January 28, 2012

January 28, 2012
The State of HIV Primary Care:
A Shifting Landscape


Welcome to another day in my life. Today is Saturday and I hope you had a safe and great week. It was another busy week for Dab the AIDS Bear and me.

Today, I would like to share some information about survey concerning the state of HIV primary care in the United States. This is the HealthHIV annual survey of HIV & primary care providers which identifies concern over increased demand And decreased funding.

Concerns over rising HIV caseloads among overworked specialists and insufficient reimbursement for HIV services are key findings from the Second Annual HealthHIV State of HIV Primary Care survey. Set against a landscape in which the federal government prepares to extend healthcare coverage to 32 million newly insured individuals (including an estimated 600,000 - 800,000 people living with HIV), the survey reveals a shifting landscape between the readiness of the HIV workforce and its ability to treat the growing number of people living with HIV, especially in primary care settings.

The survey reveals that reimbursement for HIV services is a major factor in between the HIV workforce and number of people needing HIV care. Among HIV treatment providers, two thirds report an increase in their HIV caseloads and more than a third report inadequate reimbursement as a barrier to expanding their practices. As demand for HIV care providers continues to increase, new HIV care providers are scarce. Twenty two percent of primary care providers cite reimbursement as a significant barrier to providing HIV services.

"The competing concerns of increasing HIV caseloads and decreasing funding are placing stress on the landscape of HIV care. If we hope to continue meeting the needs of people living with HIV, and prevent its spread, we must increase HIV-related education and training of primary care providers," said HealthHIV Executive Director Brian Hujdich. "We are approaching full implementation of the Affordable Care Act and more needs to be done to increase access to quality HIV care, including augmenting the specialist workforce with primary care providers who screen for and treat HIV disease - what HealthHIV terms the 'HIV Primary Care Provider.'"

Defining the Profile of the "HIV Primary Care Provider"

Other survey findings reveal that while systemic obstacles keep many primary care providers from treating HIV, out of necessity some have taken steps to begin offering HIV care. Based upon their responses, we can build a profile of the typical "HIV Primary Care Provider." She is female (58%), non-Hispanic (83%), White (68%), M.D. (58%), aged 50-59 years old (40%), living in an urban community (64%). Further, she is a Family Practice specialist (46%), practicing in the South (39%), in a community health center (36%).

Despite CDC recommendations for implementation of routine HIV testing, nearly half of primary care providers responded that they do not provide routine HIV testing to patients. However, primary care providers are not alone. Results show that 20% of HIV Treatment Providers do not routinely test all their patients for HIV. Among those who do test routinely, over half cite patient resistance to testing as the biggest barrier, including 67% of African American HIV Treatment Providers.

Providers See Patients' Stigma as Largest Barrier to HIV Care

Barriers to Care - Over half of all HIV Treatment Providers identified stigma as the top barrier to care. More than a quarter of respondents cite limited English proficiency, while nearly as many cite immigration and citizenship concerns as barriers to adequate HIV treatment. Patient lack of access to HIV care providers was cited by one fifth of respondents.

Differing Opinions on Care Provision

When providers were asked to rate the quality of HIV care delivered by primary care providers and community health centers, results demonstrate conflicting opinions between primary care providers and self identified HIV specialists. While 41% of primary care providers rated the quality of HIV care delivered by their primary care colleagues as above average, nearly one fifth of HIV Specialists rated the quality of HIV care delivered by primary care providers as below average. This conflict was even more pronounced when asked to rate quality of HIV care in community health centers. Among all providers responding, nearly half rate the quality of HIV care delivered in community health centers as being above average. However, 31% of HIV Specialists disagree and rate the HIV care offered through community health centers as below average.

Impact Of Health Care Reform

Two-thirds of all providers surveyed believe that the Patient Protection and Affordable Care Act (PPACA) will have an affect on their practice, but there is a split over whether that impact will be positive or negative. While 55% of all providers anticipate positive changes, including more patients having insurance and increased patient access to care, 31% of HIV Specialists anticipate negative effects, such as decreased Ryan White funding.

"These findings demonstrate the increasing need to train more primary care providers in HIV care. Coordinated, national efforts are required to build infrastructure, increase access points, and enhance provider capabilities to help ensure that patients get quality HIV care," said Javier G. Salazar, Project Director for the AIDS Education and Training Centers National Center for HIV Care in Minority Communities. "This need is especially acute if we are to address HIV within minority communities, and among other vulnerable populations experiencing health disparities. Helping primary care providers learn how to care for people living with HIV, despite funding and other challenges, is difficult but critical if we are going to improve HIV health outcomes for people of color."

Survey Methodology, Definitions And Summary Report

The Second Annual HealthHIV State of HIV Primary Care survey received 1,806 U.S.-based respondents between July 20 and October 28, 2011. Conducted annually, the survey of HIV and primary care providers identifies both individual and environmental features of the HIV primary care landscape, including influences, drivers, readiness, and caseloads, as well as services, funding, and reimbursement. Respondents were asked to self identify as an "HIV Specialists," an "HIV Primary Care Provider," or "Primary Care Provider." An "HIV Specialist" is defined as a credentialed HIV specialist. "HIV Primary Care Provider" is defined as a primary care provider, not identifying as an HIV specialist, who provides direct HIV primary care to patients, and "Primary Care Provider" is defined as a primary care provider that does not provide direct HIV primary care to patients. When HIV Primary Care Providers and HIV Specialists are grouped together, they are identified as "HIV Providers."

In conjunction with the survey results, HealthHIV is also releasing a "Readiness Report" of HIV care providers and primary care providers, identifying factors among different provider types, which speak to their readiness to provide HIV care in near future. Additional survey findings will be released throughout the coming year at select conferences. The Readiness Report, and an executive summary of Second Annual HealthHIV State of HIV Primary Care survey will be posted on HealthHIV's website (www.HealthHIV.org) on January 30, 2012.

HealthHIV is a leading national, 501(c)(3) non-profit working with organizations, communities, and professional to advance effective prevention, care, and support for people living with, or at risk for, HIV through education and training, capacity building, advocacy, and health services research and evaluation. HealthHIV leads the AIDS Education and Training Centers National Center for HIV Care in Minority Communities. To learn more, visit www.HealthHIV.org or www.NCHCMC.org.

Hope you have a safe and great weekend.

Until we meet again; here's wishing you health, hope, happiness and just enough.

big bear hug,



Daddy Dab