September 25, 2003
How would the states and AIDS Drug Assistance Programs handle a large influx of new HIV/AIDS patients if CDC succeeds in significantly increasing HIV testing rates? Considering estimates that 200,000-300,000 persons in the United States are HIV-positive and do not know it, a big increase in HIV testing could bring many more people into ADAP and Medicaid systems, said Murray Penner, director of the HIV Treatment Program of the National Alliance of State and Territorial AIDS Directors. "It's going to be a huge strain on the program, and we're already experiencing waiting lists, so it absolutely is a big concern," Penner said.
Bill Arnold, ADAP Working Group director, predicted the new testing push using the rapid HIV test could add 5,000-15,000 new AIDS patients to the ADAP rolls. It is a safe bet, he said, that most of the HIV-positive persons discovered through the new program will not be people with adequate health insurance to cover their antiretroviral medications.
The key will be how quickly and in what regions the new cases show up, Arnold said. If a disproportionate number of new cases appear in states with struggling ADAPs, including North Carolina, Texas and Alabama, those ADAPs will likely have serious problems meeting the increased need, Arnold said. By late summer, ADAP waiting lists held more than 600 names, and 16 states had limited access to antiretrovirals.
New York and California seem to be handling their ADAP and Medicaid clients with HIV, but a looming budget and political crisis in California could threaten that stability, and no one can say whether the states could handle a large patient influx, said Arnold.
Penner and Arnold hope Congress will come through with emergency funding, or at least increase the amount promised for next year's ADAP budget, and will pass the Early Treatment for HIV Act, which was introduced last June.
Arnold noted two pieces of good news for ADAPs. All the major antiretroviral manufacturers have agreed to stabilize the price of their HIV drugs, through voluntary rebates and other concessions, through the next 1.5 years. Also, ADAPs that have included the new Fuzeon therapy in their formularies have not seen the expected influx of clients needing the expensive new treatment.