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A Fight on Two Fronts: Covid and HIV

Administrator Tom Engels told a coalition of HIV/AIDS stakeholder groups on Sept. 30, that HRSA-supported clinics have been "nothing short of inspiring" in fighting the twin scourges of COVID-19 and HIV.
Administrator Tom Engels told a coalition of HIV/AIDS stakeholder groups on Sept. 30, that HRSA-supported clinics have been "nothing short of inspiring" in fighting the twin scourges of COVID-19 and HIV.

 

​​​​​​Strained by COVID-19, HRSA-supported clinics and organizations have instituted new measures to ensure that the half-million patients in the Ryan White HIV/AIDS Program continue to receive care -- including telehealth check-ups, self-testing kits, prescriptions by mail and more. ​

And while the latest available data show that some 87 percent of program clients are virally suppressed –- a far higher rate than the national average -- the convergence of the two viruses continues to bring about groundbreaking change in care delivery​.

In a conference with national partners on Sept. 30, HAB's Laura Cheever and BPHC's Jim Macrae acknowledged that the COVID-19 pandemic has placed HRSA-supported health centers and HIV clinics under greater stress.  At the same time, the combined ingenuity of grantee organizations has allowed them to continue serving people who have underlying conditions that place them at greatest risk.

“The novel coronavirus has affected our lives, communities, friends, patients and loved ones," said HRSA Administrator Tom Engels. “We fully recognize the profound impact this public health crisis has had ... The efforts of our grant recipients and organizations with which they work have been nothing short of inspiring."

Said Dr. Cheever: "I've been really touched (by) the number of people in different communities -- whether its geographic or racial and ethnic -- that have lost family members and friends to COVID-19. So it's not just the work in front of us, but also the people around us in our personal lives that have been severely impacted."

 

Associate Administrators Dr. Laura Cheever (HAB) and Jim Macrae (BPHC) addressed the HAB National Partners meeting on Sept. 30. "We see ourselves in a situation where we can't go back to the way we used to do work," Macrae said, noting that remote care measures have surged in less than a year.
Associate Administrators Dr. Laura Cheever (HAB) and Jim Macrae (BPHC) addressed the HAB National Partners meeting on Sept. 30. "We see ourselves in a situation where we can't go back to the way we used to do work," Macrae said, noting that remote care measures have surged in less than a year.

 

​Telehealth has proven especially useful for patients with compromised immune systems who are reluctant to venture into public, Cheever said. However, compared to traditional office visits, the long-term effects on patient retention and morale remain to be seen.

For “people that feel isolated, a telehealth visit isn't necessarily that warm, welcoming, loving clinic," she said. “It's just a different thing."

To that end, HAB aims to expedite the training and hiring of fellow HIV-positive patients as empathetic outreach workers and on-line counselors. The bureau has already expanded at-home testing, extended prescription refills and door-to-door mail order services.

The push for new delivery models also is central to the administration's ​Ending the HIV Epidemic: A Plan for America initiative –- which seeks to address persistent problems of health care delivery, stigma and high infection rates in 48 counties nationwide, Washington, DC, and San Juan (PR).

On the cutting edge of that effort are HAB and BPHC, where creative methods driven by the Coronavirus pandemic are already being used to combat stubborn HIV rates in health care shortage areas. Macrae noted that care-at-a-distance is rapidly evolving as an invention of necessity.

A recent weekly survey of health centers found, for example, that about 80 percent now have COVID-19 walk-up or drive-through testing as of Oct. 7. And nearly one in three clinical encounters takes place virtually -- as in-person visits have fallen by about a fifth from their pre-COVID volume.

These new models, Macrae predicted, will be growing -- not just for COVID-related encounters, but also in primary health care delivery generally and HIV-AIDS services as well.

Health centers have tested more than 4 million patients to date for COVID-19 as of Oct. 7, and administered more than 243,000 antibody detection tests. About 60 percent of those who have tested positive are racial and ethnic minorities. At the same time, almost 14,000 health center staff have tested positive for the virus​.

 

Nearly 1,400 health centers operate nearly 13,000 service delivery sites that serve nearly 30 million people - that's 1 in 11 in the U.S.

“Health centers have really stepped up and put themselves on the front lines," Macrae said.  “And that is not easy."

On a parallel track, HRSA-supported health centers administered 2.7 million HIV tests in 2019, a 30 percent increase in three years. More than 196,000 patients with HIV received primary care services at health centers, including many sites co-funded by the Ryan White HIV/AIDS Program.

Another 600-plus health centers purchased Pre-Exposure Prophylaxis (Pr​EP) through HRSA's 340B drug discounting program, Macrae reported. The drugs protect uninfected people from contracting HIV from a positive partner and are a key component of the administration's initiative to end the epidemic. 

Reaching people who know they have HIV but are not receiving care is a top priority, Cheever said. More than half of all new infections now arise in the American South, across seven largely rural states with widespread health care and public transportation shortages; limited housing options and often challenging terrain -- all historic barriers to care.

"We're also seeing increasing demand for substance abuse and mental health services," Cheever added.

HRSA's Federal Office of Rural Health Policy is joining the effort by funding the formation of care networks in high-need areas that include solo practitioners, colleges and universities, hospitals large and small, local clinics and faith-based organizations.​

All metrics cited are as of Oct. 7, 2020, unless otherwise noted.

Date Last Reviewed:  October 2020