June 15, 2007
BACK TO BASICS
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Walking away from care can be fatal. |
A study released this month showed once again that treating HIV requires more than just medication and reinforced the importance of initiatives such as the Early Treatment for HIV Act (ETHA) and HASA for All.
"Retention in Care: A Challenge to Survival with HIV Infection" published in the June 1 issue of Clinical Infectious Diseases demonstrated the vital connection between regular medical visits for people with HIV/AIDS and reduced mortality. The study followed 2,619 men treated at Veterans Affairs hospitals from 1997 to 2002 during their first year of care.
The researchers divided each year into four quarters and kept track of how many primary care visits the men made during each quarter. The men who made visits during only one quarter had twice the death rate of those who had visits in all four quarters. This astonishing statistic was true even though the men who saw their docs more frequently had more advanced HIV disease.
The study's coauthor, assistant professor at Baylor College of Medicine, Thomas Giordano, said that his research shows the need to move beyond our traditional understanding of how to end the epidemic. "Ten years ago, we learned how to use the medicines that treat HIV. About six or seven years ago, the focus shifted to patient adherence to those medications. Now we have to recognize how to keep people in care better," he said.
An ounce of (legislative) prevention
Although Giordano didn't study the reasons why VA patients didn't show up for regular care, his paper noted that, "The VA population generally has few resources to buffer the consequences in lapses of care... Many other populations with HIV infection in the United States are similarly vulnerable, including clients dependent on the Ryan White CARE Act and Medicaid."
Housing Works' legislative counsel Michael Kink says that Giordano's work is a timely reminder of the need to pass legislation that gets more people in comprehensive care and helps them stay there. "There are two big reasons that someone in the United States who needs lifesaving HIV care isn't getting it. It is either unaffordable or unreachable," Kink said. He would like to see Congress pass the ETHA, which gives states the option of extending Medicaid coverage to low-income people with an HIV diagnosis who have not yet become disabled by AIDS. Congress is considering both an ETHA pilot project as well as full passage of the legislation.
In New York State, the HASA for ALL effort would achieve a similar goal by expanding housing, nutrition and transportation benefits to asymptomatic people living with HIV. The housing benefits are particularly critical: A report from the Columbia School of Public Health CHAIN project showed that homelessness is the single biggest reason New Yorkers living with HIV fail to enter treatment, fall out of treatment or are non-compliant with treatment. Although Giordano's study didn't directly speak to the importance of housing, he said, "I would be surprised if lack of housing wasn't a factor for people who didn't receive care."
Catherine Hanssens, executive Director of the Center for HIV Law and Policy, says the study also highlights the inadequacy of HIV testing initiatives that seek to increase the numbers of people getting tested but not the quality of follow-up care for those testing positive. "In New York City alone, there's evidence that many thousands of people already tested and diagnosed with HIV remain outside of care," she said.
That's a real shame considering how even a little care goes a long way. In an editorial that accompanied the Giordano's report, Dr. Laura Cheever wrote about a study that showed that "for patients who have received a new diagnosis, as few as two case management visits could significantly improve linkage to and retention in care."