis.” Worse, the analysis revealed that, among the nearly 2,000 HIV infections identified during the testing program among youths who had been previously diagnosed, 92% of these patients were not in treatment at the time the analysis was performed.

With the proposed budget cuts potentially facing the CDC as a result of the healthcare law reform debate ongoing in Congress, the future of these initiatives—and the successes they’ve achieved—is very much up in the air.

Finally, speaking of money, and the potential impact of the lack thereof, a study published June 19, 2017 in JAMA Internal Medicine experimented with the use of financial incentives to encourage treatment compliance. In the study, patients received $125 gift cards at the time they received positive test results for HIV, and then were given $70 gift cards quarterly if they received ART and remained virally suppressed. The researchers found that those who complied with care (and thus, received quarterly incentives) were more likely to achieve and maintain viral suppression compared with those who did not receive incentives. The proportion of patients with viral suppression was 3.8% higher in the financial incentives group overall, and, among patients not previously consistently virally suppressed, the proportion was 4.9% higher. In addition, continuity in care was 8.7% higher in the incentivized patients.

So, what have we learned? In short: that properly addressing HIV care requires money and innovation—2 things that some believe may be in short supply going forward.

So much for “good news.”
Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.
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