Question

PLEASE PROVIDE A SOCIAL CHANGE STATEMENT FOR PEOPLE LIVING WITH HIV WHO NEED TO RE-ENGAGEMENT IN CARE

Answer 1

Ans) While admonitions to practice abstinence and/or safe sex may be helpful, rhetoric is unlikely to significantly alter the spread of HIV. Prevention must focus on those who have left care.

- Prevention science shows that persons with unsuppressed virus are 20 times more likely to transmit HIV and that out-of-care PLWH are responsible for over 60% of transmissions.

- So, if every PLWH achieved viral suppression, transmission would be close to nil while the PLWH's health would be greatly improved. Out-of-care persons must be found and re-engaged in care.

- Unfortunately, this will be unlikely as long as we maintain a system where the relevant data for determining who left care is in the hands of clinicians while the capability for locating and re-engaging individuals in care is with health departments.

- Clinicians and public health departments have to be partners in preventing HIV transmission.

- There are good examples of what can be accomplished when clinicians and public health departments work together. In the state of Washington, there is a program whereby clinicians and the public health department jointly identify and seek PLWH who have left care and re-engage them with care.

- The program was able to identify those individuals who were in need of re-linkage services by eliminating those who were deceased, had moved out to the area, were incarcerated or had found another provider of HIV care.

- This allowed providers and health department personnel to concentrate their efforts on those who were actually eligible to be re-engaged in care. When compared to a historical control group, the cooperative program was 70% more likely to re-engage PLWH with examcare.

- Another of clinical/public health cooperation was conducted in Louisiana. PLWH who had not had a VL or CD4 count in over one year were identified and an alert was placed in the Louisiana State University Health Care Services Division's electronic medical record which notified affiliated clinicians seeing the patient for any disease or condition that the patient may be out of HIV care.

- Because there was recent location data for these PLWH, contact was efficient and 81.6% of the PLWH who were in care or who refused to return to care and were, therefore, eligible for re-linkage services were returned to care.

- Because clinical care is administered by multiple providers in both the public and private sectors, health departments need to take the lead in developing systems that assure PLWH who are out of care re-engage with their clinical providers and achieve viral suppression.

- If public health authorities are not leading in this effort, providers need to contact them and establish ways to involve them in following up on their lost-to-care patients. By working together, clinicians and public health agencies can significantly alter the course of the HIV epidemic.