IOM report identifies ways to measure improvements in HIV care

People continue to be diagnosed with advanced stages of HIV/AIDS despite tools that enable health professionals to detect the condition early and federal recommendations that encourage doctors to do so, infectious diseases experts say.

Primary care physicians can help remedy the problem by testing all patients between age 13 and 64 for the virus and making sure those diagnosed with the condition start treatment, said Carlos del Rio, MD, a professor of medicine and global health at Emory University Rollins School of Public Health in Atlanta. Dr. Del Rio also is co-director of the Emory Center for AIDS Research.

“To get them into care, you have to diagnose them,” he said.

In July 2010, the Obama administration issued the first-ever national strategy on combating and preventing HIV and AIDS. The plan’s goals are clear, but the question has been how to determine whether the strategy is making strides in the right direction, Dr. Del Rio said.

To address that uncertainty, the Office of National AIDS Policy asked the Institute of Medicine to identify indicators and data systems that should be used to measure the effect of the plan on improvements in HIV care and access to supportive services, such as housing, for those with the condition.

The IOM committee issued its findings in a report March 15. Dr. Del Rio was among the 17 committee members, who included experts in HIV, clinical care and supportive services, health policy, and data collection and analysis.

The panel also assessed how HIV care will be impacted by the Patient Protection and Affordable Care Act, which is expected to bring millions of uninsured people, including many with HIV, into the health care system.

Obstacles to treating people with HIV

A record number of people — about 1.2 million 13 and older — are living in the U.S. with HIV/AIDS, according to the Centers for Disease Control and Prevention. The CDC said each year there are an estimated 50,000 new HIV infections in the U.S. and 16,000 people with AIDS die.

The IOM report outlined obstacles that prevent people with HIV from experiencing optimal health, including late diagnosis of the illness, delayed access to care, inconsistent use of antiretroviral therapy and untreated mental health conditions. Committee members used these challenges to help develop 14 indicators, which the report said “include measures of clinical HIV care, access to treatment for substance abuse and mental health disorders and access to supportive services ... all of which have been shown to influence the overall health of people with HIV.”

The committee also identified 12 data collection systems that could be used to monitor the effect of the National AIDS Policy and the health reform law. The systems include epidemiologic studies of people with HIV, claims databases, HIV program and surveillance systems, and clinical care electronic health record systems.

“If you don’t measure things, you don’t know when you achieve your goals and when you don’t,” Dr. Del Rio said.