AIDS Education and Training Centers (AETCs) ($35 million in FY 2002) support a network of 14 regional centers (and over 70 associated sites) that conduct targeted, multidisciplinary education and training programs for health care providers of clinical care for persons with HIV/AIDS.
Special Projects of National Significance (SPNS) (funded through set-aside from Titles I–IV not to exceed $25 million annually; as of FY 2003, SPNS is being funded through DHHS evaluation set-asides) are funded to establish innovative demonstration projects that respond to the challenge of HIV/AIDS service provision to underserved and vulnerable populations.
People with HIV also face challenges in accessing CARE services. As the number of people living with HIV/AIDS continues to grow and the cost of care increases, demand for CARE Act services is also increasing. Because the CARE Act is a discretionary grant program that depends on annual appropriations by Congress (and often by states and municipalities), CARE Act dollars do not necessarily match the need for services and some grantees have been unable to serve all those in need. For example, several state ADAP programs have had to place clients on waiting lists to access prescription drugs, or limit such access in other ways (16 as of September 2003)83 and, as mentioned above, ADAP formularies vary significantly across the country—while almost all ADAPs cover all FDA-approved antiretrovirals, only 15 states cover the full set of drugs highly recommended for the prevention and treatment of opportunistic infections (OIs); 39 states cover 10 or more of these drugs.49,84
In addition, CARE Act programs and services vary across the country, due to local flexibility in designing programs, different levels of funding, and the CARE Act’s role as gap filler. Much of the federal funding for the CARE Act is allocated by formula, based largely on local AIDS case burden. Yet health care system capacity and the availability of other programs vary across jurisdictions and more CARE dollars must be used to fill the gaps in jurisdictions with less generous access to other programs.66 In addition, because the current allocation formula relies on AIDS cases, not HIV infection, allocations may not reflect recent trends in the epidemic and the full burden of affected individuals in all jurisdictions. The 2000 reauthorization of the CARE Act calls for the incorporation of reported HIV cases into the Title I and II formulas as early as FY 2005, if accurate and reliable data exist (a recently released Institute of Medicine report found, however, that HIV case reporting is not yet reliable enough for this purpose. See: Institute of Medicine, Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act, 2004).