A select group of community health centers will follow best practices and quality-improvement strategies outlined by the American Medical Association as part of a nationwide effort to boost the number of visits and routine screenings for HIV, viral hepatitis, latent tuberculosis and sexually transmitted infections.
The initiative is intended to help physicians detect and treat infectious diseases earlier to reduce transmission, while also cutting healthcare spending and addressing social inequities and other barriers to screening, AMA President Dr. Jack Resneck Jr. said in a news release.
Although reported HIV diagnoses decreased by 17% in 2020 compared with 2019, most experts believe this dip in cases is the result of underreporting and lower rates of HIV testing, according to a report from the Centers for Disease Control and Prevention published in June.
"Given that access to preventive services were interrupted by the COVID-19 pandemic, many individuals may not even be aware they have an infection and are at risk of contributing to new infections,” Resneck said.
The CDC and the AMA developed a toolkit of best practices clinicians can use to scale up screening programs and encourage people from vulnerable populations to get tested.
CCI Health Services in Maryland, Circle the City in Arizona, Esperanza Health Centers in Illinois, Odyssey House Louisiana and two clinics in Mississippi are among those that will provide feedback on the toolkit and test its impact on routine screening before the strategies are implemented on a national level.
Access to testing has been severely limited by the pandemic, with clinics closing, staff being diverted to focus on COVID-19 care and local organizations putting outreach efforts on hold, said Matthew Hamill, professor of infectious diseases at Johns Hopkins School of Medicine.
“We really need to get back on track in terms of increasing the proportion of undiagnosed people who get to have access to a diagnosis,” Hamill said. “That's the gateway into the HIV epidemic. Without testing and diagnosis, people don't know their status and they're able to transmit the infection to others.”
While many community health centers’ infectious disease screening and treatment efforts have been disrupted during the pandemic, some, such as Legacy Community Health in Houston, took time to change their workflows to improve access to preventive care.
“Even in the initial stages, we always had signs outside saying that walk-ins are welcome, that we were still doing STI screenings, and we had our public health team up and running, fully staffed at most times,” said Dr. Vandana Shrikanth, medical director of specialty services at Legacy Community Health. “We started a new appointment type called Rapid HIV so that once the patient tests positive, they can be seen for treatment within a week.”
Shrikanth said Legacy has taken a multi-pronged approach to increasing HIV testing and care by offering telehealth visits and medication shipments and by using liaisons to reach patients who have fallen out of care due to mental health or other personal issues.
In Maryland, a collaboration between the Baltimore City Health Department and Johns Hopkins University allows patients to register online to receive free STI and HIV tests in the mail, Hamill said. Investing in public sexual health clinics as safety net organizations and prioritizing user-friendliness are key elements of addressing disparities in access to HIV prevention services, he said. Clinicians can encourage patients to purchase HIV tests and use free online resources, he said.
One major goal of the initiative to end the HIV epidemic is to reduce new infections in the U.S. by at least 90% by 2030, according to the Health and Human Services Department, which will require more of a focus on HIV prevention and treatment strategies.
“It's beholden on us to innovate, to think about how we meet people where they are, rather than sitting in clinics waiting for people to come to us,” Hamill said. “We as medical providers should take every opportunity that we can to provide our patients with access to HIV testing and HIV prevention services.”