In 2019, the Trump Administration launched its Ending the HIV Epidemic (EHE) Initiative, which seeks to reduce the number of new HIV infections in the United States by 75% within five years and by at least 90% within 10 years. As community stakeholders and policymakers focus on achieving the goals of the EHE Initiative, many people with HIV have felt neglected and under-prioritized. To succeed at ending the HIV epidemic, we must center the needs of people with HIV in our efforts.
It is important to tailor responses to the varying needs of people with HIV. The report describes differing strategies that are needed to support three groups of people with HIV.
People with HIV who are in care, but not virally suppressed: Numerous factors can impede sustained viral suppression. Critical work is needed to eliminate these barriers both within and outside of the clinic. Priority actions include
funding models of care that offer more flexible approaches to receiving care (such as through the use of telemedicine) and
deploying people with HIV to work as peer educators, community health workers, and clinical providers.
People with HIV who have been diagnosed, but are not in HIV care: Competing life priorities can make sustained engagement in care difficult. More attention is needed to offering linkage and retention services and adopting strategies to better identify persons who have stopped engaging in HIV care, and more intensive services models are needed for the subset of people with the greatest barriers to care. Priority actions include
establishing or expanding data sharing agreements to allow health department programs to track client outcomes and evaluate program effectiveness,
developing data dashboards drawn from electronic health records to identify individuals not in care or not virally suppressed on admission to the emergency department or inpatient hospital,
funding differentiated care models, and
monitoring missed clinic visits as a sentinel indicator of persons at risk of disengaging from care.
The report also identifies three specific areas where innovation is needed: (1) improving health literacy to strengthen engagement in care, (2) adapting the clinic for those with the greatest needs, and (3) using data to support re-engagement in HIV care. Now is the time for innovative ideas and actions to clear the path toward the end of the HIV epidemic in the United States. For more information on O’Neill Institute resources that are supportive of the EHE Initiative, visit our National HIV/AIDS Initiative webpage here.
The views reflected in this expert column are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.