The Issue
Despite significant advances in medical care and treatment for people living with HIV and AIDS (PLWHA) in the United States.
During 2021:
- 75.3% of 964,002 persons alive at year-end 2021 received any HIV medical care (at least 1 CD4 or viral load test)
- 53.9% of persons were retained in HIV medical care (at least 2 CD4 or viral load test)
- 65.9% of persons had viral suppression at the most recent viral load test in 48 jurisdictions with complete reporting of laboratory data to CDC.
Furthermore, there are significant health disparities along the continuum of care for minority populations; only 61% of African Americans and 24% of Hispanics/Latinos achieved viral suppression compared to 71% of Whites.
In 2010, the Pittsburgh Regional Health Initiative analyzed Pennsylvania Health Care Cost Containment Council (PHC4) data to understand the reasons for hospital admissions and readmissions in southwestern Pennsylvania for HIV-positive individuals in order to identify opportunities for improving care and reducing avoidable admissions.
Data confirmed that, as a result of the development of more effective HIV medications, life expectancy at diagnosis has increased dramatically, transitioning HIV into a chronic disease that needs to be managed. The picture that emerged was one of extraordinarily complex patients, with conditions ranging from HIV-related infections to comorbid common chronic diseases to the side effects of mental illness, drug abuse, and the medications used to treat HIV itself.
The Response
As part of the JHF fiscal agency, in April 2012, the Jewish Healthcare Foundation was awarded a grant from the Pennsylvania Department of Health Special Pharmaceutical Benefits Program to tackle this difficult problem. Since the start of the Minority AIDS Initiative (MAI), JHF has worked with 24 AIDS Service Organizations (ASOs) across the state to improve the quality of patient services, develop or strengthen programs to re-engage individuals lost to care, and reduce avoidable hospital readmissions for persons with HIV/AIDS.
Many organizations already work hard to re-engage individuals lost to care, but most did not have access to the program models, staff training, or quality improvement systems necessary to do so effectively. Programs for effective outreach exist, and MAI training and coaching is geared to helping organizations adopt a specific model or develop their own based on the core components of existing models.
MAI has trained and coached outreach workers (peers, medical assistants, social workers, etc.) in Motivational Interviewing techniques and skills, so that they can effectively reach out to individuals lost to care. ASOs have also been trained in Perfecting Patient Care℠, the flagship quality improvement system developed by PRHI. Twice a year, JHF facilitates a statewide learning session for partner agencies. The session provides an opportunity for peer-to-peer learning, organizational planning, and synthesis of successful strategies for re-engaging clients in care.