Most funding for case management services comes from The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. The Bush administration's fiscal year 2002 budget froze CARE Act funds at 2001 levels.
William C. Holmes, MD, MSCE, assistant professor of medicine and epidemiology at the University of Pennsylvania School of Medicine, and Kevin R. Conare, executive director of Action-AID, present their case in an editorial, "Twenty Years in the HIV Epidemic, Do We CARE Enough to Manage It Well?" in the Oct. 16 issue of Annals of Internal Medicine.
"Next year in Philadelphia, approximately 1,000 people will be newly diagnosed with AIDS," says Kevin R. Conare, of Action-AIDS, Philadelphia's largest provider of HIV case management services. Unless funds increase, we'll have to put new clients on a waiting list or discharge existing clients. "Either option will cut the number of infected people who access stable medical care and appropriate drug treatment. Either option will add financial burden to both patients and the Philadelphia health care system."
"We need a $300 million increase in funding for the Ryan White/CARE Act," said Holmes, who is also a practicing physician at the Philadelphia Veterans Administration Medical Center.
"HIV infection today can be considered a chronic disease, not necessarily a death warrant," Holmes said, "but this is possible only if a patient has access to services and treatment with new anti-AIDS drugs."
"HIV is also a public health problem," Holmes said. "If infected people do not get appropriate treatment, we add to that public health problem. Ryan White/CARE Act provides funds for appropriate treatment and the resources needed to access it. Case managers help guide financially needy HIV-infected people through our fragmented health system."
The Senate Health and Human Services Subcommittee will determine the Senate's recommendation for CARE Act funding during the week of Oct. 15. The House Health and Human Services Appropriations Subcommittee has recommended a small increase in CARE Act funding, despite the Bush administration wishes to freeze funds.
Holmes and Conare urge people interested in care for HIV-infected people and public health to contact Senators on the Senate Subcommittee. "Contacting the Senators could lead to increases that approach the $300 million increase in funding that experts recommend."
The editorial accompanies a report of a study on case management in the Oct. 16 Annals. California researchers found that HIV-infected patients with case managers had better supportive services, such as health insurance, adequate housing and counseling, and higher use of HIV medications than patients who did not have managers.
Annals of Internal Medicine, a peer-reviewed medical journal, is published in Philadelphia by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM). ACP-ASIM, the second-largest physician group in the United States, is dedicated to the advancement of internal medicine so that its 115,000 members can provide the best quality care for their patients.
NOTE TO EDITORS:
Copies of the editorial, "Twenty Years into the HIV Epidemic, Do we CARE Enough to Manage It Well?" and the article, "Effect of Case Management on Unmet Needs and Utilization of Medical Care and Medication Among HIV-Infected Persons" are available by calling 1-215-351-2656.
William C. Homes, MD, MSCE, can be reached by calling his assistant, Sheila Hall, at 215-573-5569).
Kevin Conare can be reached by calling (215-981-0088).
Members of the Senate Health and Human Services Subcommittee:
Tom Harkin (Iowa, Chairman), Robert C. Byrd (West Virginia), Daniel K. Inouye (Hawaii), Ernest F. Hollings (South Carolina), Harry Reid (Nevada), Herb Kohl (Wisconsin), Patty Murray (Washington), Mary L. Landrieu (Louisiana), Arlen Specter (Pennsylvania, Ranking Member), Thad Cochran (Mississippi), Judd Gregg (New Hampshire), Larry Craig (Idaho), Kay Bailey Hutchison (Texas), Ted Stevens (Alaska), and Mike DeWine (Ohio)
Journal
Annals of Internal Medicine