The dramatic and rapid advances in HIV treatment quickly overwhelmed busy clinicians. Results from clinical trials needed to be translated from the bench to the bedside in the form of treatment guidelines for health care providers, patients, and payers. HHS, the Office of AIDS Research, the National Institutes of Health, the Henry J. Kaiser Family Foundation, and the U.S. Centers for Disease Control and Prevention (CDC) joined forces to provide guidance on the use of ART and guidelines on how to treat HIV with antiretroviral agents. The Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection were issued on April 17, 1998, and the Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents were issued on April 24, 1998. The guidelines are updated on an ongoing basis. As of August 2011, the pediatric and adult guidelines have been updated more than a dozen times each. “Lots of information about HIV treatment comes in, all the time, every day. Providers rely on the Department of Health and Human Services guidelines to provide an unbiased synthesis of trial results,” says Cheever.
From the beginning, HRSA staff and Ryan White grantees put science into action and played a crucial role in developing, disseminating, and implementing the HHS guidelines. The Ryan White-funded AETCs, are the training arm of the program. “Clinicians got more involved because of what they were seeing. They made themselves experts,” says Steven R. Young, director of HAB’s Division of Training and Technical Assistance. AETCs provide local, regional, and national trainings to more than 150,000 clinicians each year, moving advances directly to the community. According to Frank,
AETCs are crucial. They help clinicians keep pace with current research, address disparities in access to care, develop cultural competency, and fight stigma while bringing cutting-edge information right to the community. AETCs build capacity by several means: providing onsite training at clinics, phone consults, bringing clinicians into academic centers for mini-residencies, and offering ongoing consultations for clinicians in rural areas. Many times people have decided to become HIV providers as the result of their work with AETCs. Some people even applied for Ryan White funding and opened an HIV clinic where one did not exist before.
Delivering the Drugs: AIDS Drug Assistance Programs
State AIDS Drug Assistance Programs (ADAPs) are an integral part of the Ryan White HIV/AIDS Program. The first ADAPs began in 1987, when AZT was approved. They were created to ensure that underinsured or uninsured people who did not qualify for government-sponsored health insurance programs would have access to life-saving drugs.
An ADAP volunteer recalls that “people filled out a one-page form to apply, had the doctor sign it and then mailed it, faxed it, or brought it in to the office. We processed applications immediately, so people could go right to the pharmacy and get their medications without worrying about how to pay for them.”
As soon as the treatment guidelines were issued, ADAPs sprang into action. Formularies were expanded to provide the standard of care for treating HIV and preventing opportunistic infections. Program directors began to oversee utilization, and ADAPs developed additional educational materials and programs for medical providers to ensure that clients were receiving appropriate treatment.38 “The CARE Act could roll with the changes,” says Young. “If you look at the last [years of the] 1990s, we ramped up rapidly.”