What is the extent to which federal, state, and private health insurance policies pose a barrier to expanded HIV testing? Issues for the committee to consider include the following:

1. What are the current federal and state laws, private health coverage policies, or other policies that impede HIV testing?

2. What effective HIV testing methods and/or policies should be implemented by federal, state, or local agencies, federal programs, or private insurance companies that can be used to reach populations with a high HIV prevalence and/or high prevalence of undiagnosed HIV infection?

3. What has been the impact of opt-out HIV testing?

What federal and state policies and private insurance policies/practices (such as pharmaceutical coverage limits) inhibit entry into clinical care for individuals who test HIV-positive or inhibit the provision of continuous and sustained clinical care for HIV-positive persons? Issues for the committee to consider include

1. How can federal and state agencies provide more integrated HIV care services?

2. What policies promote/inhibit clinical care services among agencies at the federal level, at the state level, or between state and federal agencies?

3. What are federal and state agency policies in funding HIV medication adherence programs? What HIV medication adherence programs work?

4. Will insurance companies and other payors pay for the treatment of an HIV-infected person who tests positive in this theoretical new, expanded testing program, but whose CD4+ T cell count and/or viral load does not fall within the “official guidelines” of starting antiretroviral therapies?

5. What can be done to promote access to HIV treatment for HIV-positive individuals with CD4+T cell counts greater than “official guidelines”?

What is the current capacity of the health care system to administer a greater number of HIV tests and to accommodate new HIV diagnoses? Issues for the committee to consider include system, workforce, and private sector issues:

1. Where do HIV-positive patients currently get care?

2. What is the HIV-related training or experience of most HIV care providers (medical doctor, nurse practitioner, physician’s assistant, registered nurse)?

3. What manpower or training/experience improvements are needed to absorb more newly diagnosed HIV-positives from expanded HIV testing services?

4. Is the age profile of providers compatible with sustainability of the HIV care delivery system? That is, are younger clinicians and/or students receiving adequate training/experience to meet future needs?

5. What are the impediments to professionals entering into, or continuing to provide, AIDS care?

6. What policies inhibit or enhance the movement of health care professionals into HIV/AIDS specialties?

7. Are there adequate financial or professional incentives to promote HIV/AIDS as a specialty among the health care professions?