Patients in the Jackson metro area need more than medical services to keep their HIV-positive status in check and their health the best it can be.
They need access to a clinic for things like the flu or an earache. They need counseling to help them remain free from the drug and alcohol addictions that often befall those who live with HIV, an infectious disease that, left untreated, is life threatening.
The 2,000-plus people living with HIV treated by the University of Mississippi Medical Center’s infectious diseases team need a long-term support system that makes getting health care less of a struggle. That’s especially true for the HIV-positive population, a group that might not have money for food or medicine, don’t have reliable transportation, lack child care, or are unemployed or financially insecure.
The Medical Center is getting a boost to help improve its delivery of HIV services while addressing everyday challenges that can keep those living with HIV from seeing a provider. UMMC is one of three programs supported through HIV Care Connect, a $7 million, five-year initiative established by the Merck Foundation to help reduce disparities in access to care and improve health outcomes for persons with HIV living in vulnerable and underserved Southeastern U.S. communities.
“In this day and age, a large number of people with HIV know that they are infected and know where they can get care, but they’re not getting it,” said Dr. Leandro Mena, professor and chair of the Department of Population Health Science in the John D. Bower School of Population Health.
“UMMC shares a significant responsibility to make sure that individuals living with HIV in Mississippi receive quality care,” said Mena, an infectious disease professor in the School of Medicine who also directs UMMC’s Center for HIV/AIDS Research, Education and Policy.
“Health is determined by biological, genetic, social, economic, environmental and place-based factors,” said Dr. Bettina Beech, founding dean of the School of Population Health.
“The funding provided by Merck will help Dr. Mena and the Medical Center to address the full range of factors that impact health and health care and improve the health of Mississippians affected by HIV.”
The Merck Foundation is providing funding to UMMC, Care Resource of Miami and Medical Advocacy and Outreach of Montgomery, Ala. The University of Alabama at Birmingham is serving as the national program office for HIV Care Connect, supporting efforts of the grantees and providing leadership in building a public-private partnership to help reduce HIV care disparities.
“We need to accelerate solutions that address the growing disparities in patients’ access to HIV care and health outcomes, and focus on communities that are most affected,” Dr. Julie Louise Gerberding, executive vice president and chief patient officer at Merck, said in a news release.
“Through HIV Care Connect, we are pleased to partner with the University of Mississippi Medical Center and help catalyze collaboration among organizations across the southeastern United States and improve care coordination among people most affected by HIV.”
More than half of those newly diagnosed with HIV live in the South, statistics from the Centers for Disease Control and Prevention show. About three quarters of them are people of color. In Mississippi, there were 428 new HIV diagnoses in 2017, latest statistics show.
A large percentage of Mississippi’s 10,000-plus residents living with HIV aren’t getting regular care for their disease, let alone primary care. HIV stigma continues to play a role, with some patients feeling shame or fear, or discomfort in going to an urgent care clinic or a health care facility in a small rural community.
“They may have had a bad prior experience with health care, and with that a lack of trust,” Mena said.
There is no judgment by UMMC caregivers.
In addition to the adult special care clinic for HIV-positive patients, directed by Dr. James B. Brock, the Medical Center’s Express Personal Health provides free HIV testing and same-day referrals to a HIV primary care provider for those testing positive. UMMC links HIV-negative patients with comprehensive services, including same-day access to PrEP, or pre-exposure prophylaxis. It’s a pill that people at risk of becoming HIV positive take daily to greatly reduce their chance of infection.
And HIV-positive patients coping with substance abuse diseases can enroll in the “Helping HAND” program at the HIV clinic, receiving services ranging from referrals for detox or inpatient rehabilitation to medication-assisted treatment and mental health care.
The HIV Care Connect grant will allow UMMC to create a central point in Jackson for care coordination with other organizations, including a centralized data system. UMMC will co-locate a new low-barrier access clinic within Express Personal Health “so that no one will be left behind,” Mena said. “This will allow patients that have experienced difficulty engaging in care to receive individualized care so that they can be virally suppressed.”
If a patient must miss work in order to get care, the clinic could give the patient a half-day of lost wages. “It’s a financial incentive to mitigate the cost of being compliant,” Mena said. “We know many of our patients are poor.”
The clinic also could pay for transportation to appointments for those who don’t have a ride. Food barriers will be broken down with vouchers for groceries and referrals to food pantries. “We want to sit down with patients and understand why they haven’t been able to get care, and find out what it will take to get there,” Mena said.
“We meet people where they are,” Mena said. “Eighty-five percent of our HIV patients are virally suppressed, but another 15 percent aren’t. This program will focus on that 15 percent, and the 40 percent in Mississippi who are not.
“This grant allows us the opportunity to provide a model of differentiated care and to mitigate the barriers.”
By Ruth Cummins