October 7, 2016
This week, a study finds that more than a third of people in HIV care did not achieve an undetectable viral load, increasing the risk of transmission. Another study predicts that the number of HIV care providers by 2019 won't be enough to manage the expected additional 100,000 people living with HIV. And remote mentorship of community HIV practitioners may help increase clinical knowledge on issues that don't fall under strict guidelines and boost confidence in providing care. To beat HIV, you have to follow the science!
More than a third of people in HIV care in 17 U.S. jurisdictions during 2012-2013 did not achieve sustained viral suppression, increasing their risk for transmitting the virus, an analysis of HIV surveillance data published in Clinical Infectious Diseases found. However, when analyzing only the last viral load, over 80% had achieved viral suppression at that point in time.
Women, people of color, those acquiring HIV by routes other than male-to-male sex, people younger than 24 years, those with gaps in HIV care, and people diagnosed between 2008 and2010 experienced higher viral loads over time than their counterparts.
Study authors list a number of implications for providing HIV treatment and prevention: monitor patients' patterns of missed medical appointments; provide brief HIV prevention counseling during routine visits; consider social and structural barriers to care engagement; use longitudinal viral load measurements, not snapshots, to guide public health planning; and estimate a patient's risk for HIV clinical events based on cumulative viral load and duration of not being virally suppressed.
The projected number of HIV care providers is insufficient to handle the additional 100,000 people expected to be living with HIV by 2019, a survey of current providers published in Clinical Infectious Diseases found.
In 2013-2014, study authors asked 2023 U.S. HIV care providers about the number of patients they saw, whether they planned to leave the profession within the next five years, and their satisfaction with various aspects of their work. Among the 1234 respondents, about 11% of HIV specialists working at Ryan White HIV/AIDS Program-funded clinics were planning to leave by 2019; 4% of clinicians in private practice planned to leave. Only around a third of those surveyed in either category rated their salary/reimbursement (37%) or administrative time (33%) satisfactory or better.
Taking into account the number of new providers who entered the field during the prior five years, study authors concluded that at current trends as many as 35,000 people living with HIV in 2019 will be at risk of not being seen by an HIV care provider. They also noted that, based on the demographics of survey respondents, "black and Hispanic providers are underrepresented relative to HIV patients."
Remote mentorship of community HIV practitioners increases health care providers' knowledge of clinical issues that do not fall under strict guidelines and boosts their confidence in providing various components of HIV care, a study of one such program in the U.S. Pacific Northwest published in Open Forum Infectious Diseases found.
The program uses regular real-time video sessions to connect providers with academic specialists in a variety of disciplines centered around HIV care. Questions asked most frequently during these consultations related to changing treatment regimens, evaluating acute symptoms, and managing mental health issues. Case presentations of the 45 participating community doctors were tracked for 3.5 years; the doctors also completed regular self-assessments.
Most of the participants were primary care providers, with 40% practicing in rural areas. In addition to increasing local physicians' HIV-specific knowledge, the video mentoring program also lowered their sense of professional isolation, thereby heightening their level of engagement. The findings show that telehealth programs could "help address disparities in HIV care access and quality," study authors concluded.
Barbara Jungwirth is a freelance writer and translator based in New York.
Follow Barbara on Twitter: @reliabletran.
Copyright © 2016 Remedy Health Media, LLC. All rights reserved.
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