End of HIV epidemic hinges on expanded health care access, Milken researchers find

A team of researchers from the Milken Institute School of Public Health found that local health centers must receive expanded funding and resources to help quash the HIV epidemic in the United States over the next decade.

The analysis, released last week, was conducted by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative, a partnership between Milken and RCHN, a nonprofit organization that supports community health centers. Researchers found that community health centers must obtain additional funding and personnel to help the Trump administration reach its recently announced goal of eradicating the nation’s HIV epidemic by 2029.

The federal plan targets areas 48 “highly burdened” counties in 19 states, D.C. and San Juan, Puerto Rico, where more than 50 percent of new HIV diagnoses occurred in 2016 and 2017. The initiative will focus on four strategies: diagnosing individuals with HIV as early as possible, treating the infection “rapidly” and “effectively,” protecting at-risk individuals and responding rapidly to growing HIV “clusters,” according to the U.S. Department of Health and Health Services.

Researchers who worked on the study said community health centers are some of the largest care providers for HIV patients in impoverished areas, and targeting the HIV epidemic must go hand-in-hand with an expansion of their services.

“This report was an attempt to both draw attention to the role of health centers as well as to take a look at how health centers in states that have expanded Medicaid and not expanded Medicaid compare,” Sara Rosenbaum, a professor of health law and policy and an author of the study, said.

The study analyzed data from the federal government on HIV diagnoses and on community health centers’ growing role in treating the illness. Community health centers care for 16 percent of people living with HIV in the United States, according to the analysis.

Rosenbaum said the Trump administration has backed policies that make it more difficult for some HIV patients to obtain insurance, like stricter work requirements for Medicaid eligibility, which can hurt patients’ financial ability to receive care.

“The president’s initiative is a welcome one, but our concern is this administration’s policies seem to working directly counter to the stated goals of the initiative,” Rosenbaum said.

She said the District has a relatively high HIV rate with roughly one in 13 people having the disease, meaning city and federal officials must expand resources for community health centers locally.

The analysis also recommends a 10-year reauthorization of the federal Health Center Fund, which is set to expire in fiscal year 2019 and awards grants to health care facilities that provide care to underserved populations.

Peter Shin, the director of the Geiger Gibson Program and an author of the study, said community health centers are the “anchor” of HIV care because they are federally mandated to serve populations that are underserved and uninsured, which typically face higher HIV rates.

“Community health centers are at the forefront of trying to get patients into screening,” he said. “They are targeting the population that really needs the help while there are no other types of resources available.”

The analysis also found that community health centers in non-Medicaid expansion states like Alabama and South Carolina will face “far greater” challenges in providing care because many patients lack a “reliable pathway” to affordable coverage. Seven of the states and 18 counties mentioned in the Trump administration’s initiative are non-Medicaid expansion states, where the uninsured rate is higher.

Shin said community health centers’ “hands are tied” in non-Medicaid expansion states.

“Insurance in itself doesn’t guarantee access and quality, but it’s a lot more difficult for populations that happen to be low-income and may not have access to coverage,” Shin said.

Feygele Jacobs, an author of the report, said additional funding is “critical” for community health centers to combat the HIV epidemic.

“Extending the Health Center Fund will be a critical step, as will active efforts to encourage Medicaid expansion,” Jacobs said in the release last week.

Jessica Sharac, a senior research associate at Milken, and Rachel Gunsalus, the assistant director of the Geiger Gibson Program, who both contributed to the analysis, declined to comment.

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