Screening, Brief Intervention & Referral to Treatment in a Rural Ryan White Part C HIV Clinic

About 24% of people living with HIV nationally are identified as needing treatment for alcohol or illicit drug use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) has evolved as a strategy to assess and intervene with substance abuse behaviors in various clinical settings. However, less is known about the processes and outcomes of using the SBIRT intervention in outpatient HIV clinics. 

This paper presents a descriptive analysis of de-identified existing SBIRT results data from an outpatient HIV clinic located in western Colorado. From 2008 to 2013, a total of 1616 SBIRT evaluations were done, which included duplicate patients because some individual patients were screened more than once in a given year. 

Over this time period, 

• 37-49% of encounters per year were notable for tobacco use, 
• 8-21% for alcohol use, 
• 6-16% for marijuana use, 
• 3-9% for amphetamine use, and 
• 0-2% for illicit opioid use. 

Unique, unduplicated patient data from 2013 revealed 40% of patients used tobacco, 16% used alcohol, and 11% used methamphetamine. Analyses highlighted that the majority of our patient population (58% in 2013) used and/or abused tobacco, alcohol, and/or illicit substances. An alarming finding was the increase in methamphetamine use over time with more than 50-fold prevalence of use in our population compared to national rates.

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By:  Graham LJ1,2, Davis AL2, Cook PF1, Weber M1.

• 1 College of Nursing , University of Colorado , Aurora , CO , USA.
• 2 St. Mary's Hospital and Medical Center , Grand Junction , CO , USA. 
• AIDS Care. 2016 Apr;28(4):508-12. doi: 10.1080/09540121.2015.1110235. Epub 2015 Nov 7.

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                                                                                  HIV-infected H9 T Cell RF

Ryan White HIV/AIDS Program Assistance and HIV Treatment Outcomes

The Ryan White HIV/AIDS Program (RWHAP) provides persons infected with human immunodeficiency virus (HIV) with services not covered by other healthcare payer types. Limited data exist to inform policy decisions about the most appropriate role for RWHAP under the Patient Protection and Affordable Care Act (ACA).

METHODS:

We assessed associations between RWHAP assistance and antiretroviral therapy (ART) prescription and viral suppression. We used data from the Medical Monitoring Project, a surveillance system assessing characteristics of HIV-infected adults receiving medical care in the United States. Interview and medical record data were collected in 2009-2013 from 18 095 patients.

RESULTS:

Nearly 41% of patients had RWHAP assistance; 15% relied solely on RWHAP assistance for HIV care. Overall, 91% were prescribed ART, and 75% were virally suppressed. Uninsured patients receiving RWHAP assistance were significantly more likely to be prescribed ART (52% vs 94%; P < .01) and virally suppressed (39% vs 77%; P < .01) than uninsured patients without RWHAP assistance. Patients with private insurance and Medicaid were 6% and 7% less likely, respectively, to be prescribed ART than those with RWHAP only (P < .01). Those with private insurance and Medicaid were 5% and 12% less likely, respectively, to be virally suppressed (P ≤ .02) than those with RWHAP only. Patients whose private or Medicaid coverage was supplemented by RWHAP were more likely to be prescribed ART and virally suppressed than those without RWHAP supplementation (P ≤ .01).

CONCLUSIONS:

Uninsured and underinsured HIV-infected persons receiving RWHAP assistance were more likely to be prescribed ART and virally suppressed than those with other types of healthcare coverage.

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By:   Bradley H1, Viall AH1, Wortley PM1, Dempsey A2, Hauck H2, Skarbinski J1.

• 1Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
• 2HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland. 

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Service Delivery and Patient Outcomes in Ryan White HIV/AIDS Program-Funded and -Nonfunded Health Care Facilities in the United States

Outpatient human immunodeficiency virus (HIV) health care facilities receive funding from the Ryan White HIV/AIDS Program (RWHAP) to provide medical care and essential support services that help patients remain in care and adhere to treatment. Increased access to Medicaid and private insurance for HIV-infected persons may provide coverage for medical care but not all needed support services and may not supplant the need for RWHAP funding.

Overall, 34.4% of facilities received RWHAP funding and 72.8% of patients received care at RWHAP-funded facilities. With results reported as percentage, patients attending RWHAP-funded facilities were more likely to be aged 18 to 29 years, female, black or Hispanic, have less than a high school education, income at or below the poverty level, and lack health care coverage. 

The RWHAP-funded facilities were more likely to provide case management as well as mental health, substance abuse, and other support services; patients attending RWHAP-funded facilities were more likely to receive these services. After adjusting for patient characteristics, the percentage prescribed ART antiretroviral therapy, reported as adjusted prevalence ratio, was similar between RWHAP-funded and non-RWHAP-funded facilities, but among poor patients, those attending RWHAP-funded facilities were more likely to be virally suppressed.

A total of 72.8% of HIV-positive patients received care at RWHAP-funded facilities. Many had multiple social determinants of poor health and used services at RWHAP-funded facilities associated with improved outcomes. Without facilities supported by the RWHAP, these patients may have had reduced access to services elsewhere. Poor patients were more likely to achieve viral suppression if they received care at a RWHAP-funded facility.

Via: http://ht.ly/S9NB8 

By: Weiser J1, Beer L1, Frazier EL1, Patel R2, Dempsey A3, Hauck H3, Skarbinski J4.

• 1Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
• 2Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia2Health Information and Technology Systems, ICF International, Atlanta, Georgia.
• 3HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland.
• 4Division of Global HIV/AIDS and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia.