Page 16 - Delaware Medical Journal - November 2015
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PUBLIC HEALTH
are afforded the opportunity to decline HIV testing.7 The Delaware Division of Public Health recommends routine testing of anyone over the age of 12 in order not to neglect the sexual health needs of Delaware’s senior population.
The goals of making HIV testing a routine part of medical care
those living with HIV by engaging them in treatment, and decrease transmission of the virus. There are evidence-based behavioral studies which show that once someone knows they are HIV-infected, they tend to reduce behaviors which can lead to transmission of HIV to sexual partners.3 It is also well- documented that HIV-positive individuals in clinical care, with undetectable viral loads, are less likely to transmit the virus to another person.
for those who are HIV-negative and are at substantial risk of
antiretroviral drug combination, tenofovir disoproxil fumarate and emtricitabine (Truvada), one pill each day. PrEP has
been shown to reduce the risk of HIV infection in high risk populations by up to 92 percent, but if not taken consistently, PrEP shows a much lower effectiveness.10 This is one of the tools in the HIV prevention toolkit and is a focus of the updated National HIV/AIDS Strategy.
As the primary provider of HIV treatment in Delaware, the Christiana Care Health System (CCHS) HIV Program is currently working in collaboration with the Delaware Division of Public Health (DPH) and the Delaware HIV Consortium (DHC) to develop a strategic initiative to increase access to PrEP for appropriate individuals as part of the comprehensive
PrEP has been shown to reduce the risk of HIV infection in high risk populations by up to 92 percent, but if not taken consistently, PrEP shows a much lower effectiveness.10
HIV prevention plan.
Also, the Medical Society of Delaware, through a contract with the Delaware Division of Public Health, will be completing on site educational presentations throughout the state of Delaware to physicians and The Health Care Professional’s
Since the introduction of combination antiretroviral therapy
in 1996, mortality and morbidity for patients living with an
HIV diagnosis has dramatically improved and life expectancy is not uniform across the United States. To better understand health care disparities in HIV care, in 2005 the Health Resources and Services Administration (HRSA) developed the HIV Care Continuum model.8,9 (Figure 1)
In this model, an individual can go through several stages, from not being engaged to being fully engaged in care. Importantly, HIV diagnosis is the entry point of the HIV care continuum
— only after establishing an HIV diagnosis can an individual
be linked to care, remain engaged in care, be prescribed antiretroviral therapy, and ultimately reach the goal of being virally suppressed.9 As noted above, individuals with suppressed or undetectable viral loads have nearly normal life spans and are much less likely to transmit HIV.
In 2014, the US Public Health Service released guidelines for the use of Pre-Exposure Prophylaxis (PrEP), which is a way
Role in Routine HIV Testing. Presented by a nurse educator, the hour long presentation provides information on HIV testing with patients, the use of Pre-Exposure Prophylaxis (PrEP) to prevent the spread of HIV for those individuals at a substantial documenting patient records, billing, delivering test results, as well as counseling and referral information for patients.
care continuum. Diagnosing those with HIV infection is the
individuals receive optimal treatment and prevention services. It is only then that the ultimate goal of improving health, reducing disparities, and preventing further HIV transmission can be achieved.
Accessible HIV testing is key in this effort. Given the recent legislative changes regarding HIV testing, physician practices in Delaware are well poised to provide routine HIV testing and thus aid in diminishing the HIV burden in Delaware.
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