Kaisernetwork.org (Washington, DC)
5 January 2009
Across The Nation
New York Times Examines Pilot HIV Testing Program in Emergency Departments
[Jan 05, 2009]
The New York Times on Sunday examined a CDC pilot program that began Dec. 1, 2008, at three Connecticut hospital emergency departments and provides no-cost HIV testing to patients. Connecticut is one of 26 states participating in the program -- which offers testing regardless of whether HIV symptoms are present -- at EDs, community health centers and clinics for sexually transmitted infections.
The hospitals involved in the program will conduct routine HIV testing for a two-year period, after which the program might be expanded to other hospitals. According to the Times, CDC in 2006 revised its guidelines to recommend routine HIV testing for patients ages 13 to 64. CDC estimates that about 25% of the 1.1 million people living with the virus in the U.S. are unaware of their HIV status. Steven Aronin -- medical director of the Infectious Diseases Clinic at Waterbury Hospital, which is participating in the program -- said Connecticut has a disproportionate number of people living with HIV/AIDS and ranks fifth nationwide in the number of cases per capita. Aronin said cities such as Bridgeport, New Haven and Waterbury have the most HIV cases, with Waterbury having as many as 1,200 HIV-positive residents, 300 of whom are unaware of their status. The other two Connecticut hospitals involved in the program are Yale-New Haven Hospital and Lawrence & Memorial Hospital in New London, Conn.
According to the Times, the traditional role of EDs has been to provide "triage for the sick and injured and not to act as testing facilities" for STIs. However, the Times reports that some physicians have said that role might "have to change as [EDs] become the only place the uninsured and low-income patients ever have contact with physicians." Some physicians have been "skeptical" of adding STI testing to the workload of EDs, which are already overcrowded, but physicians involved in the pilot program are "optimistic it will work," the Times reports. Chris Andresen, a manager with Connecticut's Department of Public Health's AIDS and chronic disease unit, said that 20 people who were unaware of their HIV status have tested positive in the last year through the program, which has already been operating in the state through the same federal funding as the pilot program. He said, "The early intervention is key. If they find out early, they can stay healthier longer and not transmit it to others" (Gordon Fox, New York Times, 1/4).
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Hawaii Grant Helps AIDS Research Program Recover After Losing Federal Funding
[Jan 05, 2009]
The Hawaii AIDS Clinical Research Program has raised more than $20 million to support research and care for HIV-positive people since 2007 when the state Legislature allocated $1.2 million to the program after it lost a $1.6 million grant from the National Institute of Allergy and Infectious Diseases because some clinical trial units were closed, the Honolulu Star-Bulletin reports.
Cecilia Shikuma, director of the program and a professor of medicine at the University of Hawaii, said the program lost access to data management and other services when it lost federal funding and has "had to reinvent for our site how to do all those things." Shikuma said that although it has been "hard work" to adjust to the funding changes, program officials are "very pleased" with the outcome. She added that the program is "still financially shaky but it's allowing us to survive."
According to the Star-Bulletin, the program is designed to create and maintain an HIV research program that is nationally competitive and to provide access to and improve health care for people living with HIV/AIDS. There are more than 2,700 HIV-positive people living in Hawaii, and the clinic provides services for about 439 patients on Oahu and the neighboring islands. According to Shikuma, a "needs-assessment" study conducted by the program to examine how HIV care can be maintained in areas that lack HIV specialists found that Hawaii "faces particular problems in maintaining an adequate HIV medical care delivery system" because of the "relatively small" and "geographically segment[ed]" population of people living with the virus, the aging of physicians in the community who provide HIV care and the "lack of interest in HIV specialization among young physicians." The program recommended a system that allows people living with HIV, particularly in rural areas, to recover from the departure of a physician and to offer multiple patient care options.
According to the Star-Bulletin, the program is one of eight university sites funded by the National Heart, Lung and Blood Institute to examine the effects of HIV on cardiovascular risk and study ways to decrease the risk. The program also conducts HIV training and research in Southeast Asia in partnership with the South East Asia Research Collaboration with Hawaii and trains Vietnamese military physicians to address HIV/AIDS cases through the Vietnam President's Emergency Plan for AIDS Relief program. Shikuma said the program plans to apply for a new federal grant from NIH in 2009 (Altonn, Honolulu Star-Bulletin, 12/24/08).
Link to this story.
In The Courts
Court Orders California To Implement Program Providing Care to HIV-Positive People
[Jan 05, 2009]
A Superior Court judge in Los Angeles late last month ruled that the California Department of Health Care Services must provide medical care to low-income state residents living with HIV in compliance with a 2002 state law, the AIDS Healthcare Foundation announced, Bloomberg reports (Pettersson, Bloomberg, 12/23/08). The ruling follows a Dec. 5 decision by the Los Angeles County Superior Court that said DHCS failed to enact the 2002 state law (AB 2197) that calls for the implementation of a program to provide medical care to low-income HIV-positive people. The Dec. 5 ruling came in response to a lawsuit filed last year by AHF claiming that DHCS failed to expand coverage under Medi-Cal, the state's Medicaid program, to HIV-positive residents who had not developed AIDS.
The law, signed by former Gov. Gray Davis (D) in September 2002, calls for the state to provide full Medi-Cal benefits to HIV-positive people who already are enrolled in the state's AIDS Drug Assistance Program, "who are not disabled and who would otherwise qualify for benefits under the Medi-Cal program." Before the law was passed, only people with an AIDS diagnosis who were considered disabled were eligible for benefits under Medi-Cal. To fund the program's expansion, the law suggested moving Medi-Cal beneficiaries with AIDS from the current fee-for-service system to a less expensive managed care program. The money saved would go toward financing the expansion of Medi-Cal benefits to people with HIV (Kaiser Daily HIV/AIDS Report, 12/5/08).
In a statement, AHF President Michael Weinstein said, "Despite an excellent record on AIDS issues," Gov. Arnold Schwarzenegger (R) "has been ill-served by his administration, which for six years has failed to enact this crucial -- and ultimately cost-saving -- health care legislation." DHCS spokesperson Anthony Cava said it was not possible to implement the law in a "cost-neutral environment" and that the law was "very clear that it should not be implemented if the costs could not be offset by savings." Cava added that DHCS "will continue to work with its partners to implement the law in a cost-neutral manner, just as the legislature intended" (Bloomberg, 12/23/08).
Link to this story.
Science & Medicine
HIV-Positive Infants More Likely To Develop TB, Study Finds
[Jan 05, 2009]
HIV-positive infants are about 20 times more likely to develop tuberculosis than infants without HIV, according to a study recently published in the journal Clinical Infectious Diseases, Reuters/Yahoo! News reports. Researchers from the Desmond Tutu TB Center at Stellenbosch University in South Africa, led by Anneke Hesseling, analyzed the prevalence of HIV and TB among infants attending the hospital between 2004 and 2006. The researchers found that 245 infants were confirmed as having TB, and they estimated that the incidence of TB was 1,596 cases per 100,000 population among HIV-positive infants and 65.9 cases per 100,000 population among HIV-negative infants. The report said, "HIV-infected infants were at a 24.1-fold higher risk of pulmonary tuberculosis and a 17.1-fold higher risk of disseminated tuberculosis."
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