• Will insurance companies and other payors pay for the treatment of an HIV-infected person who tests positive for HIV, but whose CD4+ T cell count and/or viral load does not fall within the “official guidelines” of starting antiretroviral therapies?
• What can be done to promote access to HIV treatment for HIV-positive individuals with CD4+T cell counts greater than “official guidelines”?
The 15-member Committee on HIV Screening and Access to Care is composed of experts in the areas of HIV testing and care policy, HIV/AIDS ethics, epidemiology and biostatistics, HIV/AIDS clinical care, HIV/AIDS care services research, HIV care financing, state HIV/AIDS service programming and implementation, and the behavioral sciences (see Appendix A). The committee held its second public workshop, to explore the second part of its study charge, June 21–22, 2010, in Washington, DC. Invited experts discussed barriers and facilitators to HIV/AIDS care during the following five workshop sessions: (1) overview of clinical care and social service needs of persons with HIV/AIDS; (2) entry into and sustained HIV/AIDS care: the role of federal and state and private health insurance policies; (3) payment for treatment of earlier stage HIV infection; (4) the role of federal and state agencies in supporting integrated HIV care services; and (5) the impact of housing, mental health, and immigration policies on HIV/AIDS care access and retention (see agenda and biographical sketches of invited experts in Appendixes B and C, respectively).
This report is structured in response to the committee’s charge and includes a review of the evidence, where available, from policy documents and the research literature on federal, state, and private health insurance policies as potential barriers or facilitators to improved access to HIV/AIDS care. The committee addresses the question of how federal and state agencies can provide more integrated HIV care services (question 2a) following what it felt was the broader question about policies that promote or inhibit clinical care services among agencies at the federal level, state level, or between state and federal agencies (question 2b).
The committee has attempted to provide evidence supporting the assertions made by workshop speakers, but in some instances there is no research addressing these issues. Testimony provided by workshop speakers should be interpreted as opinion by knowledgeable individuals, unless supported by relevant studies.