Delayed diagnosis, noncommunication among HIV care providers, and delayed access to support services are among several barriers to HIV care in the United States, according to a report from the Institute of Medicine (IOM).
IOM's Monitoring HIV Care in the U.S.: Indicators and Data Systems comes at a time when HIV caregivers, pharmacists, and others are concerned about changes to national healthcare reform legislation, which could impact HIV patients' access to care.
According to Kaiser Health News, in July 2010, the White House created the National HIV/AIDS Strategy (NHAS) that set out to decrease HIV-related health disparities, to increase access of care for the disease, and to improve HIV health outcomes. In order to effectively measure the success of this plan, the Office of National AIDS Policy (ONAP) commissioned IOM to identify the indicators and data systems that should be used to measure HIV care and access to support services.
The IOM addressed a number of barriers to HIV care including: late diagnosis, delayed access to care, delayed prescription and intermittent use of life-saving antiretroviral therapy, and untreated mental health and substance use disorders.
The improper and delayed use of medications to treat HIV is one of the biggest problems in HIV care, and one that pharmacists can assist with.
"Noncompliance is a major issue, that is equally as problematic as not having access," said Nora Osemene, BS Pharm, MS Pharm, PharmD, associate professor and chair of the Department of Pharmacy Practice at Texas Southern University in Houston. After HIV patients skip taking medications for a period of time, they often become resistant to them, said Dr Osemene, author of several HIV papers.
Noncompliance can be attributed to the cost of the medication as well as some patients' socioeconomic status. "Noncompliance typically goes with the level of education. The affluent communities are doing well with their medication: they know the consequence of not taking it," Dr Osemene said.
HIV care is also hampered by a problem in the healthcare system in general: lack of communication among providers, according to Dr Osemene.
"Primary care practices are not communicating with HIV doctors, for example. After the passage of HIPAA [The Health Insurance Portability and Accountability Act], no one wants to be charged with violating privacy," Dr Osemene said.
The author of the IOM report agreed. "Providers of HIV care and supportive services must contend with numerous federal and state privacy laws on proper use and disclosure of patient information," the report stated. As a result, IOM recommends that the Department of Health and Human Services issue guidance to the HIV care community, to clarify which patient information is permissible to share.
Reimbursement for HIV treatments is also a barrier to proper care, according to the IOM and Dr Osemene.
"Insurance companies want to drop you immediately, as soon as they find out you are HIV-positive," Dr Osemene said. The IOM found that health plan reimbursement policies may parse services for clinical care, behavioral health, transportation, and other benefits across separate organizations.
The IOM also was asked to monitor how HIV care will be affected by the health reform law. The report identified 12 different data systems, including ones from the US Department of Veteran Affairs' clinical case registry, CDC's Medical Monitoring Project, and Medicare and Medicaid claim systems.
The systems will help show the effects that the health reform law and the White House strategy have on HIV care in the United States, according to Kaiser Health News.