Why HIV Testing and Treatment Are Still Issues

A key concept for anyone considering the success of anti-HIV treatment in improving the health of individuals and in preventing onward transmission in their communities is the ‘treatment cascade’ or ‘care continuum’. This shows how, at every stage, patients are not retained in the healthcare system or are unable to access the medical care they need.

(Source)

President’s Welcome Video To International AIDS Conference 2012

Some history and a commitment to continue progress:

Clergy Can Fight HIV On Faith-friendly Terms

An excellent article from Science Daily:

In the United States, where blacks bear a disproportionate burden of the HIV/AIDS epidemic, black religious institutions could help turn the tide. In a new study in PLoS ONE based on dozens of interviews and focus groups with 38 of Philadelphia’s most influential black clergy, physicians and public health researchers find that traditional barriers to preaching about HIV prevention could give way to faith-friendly messages about getting tested and staying on treatment.

The public health community has long struggled with how best to reduce HIV infection rates among black Americans, which is seven times that of whites. In a new paper in the journal PLoS ONE, a team of physicians and public health researchers report that African-American clergy say they are ready to join the fight against the disease by focusing on HIV testing, treatment, and social justice, a strategy that is compatible with religious teaching.

“We in public health have done a poor job of engaging African-American community leaders and particularly black clergy members in HIV prevention,” said Amy Nunn, lead author of the study and assistant professor of medicine in the Warren Alpert Medical School of Brown University. “There is a common misperception that African American churches are unwilling to address the AIDS epidemic. This paper highlights some of the historical barriers to effectively engaging African American clergy in HIV prevention and provides recommendations from clergy for how to move forward.”

The paper analyzes and distills dozens of interviews and focus group data among 38 African-Amereican pastors and imams in Philadelphia, where racial disparities in HIV infection are especially stark. Seven in 10 new infections in the city are among black residents. With uniquely deep influence in their communities, nearly all of the 27 male and 11 female clergy said they could and would preach and promote HIV testing and treatment.

That message, delivered by clergy or other influential figures, would provide a needed complement to decades of public health efforts that have emphasized risk behaviors, Nunn said. Research published and widely reported last year, for example, suggests that testing and then maintaining people on treatment could dramatically reduce new infections because treatment can give people a 96-percent lower chance of transmitting HIV.

“For decades, we’ve focused many HIV prevention efforts on reducing risky behavior,” said Nunn, who is also based at The Miriam Hospital. “Focusing on HIV testing and treatment should be the backbone of HIV prevention strategies and efforts to reduce racial disparities in HIV infection. Making HIV testing routine is the gateway to getting more individuals on treatment. African American clergy have an important role to play in routinizing HIV testing.”

The barriers clergy members face

Many religious leaders acknowledged that they’ve struggled with how best to combat the epidemic, particularly with challenges related to discussing human sexuality in church or mosque, according to the analysis in the paper.

“One time my pastor spoke to young people about sex, mentioning using protection,” the paper quotes a clergy member as saying in one example. “I was sitting in the clergy row; you could feel the heat! I was surprised he said that. Comments from the clergy highlighted they were opposed to that. It’s a tightrope walk.”

Many clergy members also said they face significant barriers to preaching about risk behaviors without still emphasizing abstinence.

“It’s my duty as a preacher to tell people to abstain,” one pastor told the research team, “but if they’re still having sex and they’re getting HIV, there has to be another way to handle this.”

What clergy can do

Many clergy members suggested couching the HIV/AIDS epidemic in social justice rather than behavioral terms, Nunn said. They also recommended focusing on HIV testing as an important means to help stem the spread of the disease and reduce the stigma.

“We need to standardize testing,” one pastor told the researchers. “One thing that we could do immediately is to encourage our congregations — everybody — to get tested. … We’re not dealing with risk factors. And we’re all going to get tested once a year. That’s the one thing that we could do that doesn’t get into our doctrine about sexuality.”

In general, many of the religious leaders said they could encourage discussion of HIV not only in main worship services, but also in ministries and community outreach activities.

FULL ARTICLE HERE

Kaiser Permanente Announces HIV Challenge

When healthcare gets it right, I think it’s important to notice.
Contrary to the HMO stereotype, Kaiser Permanente has taken on the challenge of HIV and instituted policies and guidelines for the effective care and treatment of persons with HIV- to dramatic effect:

English: The Ordway Building, One Kaiser Plaza...

Image via Wikipedia

Kaiser Permanente announced (January 26th) the Kaiser Permanente HIV Challenge to help health care providers nationwide improve health equity for people living with HIV by increasing access to HIV care and improving health outcomes.

The HIV Challenge was announced at the Center for Medicare & Medicaid Innovation Care Innovations Summit in Washington, D.C. ( www.hcidc.org ).

Kaiser Permanente, the nation’s largest nonprofit health care provider, has treated more than 60,000 people since the HIV epidemic emerged 30 years ago, and has reduced disparities among its current HIV population of more than 20,000 people by working to meet or exceed the objectives of the U.S. National HIV / AIDS Strategy.

The crux of the HIV Challenge (kp.org/hivchallenge) is to challenge other private health care providers and public and community health clinics to increase the number of HIV-positive people getting effective treatment by sharing Kaiser Permanente’s toolkit of clinical best practices, provider and patient education materials, mentoring, training and health IT expertise.

(Watch the excellent video series about Kaiser’s HIV Challenge here)

HIV is still an epidemic in the United States, with 56,000 people becoming infected each year and more than 1.1 million Americans living with HIV, but one in five people with HIV don’t know they are infected.

“The organizations presenting challenges here today are pushing the best minds in the country to create a better health care system. They represent exciting solutions to help address some of the nation’s most urgent health needs,” said CMS Acting Administrator Marilyn Tavenner.

Health care disparities are gaps in the quality of care associated with inequities encountered by racial, ethnic, poor and marginalized groups. The HIV Challenge is part of Kaiser Permanente’s larger work to identify, measure, research and eliminate disparities in health and health care in the United States. To learn more go to kp.org/healthdisparities.

“Too many people are unaware they have HIV because access to effective prevention and care is insufficient,” said Michael Horberg, MD, director of HIV/AIDS for Kaiser Permanente, executive director of research for Mid-Atlantic Permanente Medical Group, and a member of the Presidential Advisory Council on HIV/AIDS. “People with HIV need to get into treatment because quality HIV treatment prevents others from getting infected. Patients on effective therapy and better case management are living longer and more productive lives. However, quality HIV treatment requires effort.”

Kaiser Permanente has demonstrated excellence in HIV clinical care outcomes with:

  • HIV mortality rates that are half the national average
  • 94 percent median treatment adherence among patients regularly in care and on antiretroviral therapy
  • No disparities among its black and Latino HIV-positive patients for both mortality and medication rates, compared to a 15 percent higher rate in the United States for mortality and for medication
  • 89 percent of its HIV-positive patients are in HIV-specific care within 90 days, compared to 50 percent in the U.S. within one year
  • 69 percent of all its HIV-positive patients have maximal viral control compared to 19 percent to 35 percent nationally

As part of its HIV Challenge effort, Kaiser Permanente is sharing these best practices and tools for private health care providers and community health clinics to replicate: quality improvement programs that measure gaps in care; testing, prevention and treatment guidelines; how to set up multi-disciplinary care team models that emphasize the “medical home” so HIV specialists, care managers, clinical pharmacists and providers work together; and education for both the provider and patient.

For more details on the HIV Challenge, to download the best-practices toolkit and to watch videos of success stories in setting up HIV clinics and reducing disparities, go to: kp.org/hivchallenge

“Our success in the treatment of patients with HIV/AIDS results from the excellence of our clinicians, our advanced IT systems, our integrated delivery system and our effective coordination across specialties,” said Robert Pearl, MD, chief executive officer and executive medical director of The Permanente Medical Group and Mid-Atlantic Permanente Medical Group. “In the same way that we have reduced the chances of our patients dying from cardiovascular disease and cancer significantly below the national averages, we have achieved outstanding clinical outcomes for our patients with HIV/AIDS.”

The National HIV/AIDS Strategy ( http://www.aids.gov/federal-resources/policies/national-hiv-aids-strategy/ ) calls for increased testing so that all Americans can know their HIV status, increased access to culturally sensitive prevention messages, community-targeted prevention and condom and clean needle access. NHAS also calls for improving access to quality HIV care because HIV medications not only improve individuals’ health and extend their life expectancy, they also reduce their risk of transmitting HIV to others. A recent scientific study found that effectively treating HIV patients with antiretroviral medications reduces HIV transmission by 96 percent. The study, known as HPTN 052, found that treating people with antiretroviral drugs before they are symptomatic can reduce the amount of virus in the blood sufficiently to reduce the risk of sexual transmission of HIV to an uninfected partner.

The Kaiser Permanente HIV Challenge is part of Kaiser Permanente’s ongoing research of HIV and HIV treatment. Published Kaiser Permanente research studies include:

  • A study that found there are no disparities by race or ethnicity in risk of AIDS and death among HIV-infected patients in a setting of similar access to care, despite lower anti-retroviral therapy adherence among Latinos and blacks compared to whites.
  • A study that found HIV-infected patients are at increased risk for cancer as a result of both their impaired immune system and lifestyle factors, such as smoking.
  • A study that found 17 measures, such as screening and prevention for infections and monitoring of antiretroviral therapy, should be adopted uniformly to improve the quality of HIV care and treatment nationwide.
  • A study that found that cholesterol medications can work well among certain HIV patients who are at risk for cardiovascular disease.

About the Care Innovations Summit:

Sponsored jointly by the Department of Health and Human Services, the Centers for Medicare & Medicaid Services, Health Affairs, and the West Wireless Health Institute, the Care Innovations Summit brings together more than 1,000 health care leaders, entrepreneurs, innovators, government officials, and finance experts to stimulate investment in a high-quality, sustainable health care system. Made possible by the Affordable Care Act and the Obama Administration’s commitment to open government, the Summit represents a new opportunity for industry and government to work together to help spur innovation in the public and private sectors to improve health care quality as never before and lower costs through improvement.

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 8.9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: http://www.kp.org/newscenter .

For more information:
Danielle Cass, danielle.x.cass@kp.org, 510-267-5354
Farra Levin, farra.r.levin@kp.org, 510-267-7364

SOURCE Kaiser Permanente

“The Race To End AIDS”

On Today’s Morning Edition from NPR, a story about HIV Treatment As Prevention:

AIDS Awareness

2011 has been a momentous year in the 30-year-old AIDS pandemic.

The big breakthrough was the discovery that antiviral drugs can prevent someone who’s infected with HIV from passing the virus to others. It’s nearly 100 percent effective. That led President Obama to declare earlier this month that the U.S. will expand HIV treatment in hard-hit countries by 50 percent.

As recently as last year, many of those experts were saying that just giving more people with HIV more drugs would never work. “For every one person that was put on antiretroviral therapy or treatment, we would have two to three new infections identified,” Dr. Eric Goosby, U.S. Global AIDS coordinator, says.

It looked like a losing game, but not anymore.

The new research shows that antiviral drugs not only save the lives of infected people, they also stop people from spreading the virus and causing new infections, if the drugs can be given early enough after someone gets infected. The new strategy is called “treatment as prevention.”

“So we suddenly are looking at a moment where we can treat our way out of the epidemic,” Goosby says. “That’s the turning point that we’re looking at.” Still, it’ll take decades to end AIDS, according to experts. But many say the world has to be much more aggressive about treating HIV.

But just the fact that this is being reported on and is being taken seriously is a big deal.

You can read and/or listen to the whole story here

HIV 2fer: Early Treatment Works and Truvada Prevents

HIV DataToday’s HIV News shelf is crowded. Two stories on the HIV front involve good news about early HIV treatment and Pre-Exposure Prophylaxis(PrEP) to reduce infection rates among high-risk persons.

A study (popularly known as the Setpoint Study) finds that people newly-infected with HIV-1 who immediately start anti-retroviral therapy are more likely to have beneficial medical outcomes than those who wait until CD4 counts fall below medically acceptable levels (currently 350-500 depending who you talk to).

“This is very welcome news,” said Frank J. Oldham, NAPWA President and CEO. “The study supplies scientific confirmation of something we at NAPWA have always believed: the closer we can come to bringing all people living with HIV into treatment, and the earlier they start treatment, the better. We already knew this is true for populations as a whole: more and earlier treatment means fewer new infections. Now we know that – on the whole – it’s also better for individuals already infected.”

The news on the HIV front just keeps getting better. The setpoint study follows on the heels of a groundbreaking study which provides proof of HIV treatment as prevention: HIV-infected persons on medication with undetectable viral levels are 96% less likely to pass on the virus.

It also accompanies Gilead’s application to offer Truvada as the first drug marketed to prevent HIV:

Gilead Sciences Inc. announced that it has submitted a supplemental New Drug Application (sNDA) to the U.S. Food and Drug Administration (FDA)for the approval of once-daily Truvada (emtricitabine/tenofovir disoproxil fumarate) for pre-exposure prophylaxis (PrEP) to reduce the risk of HIV-1 infection among uninfected adults. Truvada was approved by the FDA in 2004 for the treatment of HIV-1 infection and is currently the most-prescribed antiretroviral treatment in the United States.

If the sNDA is approved, Truvada would be the first agent indicated for uninfected individuals to reduce the risk of acquiring HIV through sex, a prevention approach called PrEP. The sNDA is based on the results of two large placebo-controlled trials of Truvada as PrEP, sponsored by the U.S. National Institutes of Health (NIH) and the University of Washington. Several other clinical studies support the use of Truvada for HIV risk reduction.

“The data from these large-scale clinical trials suggest that Truvada may have a role to play in meeting the urgent public health need to reduce new HIV infections,” said John C. Martin, PhD, Chairman and Chief Executive Officer of Gilead Sciences. “Gilead is proud to have played a part in helping to define the use of Truvada as a potential new prevention tool and we commend the many institutions, investigators and study volunteers for their commitment to advancing this important area of research.”

Truvada is not currently labeled to reduce the risk of infection, it is labeled only for HIV treatment.

This could be an important step in slowing HIV. Around 50,000 people are still being infected with HIV every year in the U.S. according to the CDC. More than half of new infections (61%) occur among men who have sex with men, and nearly a quarter (23%) occur among women.

If Truvada can be given to high-risk persons (which includes negative partners in a sero-discordant relationship) and insurance companies will pay for it, it may, along with the groundswell of early treatment science, start a trend of slowing the progression of HIV in this country.

But only if we can get more high-risk people in for testing and treatment….

When was your last HIV test?

ADAP Watch 12/19/11

From NAPWA:

President Obama called for the end of AIDS on World AIDS Day. But achieving that in America requires more public sector funding than Congress has provided to date, and the political climate for more funding is brutal.

 

We could make a classic business Republican argument for more funds: the increases would be trivial in the context of a $3.5 trillion federal budget, and the rate of return on investment would be as high as it gets – reduced public sector health care costs in future years, and improved private sector productivity. It cost next to nothing (in context) this year, and it pays back big for years to come. 

 

With recent additional federal money, ADAP waiting list numbers have come down some over the past month, but more than 4,000 Americans are still on wait lists. Ninety percent of them are in four Southern states, Florida, Georgia, Louisiana, and Virginia. All four are having financial difficulties in this economy, but the millions of dollars they would have to spend to eliminate their waiting lists are insignificant in multibillion dollar budgets, and spending the millions or not will not make their difficult positions materially any worse or any better.

 

Here are the latest numbers from our friends at NASTAD: