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From page 347... ...
Index A Acute infection care trends, 6 Access to care clinical features, 40 CARE Act programs, 1213, 17 Adherence to HAART case management and, 130131 clinical significance, 5, 9, 46, 47, 63 current system, 5, 13, 268269, 271 current rate, 46 demographic disparities, 129130 determinants of, 46, 4749 goals, 67, 1415, 16, 33, 36, 50, 134 drug resistance and, 9, 4647 HAART, 1113, 14, 129130, 136, 181, mental illness and, 47, 49, 5657, 91 218223 93, 254, 256257, 260 insurance access and, 272274 patientprovider relationship and, 47, mental illness and, 5556, 252, 258, 49, 163 259260, 263 predictive factors, 49 outreach to improve, 304 requirements for success, 9, 46, 162163 provider participation in federal substance abuse and, 59, 9193, 320 programs and, 12, 14, 19, 111, 136, 321 203 AIDS Drug Assistance Program, 109, 299 public perception, 2728 barriers to access, 13, 118, 145, 300 shortcomings of current system, 6, 11 drug purchases, 20, 125, 204, 270, 306 12, 14, 19, 135136 eligibility, 13, 17, 197 state-to-state disparities, 11, 14, 75, 110, HIV-CCP and, 197198, 207 112, 113, 114117, 118, 119122, purpose, 80, 299 284290, 291, 292, 300, 326 resource allocation, 13, 145, 248, 299 See also Barriers to care spending, 80, 84, 297298 Accountability, 13, 14, 136 AIDS Education and Training Centers, 29, in Centers of Excellence, 171174 81, 190, 300 criteria for assessing programs, 142 Alternative delivery and financing systems, goals, 15, 134 195 in Medicare, 146 assessment criteria, 16, 142, 214 347
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From page 348... ...
348 INDEX block grant program, 153157 Barriers to care enhanced or expanded Medicaid, 148 in CARE Act programs, 118122, 300 153, 195, 213214, 230, 231 conflicting goals among programs, 133 expanded CARE Act programs, 144145 134 goals, 16, 141142 coordination among programs and, 127 HAART modeling for evaluation of, 129, 136, 268, 305306, 328 214216 cost of care, 132133 inputs for modeling, 217225 in current system, 6, 14, 19, 27, 133 Medicare expansion, 145148, 195 134, 280283, 304307 projected enrollment, 224225 in Medicaid, 12, 17, 109114, 132133, projected utilization, 223224 291293 prospects, 174175 in Medicare, 117, 295297 range of, 1516, 141, 142, 213 mental illness, 5556, 131 sensitivity analyses, 234243 in private insurance programs, 107109, state participation, 142144 301, 302303 See also HIV Comprehensive Care provider reimbursement, 19, 111, 325 Program 326 American Public Health Association, 47 sources of, 129 Antiretroviral drugs for substance abusers, 5859, 313, 318 access disparities, 129130 323, 325327, 330332 alternative therapies, 46 for women of color, 59 for children, 90 See also Access to care costs, 20, 21, 204, 270 Bipolar disorder, 251 effectiveness, 42, 4344 Block grants technical evolution, 4243 advantages, 154 See also Highly active antiretroviral disadvantages, 155157 therapy structure, 153154 Anxiety disorders substance abuse treatment, 324 adherence to HIV treatment and, 91 prevalence, 251, 253 risk behavior and, 5455, 255 C Assessment adherence prediction, 49 Cancer, 44 Candidiasis, 42 depression, 55 insurance status and time of diagnosis, Capitation rates, 111, 114 274 CARE Act. See Ryan White CARE Act Care coordination model of service, 170 role of primary care, 98 Asymptomatic infection, 4041 Care-seeking behavior At-risk populations, 37 cost of care and, 132 substance abuse and, 58, 94, 319 implications for health care delivery, 50 trends, 9, 10, 38, 50, 63 Case management, 127 Automobile restraints, 187 benefits, 96, 130131 CARE Act coverage, 298299 Awareness of HIV status, 156, 181, 218, 226 Centers of Excellence model, 170 definition, 96 delivery models, 96 AZT, 4243, 269, 299 HAART utilization and, 224 modeling service needs, 223224 B CD4 lymphocyte levels course of HIV, 41, 42 Bailey Boushay House, 333 depression effects, 9394 Balanced Budget Act, 18, 197 HAART guidelines, 44, 89
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From page 349... ...
INDEX 349 CD8 lymphocyte levels, depression effects, Coronary angioplasty, 187 9394 Cost effectiveness Center for Substance Abuse Treatment, 324 current HIV care, 270 Centers for Medicare & Medicaid Services, HAART, 89, 179, 196 114, 128129, 233234 HIV-CCP, 16, 2223, 24, 179, 180181, Centers of Excellence for HIV care 185188, 231232 accountability mechanisms, 171174 program evaluation methodology, 185 existing programs, 168169 186, 214 features, 168 Cost of care functions, 7, 170171 as barrier to care, 132133 HIV-CCP demonstration project, 180, buy-in provisions, 18, 111 206 care-seeking behavior and, 132 reimbursement practice, 168, 169, 171 drugs, 1921, 203205, 270, 306 174, 188 enhanced Medicaid program, 234 structural models, 169170 goals, 134 Childcare services, 322 HAART, 23, 179, 185, 196, 204206, Children and adolescents 223, 269270 CARE Act services, 8081, 202 HIV care as portion of all health care HIV transmission at childbirth, 19, 90 spending, 270 HIV treatment, 9091 HIV-CCP budget, 233234 Medicaid coverage, 278 inputs for modeling alternative mental illness among, 6162, 252 programs, 217218, 223224, 234 sexual abuse as HIV risk factor, 255 243 unsupervised youths, 6162 preventive intervention outcomes, 193 Chronic care private insurance premiums, 107108, clinical model, 162164 302 definition of chronic illness, 161 provider reimbursement rates, 111 HIV/AIDS requirements, 161162 psychopharmacotherapy, 262 implications for health care delivery, 6, recommendations for federal program, 12, 31, 88, 161164, 165 21 integrated and coordinated model, 165 spend-down eligibility in federal 168 programs, 18, 326 trends, 6, 12, 63, 88, 100 subsistence purchases and, 131 Colorectal cancer screening, 186187 substance abuse treatment, 327328 Community health centers, 303304 trends, 276 Co-morbidity for uninsured HIV/AIDS patients, 189 among HIV-infected youth, 6162 Course of disease, 4042 HIV-CCP coverage, 201, 202 disease state-transition model, 215 infections, 5960. See also Opportunistic initiation of HAART, 226227 infection insurance coverage and, 87 recommendations for federal care insurance status and time of diagnosis, program, 19 274 social conditions as, 54, 6063 mental illness effects, 9394, 257 trends, 56, 10, 3839 oral manifestations, 98 types of, 5254 See also Mental illness; Substance abuse; specific disorders D Consolidate Omnibus Reconciliation Act, Data collection 109, 302 Coordination among HIV/AIDS programs on CARE Act program performance, 13, need for, 127129, 268 14, 122123, 126127, 136, 145 current inadequacies, 13, 14, 136 research needs, 305306
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From page 350... ...
350 INDEX HAART use and need, 218223 Department of Veterans Affairs, 33, 282 HIV population characteristics, 218 283, 303, 327 inputs for modeling alternative drug purchases, 19, 20, 203 programs, 217225 Depression Medicare, 146 adherence to HIV treatment and, 5657, privacy and confidentiality issues, 196 91, 256 records management in Centers of HIV progression and, 9394 Excellence, 169170 identification, 55 on substance abuse, 315317 immune function and, 257 Delivery of care prevalence, 251, 253 case management services, 96 risk behavior and, 5455, 255 consideration of substance abusers in Diabetes, 47, 162 policy planning, 314 Drug-resistant viral strains coordination among programs, 124, adherence and, 5, 9, 4647 125, 127129, 268, 305306, 328 screening for, 89 current system, 56, 12, 34, 63, 99, 100 trends, 9, 47 demographic factors, 50 Dysthymia, 253 financing of care and, 10 functions of system, 167 future challenges, 36, 3839 E goals, 1415, 16, 33, 36, 88, 133134, Early Treatment for HIV Act, 292 161, 178 historical development, 8788 Education and training of health providers integrated and coordinated model, 165 CARE Act programs, 29, 81, 190, 300 care for substance abusers, 321 167 organizational structure, 167168 in Centers of Excellence, 168 primary care, 9899 Medicaid providers, 111114 Efficiency of service delivery, 134. See also prospects for reform, 174175 shortcomings of current system, 1314, Cost effectiveness 107, 134136, 165, 167, 194195 Eligibility, 278, 280283 alternative block grant program, 153 system evaluation, 32 trends, 6, 12, 36 157 See also Alternative delivery and asset testing for, 198199 buy-in provisions, 18 financing systems; specific programs Demographic patterns CARE Act, 17, 82, 144145, 196, 197, access disparities, 129130, 305 207, 249, 298 criteria for assessing programs, 142 geographic distribution, 5152 implications for service delivery, 50 current status, 17 infection rate, 910, 38, 51 expansion of Medicaid eligibility, 149 153, 217 insurance access, 272 mental health care utilization, 258 HIV-CCP, 7, 18, 157158, 178, 179, mental illness risk, 251 181182, 190, 196201, 207, 217, 226 mortality, 9 trends, 50, 5152, 63, 194195, 270, Medicaid, 17, 18, 7576, 109, 114, 196, 307 197, 201, 278, 279290, 291292, 305, 325 See also Racial/ethnic minorities; Women Medicare, 78, 145146, 147, 294295, Dental health.
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From page 351... ...
INDEX 351 recommendations for improving access, criteria for assessing programs, 142 18 current HIV spending, 73, 188, 274277 Social Security Disability Insurance, 294 current system, 5, 11, 73, 100, 216, 268 spend-down provisions, 18, 197198, delivery system and, 10 279, 326 federal block grant program, 153157 substance abuse treatment, 325 geographic variation, 122 Supplemental Security Income, 279, 325 goals, 1415, 16, 178 Eligible Metropolitan Areas, 119, 122123, insurance coverage distribution, 271 246247, 298299, 329, 331 274 Emergency room admission, 59 prevention services, 306307 current utilization, 99 problems of federal-state partnership, 6, modeling service needs, 223 11, 14, 136 substance abuser care-seeking behaviors, shortcomings of current system, 6, 11, 319 14, 134136, 194195, 268269, Entitlement programs, 73, 153, 156, 276 304307 Evidence-based practice, 163 substance abuse services, 323326, 327 328 See also Alternative delivery and F financing systems; Cost of care; specific programs Federal Ceiling Price, 20, 21 Fusion inhibitors, 37 recommendations for HIV-CCP, 179 180, 203, 205 Federal Employee Health Benefits, 304 G Federal programs for HIV/AIDS care, 278, 280283, 328 Geographic distribution barriers to access, 132, 133134 CARE Act spending, 122 benefits, 280283 disease prevalence, 5152 Centers of Excellence oversight, 174 drug use patterns, 316 current spending, 73, 75, 78, 188, 274 uninsured population, 129 277 Guidelines for the Use of Antiretroviral eligibility, 280283 Agents in HIV-Infected Adults and financing mechanisms, 73, 100 Adolescents, 4446, 89 goals, 8, 133134 mandatory vs. discretionary spending, 276 H origins and development, 8 HAART.
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From page 352... ...
352 INDEX assessment for, 49 maintenance of effort requirements, 160 cost-effectiveness, 89, 179, 196 morbidity and mortality outcomes, costs, 2021, 23, 159, 179, 185, 196, projected, 16, 22, 179, 183184, 204206, 223, 269270 225, 230231 criteria for evaluating alternative prevention effect, 192193 delivery and financing systems, 214 private insurance market effects, 181, 215 199200 current access, 1113, 14, 129130, projected enrollment, 22, 178, 182183, 136, 181, 214215, 218223, 226 190, 217, 224225, 226 disease status of recipients, 226227 projected service utilization, 217224 dosing schedule, 4849 projected spending, 23, 160, 179, 188 drug interactions, 127, 320 189, 233234 effectiveness, 5, 8, 31, 37, 4344, 130, provider payment, 19, 158, 179, 185, 184185 188, 202203, 217 implications for care delivery system, 6, quality of care goals, 21 31, 36, 39, 88 rationale, 16, 2324, 33, 158159, 179, income levels of recipients, 222 193194, 208209 insurance status of recipients, 181, 222 recommendation for establishment of, Medicaid coverage, 77, 217, 230 17, 179, 194196 in pregnancy, 90 Ryan White CARE Act and, 2122, 160, requirements for clinical effectiveness, 18 180, 189191, 206208 substance abusers and, 320 state participation, 159160, 195, 196, transmission risk and, 8, 3738, 135 234 treatment guidelines, 4446, 89 Home and community-based services, 223, viral resistance to, 9 303304 See also Adherence to HAART CARE Act coverage, 329 High-risk pools, 304 Medicaid coverage, 114, 290291 HIV/AIDS Integrated Services Project, 306 Homelessness, 61 HIV/AIDS Mental Health Services Housing Opportunities for Persons with Demonstration Program, 95 AIDS, 276 HIV Comprehensive Care Program, 213 administrative structure, 157, 159 benefit package, 1819, 157, 158, 179, I 186, 201202, 215216, 217 Centers of Excellence demonstration Immigrant population, 62, 200 project, 180, 206 Immunophysiology AIDS, 4142 cost-effectiveness, 2223, 24, 179, 180 181, 185188 chronic stage infection, 4041 disadvantages, 159160 co-morbid disease infection, 60 depression effects, 257 drug purchases, 21, 159, 179180, 203 206 HAART, 4445 eligibility, 7, 18, 157158, 178, 179, primary infection, 40 tuberculosis risk, 60 181182, 190, 196201, 207, 217, 226 Incarcerated populations, 6263, 200201, financing, 157, 158160, 196, 217, 326 Incidence 233234 goals, 67 current rate, 5, 78, 27, 3637 HAART access and use under, 159, demographic patterns, 910, 38, 307 trends, 910, 3738, 194195, 307 178179, 182183, 217, 226230 inputs for modeling, 217225
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From page 353... ...
INDEX 353 L dental services, 130 drug purchases, 20, 21, 203204, 270, Low-income population 293, 306 care delivery system goals, 1415 dual enrollment, 271, 294 challenges for service delivery, 50 eligibility for AIDS/HIV care, 17, 18, crowd-out response to government 7576, 109, 114, 149153, 196, programs, 181 197, 201, 278, 279290, 291292, current estimates, 218, 270 305 current HIV/AIDS care system, 34 enhanced or expanded models, 1516, definition, 197 141, 148153, 195, 213214, 217, eligibility for federal care programs, 17, 230, 231, 234 18, 197 managed-care services, 111113, 293 eligibility for Medicaid HIV benefits, mental illness treatment, 115 109, 111, 279, 290 performance evaluation, 32 expansion of eligibility for Medicaid preventive interventions, 97 HIV benefits, 149153 primary care services, 98 HAART access among, 222 provider participation and HIV-CCP eligibility, 179, 181182, 196, reimbursement, 12, 19, 111, 114, 197199 202203, 325326 infection risk, 38 quality of care, 273274 mental illness risk, 251 role in HIV care system, 7 poverty level, 181, 196 Section 1115 waivers for HIV care prior recommendations for CARE Act to disability, 7, 15, 109, 111, 149 programs, 22 150, 291292, 305 social co-morbidities, 54, 6061 spending, 75, 274275, 276, 279, 328 substance abuse treatment access among, state cost control strategies, 293 5859 state-to-state disparities, 11, 14, 75, 110, 112, 113, 114117, 284290, 291, 292, 305 M strategies for improving service delivery, Mammography, 187 114 Managed care, 117 structure, 75, 278 substance abuse treatment, 95, 115, Centers of Excellence model, 170 Medicaid, 111113, 293 325326 Medicaid Medicaid Managed Care Organizations, 205 barriers to access, 12, 17, 109114, 132133, 272273, 291293, 305 Medicare benefits, 7677, 290291 access, 19 barriers to access, 117, 295297, 305 capitation rates, 111, 114 case management services, 96 benefits, 79, 117, 147148, 295 community-based services, 304 coverage, 7778, 293 current enrollment, 10, 73, 78, 129, coordination with other programs, 128 129 218, 271, 272, 293294, 328 coverage for privately-insured dual enrollment, 271, 294, 296297 eligibility, 78, 145146, 147, 294295, individuals, 199 coverage for working individuals, 109 305 111, 291292 expansion of, to improve care, 141, 145148, 195 current participation, 10, 73, 75, 129, 218, 271, 272, 274, 278279 financing sources, 146 definition of "disability," 279 prescription drug coverage, 79, 147 148, 294295, 296297, 305, 306 demographic patterns in HIV care, 272
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From page 354... ...
354 INDEX program accountability, 146 HIV-CCP projected outcomes, 22, 179, project growth in enrollment, 78, 294 183184, 230233 provider participation and insurance coverage and, 130 reimbursement, 12, 19, 111, 146, mental illness, 251252 203 obstacles to greater reduction, 56, 12 spending, 78, 274275, 276, 294, 328 treatment effectiveness, 43 strategies for improving service delivery, trends, 8, 42 117 Multidisciplinary treatment approach, 163 utilization patterns, 127128 164 Medicare Prescription Drug, Improvement and Modernization Act, 147, 294 295 N Medigap policies, 117, 296 Mental illness National health insurance, 33 access to care, 252, 263 Natural history. See Course of disease Nonmedical services, 190 adherence to HIV treatment and, 47, 49, 5657, 9193, 254, 256257, 260 Medicare coverage, 117 among HIV-infected youth, 6162 modeling service needs, 223 NorthSTAR Behavioral Health Pilot barriers to care, 5556, 131, 258, 259 260 Program, 334 challenges for service delivery, 50 clinical features, 251 O co-morbid substance abuse, 251, 327 disability outcomes, 251, 252 Obstetric care, 19, 90, 201, 223 HAART utilization and, 224 Omnibus Budget Reconciliation Act, 203 HIV-CCP coverage, 201 204, 279 HIV detection in people with, 55, 258 Opportunistic infection, 42, 8990 HIV risk, 5455, 94, 252253, 254256 guidelines for prevention and treatment, impact on course of disease, 9394, 257 90 implications for HIV treatment, 95, 250, HAART effectiveness, 44 261263 modeling service needs, 223 Medicaid coverage, 115 types of, 90 modeling service needs, 223224 Oral health mortality, 251252 access to care, 130 pharmacotherapy, 261262 CARE Act provisions, 30, 81, 9899, prevalence, 54, 250, 251, 252253 190, 202, 299 severe forms, 252 disease progression, 98 socioeconomic status and, 251 Medicaid services, 130 standard of HIV care, 10, 19 modeling service needs, 223 stigmatization and discrimination, 260 primary care, 98 trends, 10, 253254 Origins of HIV, 40 Montefiore Substance Abuse Treatment Center, 333 Mortality P cause of death in HIV disease, 42 co-morbid depression, 94 Panic disorder, 91, 253 course of HIV, 42 Patientprovider relationship current rate, 5, 78, 37 discrimination against client with mental demographic patterns, 9, 51 illness, 260 HAART outcomes, 5, 8, 37, 130, 184 HAART adherence and, 47, 49, 163 HIV-CCP goals, 16 substance abusing patients, 321322
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From page 355... ...
INDEX 355 Pneumonia, 42 Primary infection, 40 Posttraumatic stress disorder, 253, 255 Prisons. See Incarcerated populations Pregnancy Privacy and confidentiality issues, 196 HAART and, 90 Private insurance, 33 HIV transmission prevention in, 19, 90 anti-discrimination protections, 301302 91 barriers to care, 107109, 301, 302303 Prescription drugs CARE Act purchases, 108109, 302 CARE Act coverage, 118, 204 COBRA extensions, 302 costs, 1920, 270, 306 consumer costs, 107108 goals for federal purchasing, 7 coverage over course of disease, 87 HIV-CCP drug purchases, 21, 159, 179 crowd-out response to government 180, 203206 programs, 181, 199200 Medicaid benefits, 7677, 113, 203 current coverage, 10, 73, 85, 100, 108, 204, 290, 291, 293, 328 129, 218, 271, 272, 274, 301 Medicaid spending, 270 demographic patterns in HIV care, 272 Medicare benefits, 79, 117, 147148, denial of service, 108, 301 294295, 296297, 305 HIV-CCP eligibility and, 199 pharmacy assistance programs, 304 Medigap policies, 117, 296 psychotropic medications, 261262 portability protections, 301 research and development, 2021 regulation, 8587, 108, 301302 See also AIDS Drug Assistance Program; state-by-state variation in care, 108 Highly active antiretroviral therapy PROTOTYPES, 332333 Prevalence Public perception and understanding CARE Act EMA eligibility, 246247 of HIV/AIDS care, 2728 childhood sexual abuse, 62, 255 stigmatization of HIV-infected persons, co-morbid disease infection, 60 260 co-morbid mental illness, 54, 252253 co-morbid substance abuse, 5758, 253, 316317 Q current estimates, 218, 226 Quality-adjusted life years geographic distribution, 5152 homelessness, 61 evaluation of alternative care systems, mental illness, 54, 250, 251 22, 215, 216 HIV-CCP goals, 16 socioeconomic distribution, 270 trends, 3738 HIV-CCP projected outcomes, 2223, Preventive interventions 179, 184185, 186188, 231233 Quality of care among HIV-positive individuals, 97 antiretroviral therapy, 97 CARE Act programs, 118, 123 financing, 306307 current system, 305 goals, 15, 134, 164165 HIV-CCP coverage, 201, 202 HIV-CCP effects, 192193 HIV-CCP goals, 21 with mentally ill individuals, 262263 insurance access and, 273274 in managed-care organizations, 111113 Primary care access, 10 Medicaid providers, 111114 advantages of health care delivery in, 98 mental illness and, 260, 262263 promptness of diagnosis, 274 CARE Act provisions, 9899, 118, 126 HIV-CCP coverage, 201 in rural areas, 99 Medicaid coverage, 98 specialists in HIV care, 113, 114 strategies for improving, 164165 role in HIV care system, 98 scope of services, 98 substance abuse and, 319320
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From page 356... ...
356 INDEX R eligibility, 17, 82, 144145, 196, 197, 207, 298 Racial/ethnic minorities, 38 Eligible Metropolitan Areas, 119, 122 barriers to care, 59, 129130, 131, 132 123, 298299, 329, 331 133 emerging communities awards, 249, 299 CARE Act services, 82, 247, 249 expansion of, to improve care, 141, co-morbid disease infection, 60 144145 HIV risk, 9, 38 funding, 118, 145, 297298, 300, 328 infection patterns, 51, 307 HIV-CCP and, 2122, 160, 180, 189 insurance access and utilization, 272 191, 206208 mental health care utilization, 258 HIV treatment evolution and, 3031 mental illness risk, 251 performance evaluation, 13, 14, 122 mortality patterns, 9 123, 126127, 136, 145 substance use in HIV transmission planning bodies, 13, 8485, 123127, among, 57, 315 144, 329, 331 Reimbursement primary care services, 9899, 118, 126 alternative block grant program, 156 private insurance purchases under, 108 carve-out programs, 114, 170 109, 302 Centers of Excellence, 168, 169, 171 purpose, 8, 11, 2830, 50, 79, 268, 297 174 services and components, 2930, 8081, criteria for assessing programs, 142 8284 disincentive programs, 173174 spending, 80, 81, 119, 125, 276, 298, HIV-CCP, 19, 158, 179, 185, 188, 202 299, 300 203, 217 state and local administration, 13, 80, Medicaid, 12, 14, 19, 114, 132133, 144, 145, 248, 298, 299, 329 202203, 293, 325326 state-to-state disparities, 17, 118, 119 Medicare, 12, 19, 111, 146, 203 122, 144145, 284290, 298, 300, obstacles to access, 12, 14, 19, 132133, 305 136, 203, 293 substance abuse treatment, 95, 314, risk-adjusted capitation, 114 328331, 334335 state-to-state variation, 326 Title I, 13, 29, 80, 82, 84, 85, 96, 119, Research and development in 123, 125, 145, 190, 207, 246247, pharmaceutical industry, 2021 298299, 328330 Rivington House, 334 Title II, 13, 29, 80, 8284, 96, 108109, Rural areas, 323 119, 122, 190, 207, 248249, 299, Centers of Excellence in, 173 328330 quality of care in, 12, 99 Title III, 29, 80, 119, 190, 202, 207 substance abuse treatment in, 326 208, 299 Ryan White CARE Act, 7, 11, 28 Title IV, 29, 8081, 119, 190, 202, 299 barriers to care, 1213, 118122, 300 See also AIDS Drug Assistance Program benefits, 202, 298300 Ryan White Planning Councils and case management services, 96 Consortia, 123127 clients, 30, 35, 8182, 298 coordination with other programs, 124, 125, 128129 S dental program, 30, 81, 9899, 190, 202, 299 Schizophrenia, 251, 253, 255, 261 early intervention services, 80, 119, 202, Screening 207208, 299 cost-effectiveness, 186187 education and training centers, 29, 81, for drug-resistant viral strains, 89 190, 300 HIV detection in people with mental effectiveness, 3132 illness, 55, 258
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From page 357... ...
INDEX 357 incarcerated persons, 63 HIV care spending, 276, 279, 328 prenatal, 9091 in HIV-CCP, 17, 157158, 159160, rapid testing, 37 189, 195, 196, 234 Sensitivity analysis, 234243 inadequacies of current care system, 6, 7 Settings for care insurance regulation, 108 current utilization, 12, 99, 100 Medicaid administration, 11, 75, 7677, insurance coverage and, 10, 268 279290, 291, 328 for substance abusers, 59, 319320 problems of federalstate partnership, 6, trends, 6, 8788, 165 11, 14, 136 Sexual abuse purchase of private insurance by, 108 HIV transmission risk and, 255 role in alternative delivery and financing prevalence, 62, 255 systems, 142144 Sexual behavior substance abuse treatment programs, HAART and, 135 323324 mental illness and, 5455, 94, 254256 State-to-state variation in services prevention of transmission-risk CARE Act programs, 118, 119122, behaviors, 97 144145, 284290, 298, 300, 305 prior sexual abuse and, 255 current system, 6, 7, 305 substance use and, in HIV transmission, Medicaid programs, 11, 14, 75, 110, 315 112, 113, 114117, 284290, 291, Sexually transmitted diseases, co-morbid, 305 5960 private insurance, 108 Social co-morbidity, 54, 6063 reimbursement policies, 326 Social Security Disability Insurance Stigmatization, 260, 318 eligibility, 294 Substance abuse Medicare eligibility and, 78, 294 abuser attitudes toward health care, spending, 275276 321322 Social services access, 10 among HIV-infected populations, 5758, Special Projects of National Significance, 6162, 253, 316317 29, 81, 190, 300 barriers to HIV/AIDS care, 313, 318 Standard of care, 10, 8889, 100 323, 330332 alternative block grant program, 155 CARE Act provisions, 314, 328331, 156 334335 criteria for assessing programs, 142 care-seeking behavior and, 58, 94, 319 current delivery system, 6 challenges for service delivery, 50, 57, HIV-CCP, 158, 179, 201202 5859 recommendations for federal program, co-morbid mental illness, 251, 327 1819 considerations in HIV policy planning, State Children's Health Insurance Program, 314 142, 153154, 155, 200, 201 current research base, 315317 State governments current treatment system, 323332 alternative block grant program, 153 denial of services based on, 322 157 effective programs, 331335 CARE Act administration, 80, 119, 122, funding for treatment services, 323326, 248, 298, 299 327328 drug purchases, 203204 HAART utilization and, 224, 320 eligibility for AIDS/HIV care, 17 hepatitis infection and, 60 expansion of Medicaid eligibility, 149 HIV-CCP coverage, 201 153 HIV course and, 91, 9394 health care for incarcerated persons, HIV transmission and, 57, 94, 313, 315 200201 Medicaid coverage, 115, 325326
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From page 358... ...
358 INDEX modeling service needs, 223224 U patterns, 315316 provider attitudes, 321 Underinsured/uninsured population, 33 recommendations for federal care among individuals with HIV/AIDS, 11, program, 19 100, 129, 226, 271, 272, 274 service needs of HIV-infected substance CARE Act coverage, 79, 82, 297 abusers, 91, 95, 317318 costs of HIV care, 189 standard of HIV care, 10, 19 demographic patterns, 272 syringe exchange program, 314 geographic distribution, 129 treatment adherence and, 47, 49, 59, HAART access and utilization, 181 9193, 320321 HIV-CCP projections, 189 treatment capacity, 326327 infection trends, 38, 50 treatment for, 322323 settings for care, 10, 268 Substance Abuse and Mental Health substance abuse treatment access among, Services Administration, 95, 315 5859 316, 324 Substance Abuse Prevention and Treatment Block Grants, 95 V Supplemental Security Income, 18, 76, 112, Viral load, 4142, 43 197, 275276, 279, 305, 325 depression effects, 9394 Syringe exchange program, 314 W T Women Teaching hospitals, 99 barriers to care, 59, 322 Temporary Assistance for Needy Families, CARE Act services, 80, 82, 202 112 depression risk, 251 Testing. See Screening infection patterns, 910, 51 Therapeutic relationship.
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