The Dallas agency offered insight into their successful treatment of Hep C, homelessness and more to control HIV
Dr. Jason Gillman.
DAVID TAFFET | Senior Staff Writer
Seven scientific studies written by 11 staff members were presented at the 2016 National Ryan White Conference on HIV Care and Treatment in Washington, D.C. in August.
The theme for this year’s conference was “Forward Momentum: Accelerating Access. Optimizing Care.
Transforming Public Health,” in recognition of the Ryan White HIV/AIDS Programs commitment to the national HIV/AIDS strategy, focused on decreasing new HIV infections, reducing HIV-related health disparities and improving access to HIV care and treatment without stigma and discrimination.
Among the papers was one on Hepatitis C treatment outcomes at AIDS Arms’ Peabody and Trinity clinics, prepared by the agency’s medical staff and presented by lead researcher, Dr. Jason Gillman.
Gillman explained that because Hepatitis C treatment is so expensive, despite the release of new drugs therapies, few HIV agencies around the country are treating that disease as aggressively as AIDS Arms, which has been a leader in the field. Nationwide, about 25 percent of people with HIV are also infected with Hep C.
Between February 2014 and the end of 2015, the AIDS Arms clinics treated 62 patients for Hep C, Gillman said, adding that new therapies for the disease have shown a 97 percent effective rate in pharmaceutical trials.
However, Gillman continued, his study was looking at real outcomes in a less controlled environment. Because AIDS Arms patients are more likely to also be dealing with drug abuse issues and mental illness and may lack insurance, he said the outcome surprised him.
“Our results were similar to what was in the pharmaceutical studies,” Gillman explained, noting that only three patients relapsed with the disease and since the study was completed, new drugs have come on the market.
Explaining that there are “six genotypes of Hep C and each is treated differently,” Gillman the AIDS Arms patients that relapsed were retested and showed recurrence of the same genotype.
Despite the high cost of treating Hep C — treatment for the 62 patients would cost $6.5 million at retail prices — there was no cost to AIDS Arms thanks to insurance, grants and assistance from the drug companies.
AIDS Arms currently has 144 patients with Hep C. The goal, Gillman said, is to “achieve complete viral eradication.”
While “money hasn’t been a barrier,” Gillman said, the perception that Hep C isn’t as much a problem as HIV has created problems. Many patients with Hep C show no symptoms, since it takes longer to get sick from Hep C.
Insurance companies have created problems, too, since some insurance companies require a negative urine drug screen before paying for the three-month one-pill-a-day treatment.
In a new study already underway, Gillman is comparing outcomes for Hep C treatment in active drug users and non-users. He expects that those who are compliant in taking HIV medication would also be compliant in taking a Hep C drug. He’ll have those results in October.
In the mean time, he said, “Anyone who comes in [to the AIDS Arms clinics] with Hepatitis C is offered treatment.”
Health, Hope, Recovery
AIDS Arms Care coordinators Ben Callaway and Luis Moreno presented results from a study of Health, Hope and Recovery, another AIDS Arms program, at the D.C. conference. The two men work to ameliorate other issues for clients, such as homelessness, which may prevent clients from successfully treating their HIV.
Manisha Maskay, chief program officer for AIDS Arms, said some clients deal with homelessness and may have substance abuse or mental health issues as well. When someone doesn’t know where their next meal is coming from, she said, taking HIV meds isn’t always a priority. So stabilizing housing for a client can make a big difference in successful treatment of HIV.
Maskay said that AIDS Arms obtained a grant to help understand some of the reasons homelessness will interfere with adherence to a treatment regimen. Those reasons started with difficulty to keep one’s possessions safe.
“If you’re homeless, the likelihood you can keep your possessions safe is low,” she said. That means homeless clients often lose important documents, and without a birth certificate or driver’s license, clients have a hard time getting a job or finding housing. Care coordinators help these clients obtain documents and then store them safely.
To get into a shelter, a person has to get in line early enough to be processed and secure a bed. If someone has a late job interview or medical appointment, care coordinators can intervene on behalf of their client with community partners to help secure a bed for the night, Maskay continued.
Most housing programs require a person to be sober before they will give housing assistance. But if a person is housed, they’re more likely to become sober. So, she said, care coordinators have intervened to help those dealing with substance abuse stabilize their housing as they are reducing their reliance on drugs or alcohol.
Care coordinators also work with clients to develop a plan to help them through the process of getting clean and sobers, guiding clients through steps they would need to take but may not understand.
The outcome, in terms of treatment adherence, has been impressive, Maskay said. Those in the program show almost the same rate of viral suppression as AIDS Arms clients in general. In addition, they are getting help dealing with the other issues in their lives.
Program Director Martha Guerrero wrote a paper on AIDS Arms’ Viviendo Valiente program.
AIDS Arms is one of 10 sites across the country receiving federal funding to demonstrate and evaluate culturally specific service delivery models. The multi-layered approach uses a combination of community, group and individual interventions, social media by staff and volunteers to promote treatment for those with HIV.
This is one of the first federal public-health initiatives to use a transnational approach.
This article appeared in the Dallas Voice print edition September 16, 2016.