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Conclusion

The quality of my health care is based on the fact that the Federal Government is involved. Without the force of the HHS guidelines and the HIV/AIDS Bureau performance measures, people like me wouldn’t be doing what I do today. I was diagnosed with HIV in 1987 and got my AIDS diagnosis in 1995.

—Brian Feit,
public health analyst in HAB’s Technical Assistance Branch and HRSA’s National HIV/AIDS Training and Technical Assistance Program

Ryan White grantees can now demonstrate that their patients are getting optimal care and treatment by using tangible measures selected according to the needs of the populations they serve. Measures include core clinical items relevant to the health outcomes of PLWHA (e.g., antiretroviral use, CD4 cell count; PCP prophylaxis; screenings for tuberculosis, hepatitis B and C, and syphilis; influenza vaccines; screenings for substance use and mental health) as well as oral health, pediatrics, medical case management, and systems-level measures, such as waiting time for access to care and disease stage at entry into care.

It is clear that Ryan White grantees are continuing to step up to the challenge of a dynamic epidemic that has transformed their role from administering palliative care to providing comprehensive health care in a culturally competent, patient-centered, multidisciplinary medical home. “We provide for the needs of infants, children, and the families that love and care for them in a welcoming environment,” says Cheever. “Given the complex nature of HIV—how it intersects with stigma and health disparities—you need to treat the whole patient. If you can get people into care with providers who know what they are doing, and support, case management, food and transportation are provided, you will have a good outcome.”

For more than two decades, the Ryan White HIV/AIDS Program has brought scientific advances to people who need it most: the poor and the underserved. Grantees have taken the lead in implementing new data, and they have successfully translated scientific progress into life-saving clinical practice.

Ryan White grantees have demonstrated the capacity to adapt rapidly. The system can adjust rapidly to changing circumstances and is staffed by a remarkable people. In coming years, grantees face the challenges of serving an aging population; finding undiagnosed persons, bringing them into care, and retaining them; and implementing recent advances in HIV prevention, all in the context of a shifting health care system.

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