Guide to Better HIV Management

All individuals between the ages of 15 and 65 should be tested for HIV at least once, reports the Centers for Disease Control and Prevention (CDC). However, those with a higher risk for HIV infection should be tested at least annually.

Upon receiving an HIV diagnosis, it can be difficult to figure out how to proceed. The disease still carries some of its original stigma, but new treatment approaches and recommendations are transforming the disease into something that can be fought by community health and social services providers. Yet, the only way to understand how to approach HIV management starts with screening and ends with continued care.


The Importance of Screening For HIV

Cases of HIV in modernity do not result in obvious symptoms. Today’s awareness and quality of care has led to many cases of HIV being diagnosed early (within six months of infection), asserts AIDSInfo.

When left untreated, the virus replicates exponentially, weakening the immune system and resulting in opportunistic infections. Early detection of HIV allows individuals to begin human antiretroviral therapy (HART) sooner, promoting the recession of the virus. In addition, early detection helps individuals to ensure safe sexual practices to reduce the risk of transmitting HIV to another person.

Screening for HIV has changed from the doctor-required appointments of the past. In fact, those who may be leery about getting an HIV test can actually purchase a simple, in-home HIV test at many national drug stores, such as this test from Walgreens. This only requires an oral swab, and results are available in 20 minutes.

Obviously, not everyone can afford to pay for an in-home HIV test, but there are free testing options available. On the CDC’s website, users can locate free, confidential testing centers without the cost of locating services. Moreover, these testing centers do not exclusively test for HIV. Users can find testing centers for sexually transmitted diseases (STDs) and hepatitis as well. As a result, more people can know their status, which reduces the risks of complications and transmitting the virus.


Selecting the Best Treatment Regimen.

Unlike previous recommendations, everyone who tests positive for HIV is advised to start “HART as soon as possible.” Some providers may opt to perform additional tests for other health conditions before starting HART. However, those who are pregnant, suffering from a CD4 count of less than 200 (AIDS) or living with an opportunistic infection must start treatment even sooner. As a result, the step after being diagnosed with HIV is selecting a treatment regimen.

An HIV regimen consists of three HIV mediations from at least two drug classes, which include the following:

  • Nucleoside/ nucleotide reverse transcriptase inhibitors (NRTIs).
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs).
  • Protease inhibitors (PIs).
  • Fusion inhibitors (FIs).
  • CCR5 antagonists.
  • Integrase strand transfer inhibitors (INSTIs).
  • Pharmacokinetic (PK) enhances.

Those who have not previously been treated for HIV are usually given two NRTIs and a INSTI, an NNRTI or a PK-enhanced PI. As mentioned in our previous discussion, anyone who has a positive test for the HLA-5701 gene must not be given an abacavir-containing NRTI.


Obtaining Funding for HIV Medications.

Obtaining funding for HIV medications is where community health and social services come into play. Social workers at community health settings can help individuals with HIV locate the appropriate program to use. According to POZ magazine, the most common forms of funding for HIV treatment include the following:

  • AIDS Drug Assistance Program (ADAP) – A federal program to pay for the cost of HIV treatment, and recipients are required to recertify information for eligibility on a recurring basis. The recertification timeline varies by state and cost of HIV treatment.
  • Co-Pay Programs – These programs are often created by the drug manufacturer, and clients can apply to the programs independently or with the help of social worker. For example, Gilead’s Advancing Access® covers up to $6,000 in co-pays annually.
  • Patient Assistance Programs (PAP) – Programs in this category are for those who do not meet eligibility requirements for ADAP or whose insurance carries co-pays in excess of the limitations of co-pay programs.
  • Medicaid and Medicare – Those who do not meet eligibility for any of the aforementioned programs may qualify for Medicaid temporarily. If a person files for disability, Medicare is available after two years, but co-pays can continue to be high. Yet, most manufacturer’s co-pay programs do not cover individuals who receive government benefits.

Each form of funding relies on the financial and medical information for a specific client. If he or she has insurance to cover HIV treatment, a co-pay program+ may be most appropriate. Meanwhile, an APA can provide funding until obtaining a more permanent form of funding, such as ADAP or Medicare. However, some funding sources may require documentation from a social worker, case manager or treating physician.

For example, an application for ADAP requires a certification of financial inability to pay, documentation from a treating physician and submission by a social worker. Similarly, those who suffer from severe complications may file for disability, and a social worker may be needed to locate additional funding sources for high co-pays.


Final Thoughts: Where Do You Start the Conversation on HIV Management?

Although no longer terminal, HIV is scary, and you need to bridge the provider-client gap when discussing management of HIV with those you serve. You must continue to be professional and mindful of changes in mental state, inability to cope and struggles that may arise secondary to HIV treatment in your clients.

For example, a client may have trouble locating housing due to lost wages from hospitalization or other treatment. As a result, the role of a social worker and community health provider becomes more involved.

Although those with HIV are legally protected from discrimination, reports, the stigma can be one of the most discriminating forces on the planet. You must be ready to be a caregiver, advocate, friend, listener and confidant.

HIV is not curable. HIV is not always preventable. However, HIV is treatable, and you need to know how to help those who are living with it.

Jason Vanover

Working in health care since 2005, Jason's body of experience encompasses dozens of care settings, including Senior care, psychiatric facilities, nonprofit health service centers, group homes for those with developmental disabilities and beyond. Jason understands the need to tailor his skills to each setting to encourage the best treatment outcomes and promote an inclusive, healing environment.

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