Ryan White HIV/AIDS Program grantees and providers play an important role in helping older HIV patients prevent or mitigate cognitive impairment by treating depression and other comorbidities, counseling them to reduce alcohol and substance use, and promoting healthy eating.136
Ryan White and a Dynamic Epidemic
“There’s been a paradigm shift in how you care for people with HIV; we really need primary care providers. With older adults, you have to care for the whole person—their HIV disease and other things that may or may not be related to their HIV—everything that comes with aging,” says Travieso Palow. “It is better to have providers with a larger knowledge base, who can do it all.”
As Telzak explains, “Models of care for HIV certainly already contribute to models of care for all chronic diseases, and there is a lot more to learn from what has been created in HIV care coordination. Ryan White, in partnership with HIV providers, has established the concept of a medical home, and the ability to get better outcomes in patients who consume most of the medical resources.”
Since the beginning, dedicated Ryan White HIV/AIDS Program grantees have continually invented and improved upon models of HIV care, to meet the evolving needs of their patients, as they grow up—and grow older—with HIV/AIDS. Despite increasing clinical complexity and a growing patient population, Ryan White HIV/AIDS Program grantees continue to deliver high-quality, patient-centered HIV primary care and a range of supportive services in a dynamic epidemic. “You don’t know what is going to work until it works; if it works you have a model. If it doesn’t, figure out why, fix it, redesign it, and try it again,” says Garcia.
Ryan White's Toolbox for Providers
The Ryan White HIV/AIDS Program supports and develops a range of tools and resources for providers dealing with an aging patient population. In 2011, HRSA published a comprehensive guide to clinical care for HIV/AIDS, which is available at http://hab.hrsa.gov/deliverhivaidscare/clinicalguide11/
AETCs continue to keep providers up to date on advances in research and clinical care. Guidelines, curricula, and additional information are available at http://hab.hrsa.gov/deliverhivaidscare/clinicalguide11/
HRSA’s HIV Quality Improvement (HIVQUAL) Program provides onsite technical assistance to Ryan White grantees. HIVQUAL teaches sites to systematically plan, implement, and evaluate quality improvement programs. In 2011, the National Quality Center’s Quality of Care Award for Quality Improvement Activities went to Brooklyn’s Special Treatment and Research (STAR) Health Center, for incorporating primary care indicators relevant to the clinical needs of their aging HIV patients: diabetes management and cardiovascular health. STAR’s clients reflect the epidemic: More than half of their 1,129 HIV patients are over 45; many are diabetic, and at risk for cardiovascular events. A description of the indicators, interventions, and results is available at http://hab.hrsa.gov/deliverhivaidscare/hivqual.html.