The following is an interview by Dr. Laura Cheever, Associate Administrator for HRSA's HIV/AIDS Bureau, and Chair of the Clinical Pathway, held at the 2016 Ryan White Conference. Cheever outlined highlights from sessions held at the Clinical Pathway.
The Ryan White HIV/AIDS Program sees approximately half of the nation’s HIV/AIDS population. The Ryan White conference’s Clinical Pathway, said Dr. Cheever, is structured for those providers seeing most of these patients, typically in the context of community-based clinics.
All Clinical Pathway resources are available online from the Clinical Pathway co-convener, the AETC National Coordinating Resource Center.
“We really do have an opportunity to end the epidemic and the key to that is use of antiretrovirals effectively and achieving viral suppression for patients,” said Cheever. That is what drives the focus of the Clinical Pathway on what we need to do to engage and retain people in care and treat HIV and other barriers to viral suppression.
Changes in HIV Therapy
In a presentation titled "HIV Cures and Immunotherapy: New Horizons," Daniel Douek from the from NIH talked about where we are in terms of HIV care therapy, noting that providers need to be able to talk to patients about what’s on the horizon with antiretrovirals. This is of key interest to patients who have been on therapies for many years and bring their knowledge base to the clinic, and they are primed to ask clinicians for updates.
“We try to synthesize the state of the art, to apply it to a practical clinic setting and promote use of the HHS guidelines.”
Managing Complex Therapies
Several discussions covered antiretroviral therapy, which “continues to be incredibly complex,” said Cheever, even if many can benefit from 1-pill, once-a-day options. Complexities come into place because of co-morbidities affecting many RWHAP patients. Over half are 40 years old and many have such challenges as drug abuse and diabetes to deal with in their clinical encounters. Also, many RWHAP patients are long-term survivors, have been on many regimens, and have the potential for resistance. Clinicians need to carefully consider this when making changes in regimens that maintain full viral suppression so as to avoid creation of new resistance.
Managing Hard-Hit Populations
Several sessions focused on special populations with the highest disparities, as highlighted in NHAS 2020. Populations-focused sessions included managing transgender patients, caring for adolescents (who have overall less successful viral suppression rates), and transitioning adolescents to adult care.
Leadership and Leveraging
Various sessions also focused on supporting clinicians in their role as leaders of culturally competent care in their communities to use the backbone of RWHAP to leverage other sources (e.g., 330 funding, state resources, insurance) to provide such services as PrEP as part of their work to keep their uninfected patients that way.