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Returning to HIV Care

CE / CME

Returning to HIV Care: Ensuring Services Are Inclusive and Equitable

Nurses: 0.75 Nursing contact hour

Pharmacists: 0.75 contact hour (0.075 CEUs)

Physicians: maximum of 0.75 AMA PRA Category 1 Credit™

Released: July 24, 2024

Expiration: July 23, 2025

CME/CE Information

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Introduction

In this module, Jason Halperin, MD, MPH, FIDSA, discusses how a slight shift in focus in HIV treatment can really help improve outcomes.

Read his commentary, and be sure to listen to the audio clips throughout the module to hear additional insights from patient advocates.

The key points discussed in this module are also illustrated with thumbnails from the accompanying downloadable PowerPoint slideset, which can be found here or downloaded by clicking any of the slide thumbnails in the module alongside the expert commentary.

For those providing patient care, how many people living with HIV do you provide care for in a typical week?

How confident are you in your ability to get people consistently back into HIV care after they have fallen out of care?

Is it appropriate to resume antiretroviral therapy (ART) immediately after someone has returned to HIV care after an extended absence from care?

Introduction: UNAIDS 2020 Targets: 90-90-90

As shown, the UNAIDS 2020 target was 90-90-90. That means 90% diagnosed, 90% receiving ART, and 90% virologically suppressed.

However, we recognize that even if we achieve these 90% goals, we are still missing the 10-10-10. The highest-risk individuals, where we really need to focus our efforts, are part of that 10-10-10.

So, let's shift our focus and reframe our efforts to meet those 10-10-10 where they are.1

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Prevalence-Based HIV Care Continuum in US in 2022

In the prevalence-based HIV care continuum, we continue to struggle in the United States with only 47% of patients retained in care.

We have to ask ourselves, what can we do? What can we do, as healthcare professionals and as advocates? How do we change the infrastructure to increase retention in care and ensure that our patients feel welcomed and empowered in our clinics?2

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Factors That Predict Delayed Care Linkage and Inconsistent HIV Care and Treatment

What are the factors that predict delayed linkage to care and inconsistent care and treatment? These are the same factors that will be important when welcoming people back into care.

You can see here that the big factors that impact care and treatment include structural barriers, race and ethnicity, unique factors associated with youth and adolescents, and treatment fatigue.

Along the continuum, barriers such as substance use, mental health issues, gender identity, coinfections, poverty, fear of stigma, and fear of medication adverse events also play a role. These conditions also lead to difficulties with adherence.

Different populations, such as youth and adolescents, particularly struggle with medication adherence and viral suppression.

We also face treatment fatigue, especially with increased access to injectable medications. These factors make it difficult for our patients to remain engaged in care.

Click here to listen to an example from Nina Martinez, a public health consultant living with HIV, who shares her story of when she fell out of care.

We need to consider what changes we can make in the structures. I am excited to discuss some potential interventions with you.3-7

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National HIV/AIDS Strategy for the United States 2022-2025: Vision

The National AIDS Strategy is crucial because it represents a top-level commitment in the United States. It envisions that all people with HIV receive high-quality care and treatment, live free from stigma and discrimination, and achieve their full potential for health and well-being across their lifespan. This vision should frame our work in HIV care.8

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Goal 2.2: Identify, Engage, or Reengage People Living With HIV Who Are Not in Care or Not Yet Virally Suppressed

The strategy goes further, emphasizing the need to expand data-to-care models. We aim to work together using our surveillance systems to reengage people who have fallen out of care.

I have a great example of this from my experiences in clinics in New Orleans and now in San Diego County. We partner with our pharmacy so that if a person does not pick up their medications, we are notified. This allows us to reach out as soon as possible to someone who has started to fall out of care, so we can try and understand and address their barriers. They might be facing transportation issues, family crises, or the need for childcare. By engaging them promptly, we can bring them back into care quickly.

We also need to identify individuals living with HIV who have never been engaged in care. The highest rate of transmission occurs among those who either do not know they have HIV or know but are not engaged in care. Once someone is on medication and virally suppressed, it is unlikely for them to transmit the virus. This is U = U (Undetectable = Untransmittable), a crucial concept for destigmatizing those living with HIV.8

Click here to hear another example of ways to reengage people into care. Listen to Tatyana Moaton, PhD, MBA-HRM, who is Director of Strategic Innovation and Partnerships at the San Francisco Community Health Center, describe the “She Boutique” at her clinic and how it reaches transgender people.

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