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  September 2011
Digest: The Month In Review
From the Field: Facilitating Access to Medications
Program Updates: Health Care Access
  Collaboration with Community Health Centers
  The Virology Portal: Resource for Frontline HIV Service Providers
Member and Staff Updates
Inventory of NASTAD E-mail last month
August ADAP Waiting List Numbers Compilation
NVHR Announces Community Grant Fund
Update: Ryan White and Part B Grant Awards
New HIV Incidence Estimates
ADAP Crisis Task Force Agreement with Boehringer Ingelheim
Reducing Data Submission Frequency Prevention Partners
Update: New Multi-year HIV Incidence Estimates
Statement of Commitment: Promoting Injection Drug User Health
  From The Field: Facilitating Access to Medications

As AIDS Drug Assistance Program (ADAP) waiting lists continue to grow and resources remain flat, ADAPs continue to look for other avenues for access to medications for clients on their waiting lists. ADAPs have developed ways to accurately capture clients not eligible for their programs and identify how clients are accessing medications. Each of the 12 ADAP waiting list states confirms that all ADAP waiting list clients currently on or in need of medications are receiving medications through a pharmaceutical company patient assistance program (PAP) and/or Welvista.

PAPs offer free HIV drugs to low income people who do not qualify for any other insurance or assistance program, such as Medicaid or ADAP. Different company programs have different eligibility criteria based on the Federal Poverty Level (FPL) designation. To access information on pharmaceutical company co-payment assistance and patient assistance programs, please visit the Fair Pricing Coalition's website.

Most recently, a collaboration with the non-profit mail-order pharmacy Welvista has been initiated to simplify access to HIV medications for ADAP waiting list clients. These clients can access medications from all antiretroviral manufacturers directly from Welvista, as opposed to accessing individual PAPs for each ADAP. Please visit Welvista's website for additional information on the collaboration with ADAPs.

States are using multiple mechanisms to confirm individuals on ADAP waiting lists are accessing medications, including:
Contacting ADAP waiting list clients by phone to confirm needed medications, and whether and how they are accessing medications while on the waiting list. For clients in need of medications with no current access, referrals are made to PAPs and case managers.
Reviewing ADAP waiting list clients’ current information to verify eligibility for ADAP and/or other programs such as Medicaid or Medicare Part D and to ensure access to PAPs.
Conducting chart audits at large agencies to review what medications clients receive and through what mechanism they are receiving them.
Receiving client level dispensing data from Welvista by request, on a quarterly basis, for any ADAP waiting list client being served.

States will continue to develop, refine and hone mechanisms for ensuring access to care while waiting lists continue and expand. For additional information on access to medications through PAPs and Welvista, please contact Britten Pund.

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Program Updates: Health Care Access

Collaboration with Community Health Centers

Earlier this year, NASTAD received an educational grant from Janssen Therapeutics (formerly Tibotec Therapeutics) to examine the collaborative relationships between state HIV/AIDS and viral hepatitis programs and community health centers (CHC). This project is focused on identifying current collaborations and challenges to working together and pinpointing new technical assistance opportunities to help state health departments build upon or create new relationships with CHCs. NASTAD is collaborating with the National Association of Community Health Centers (NACHC) on this project.

NASTAD convened a consultation in May with representatives from state health departments, CHCs and federal partners from the Department of Health and Human Services (HHS) Office of the Assistant Secretary of Health, the Centers for Disease Control and Prevention (CDC), and the Health Resources and Services Administration (HRSA). Topics included the creation of common language, drivers and opportunities for greater collaboration, and challenges to collaboration between state health departments and CHCs.

Developing common language is necessary to focus on the roles of public health and CHCs and developing a shared understanding of the patient centered medical home (PCMH) model of care delivery. The drivers pushing for greater collaboration include: lack of increased federal funding for HIV-specific prevention and care and treatment; provisions of the Affordable Care Act (ACA); the National HIV/AIDS Strategy; the future of the Ryan White Program; biomedical and technological advances related to pre-exposure prophylaxis for HIV/AIDS; and the new rapid hepatitis C test and new hepatitis medications with less toxic side effects.

Many examples of successful collaborations between state health departments and CHCs currently exist, including Project ECHO in Seattle, Washington and the Sixteenth Street Health Clinic in Milwaukee, Wisconsin. Project ECHO (Extension for Community Health Care Outcomes) is an innovative telemedicine initiative created by the University of New Mexico that is currently being implemented through a partnership between the viral hepatitis program at the Washington Department of Health and the University of Washington. This program is giving primary care providers the ability to treat their patients with hepatitis in many rural CHCs around Washington State by allowing providers the opportunity to learn and be coached by specialists based in Seattle. This also allows more patients to get immediate and direct care from their local CHC, minimizing the personnel costs related to travelling back and forth to the specialist. Project ECHO also educates primary care providers to move beyond their traditional practice and promotes a more dynamic PCMH model of care for many patients.

While there are many existing examples of collaboration, there are even more new opportunities for collaboration under the ACA, which calls for expansion of CHCs and services provided by primary care providers. The legislation also allows for the expansion of PCMH models in more CHCs across the country. State health departments have an opportunity to work with communities in planning and designing expansion projects. State health departments also have the opportunity to educate providers on issues of prevention, data collection and surveillance, and cultural competency, all of which have been identified as needs for many CHCs. At the same time, challenges remain for greater collaboration, not overburdening CHCs and ensuring available funding and staff resources in health departments and CHCs, as well as increasing data compatibility and availability of existing models of HIV care delivery.

Following the meeting, NASTAD is implementing an assessment of health department HIV and viral hepatitis programs to get baseline data on existing relationships between state health departments and CHCs that will assist in delivering technical assistance to health departments on building stronger collaborative relationships with CHCs.

For additional information on CHCs contact Christopher Cannon.

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Resource for Frontline HIV Service Providers

NASTAD collaborated with Janssen Therapeutics (formerly Tibotec Therapeutics) in the redesign of its free Web resource for frontline HIV service providers - The Virology Portal. Formerly known as "the HIV Case Manager Portal," this resource is intended for frontline HIV service providers working directly with clients, including but not limited to case managers. The site has undergone a complete redesign, with an easy-to-use layout and revamped graphics for easier navigation. Please provide feedback on this tool directly to Janssen or contact Christopher Cannon at NASTAD.

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Member and Staff Updates

In staff news, Gen Meredith has been promoted to Associate Director of the Global Program.

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