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Institute of Medicine Releases Report on Health Care System Capacity for Increased HIV Testing and Provision of Care

March 21, 2011

Cross-posted from the Office of National AIDS Policy Blog on March 18, 2011.

Today, the Institute of Medicine (IOM) released its third and final report in a project commissioned by the Office of National AIDS Policy (ONAP). Entitled "HIV Screening and Access to Care: Health Care System Capacity for Increased HIV Testing and Provision of Care," the report examines the current capacity of the health care system to administer a great number of HIV tests and accommodate new HIV diagnoses.

More than 200,000 people in the United States are living with HIV, but unaware of their status. Increased HIV testing may help identify these individuals, reducing the chance that they will transmit HIV to others and improving their own health outcomes. But some individuals may not receive the care they need if the health care system does not have the capacity to care for them.

The report finds that budget constraints at state and local health departments pose a barrier to more widespread HIV testing. In addition, fewer practitioners are specializing in HIV/AIDS care and the number of specialists entering the workforce is not replacing the number retiring. Among the report's findings, the report concludes that, to meet the growing demand for care, more practitioners need training in HIV/AIDS treatment and care; and hospitals, clinics, and health departments must receive sufficient funding to maintain their staff and support screening efforts.

The Affordable Care Act (ACA), the landmark health reform legislation signed into law by President Obama in March 2010, includes several provisions to expand and better support the health care workforce. These provisions also create opportunities for addressing some of the HIV workforce challenges identified in this report. The National HIV/AIDS Strategy for the United States (PDF) recognizes the importance of ensuring that all people living with HIV know their HIV status and are well supported in a regular system of care. The Strategy states that public and private sector entities must take the steps to improve service delivery for people living with HIV by: establishing a seamless system to immediately link people to continuous and coordinated quality care when they are diagnosed with HIV; taking deliberate steps to increase the number and diversity of available providers of clinical care and related services for people living with HIV; and, supporting people living with HIV with co-occurring health conditions and those who have challenges meeting their basic needs, such as housing.

In 2009, ONAP commissioned the IOM to convene a 15-member Committee on HIV Screening and Access to Care, which was tasked with planning and conducting a series of three workshops and activities that evaluate barriers to expanded HIV testing and treatment programs. The outcome of these efforts is the issuance of three reports that examine certain questions related to HIV testing policy and access to care. The Committee's first report focused on the extent to which Federal and State laws and policies, private health insurance policies and practices, and other factors inhibit or promote expanded HIV testing. The second report studied how Federal and State laws and policies and private health insurance policies affect entry into clinical care and the provision of continuous and sustained care for people with HIV.

ONAP thanks the Committee for its efforts. These reports will inform our collective efforts to implement the Strategy.

To view this report and the entire report series, please visit the IOM website,

Jeffrey S. Crowley, M.P.H., is director of the Office of National AIDS Policy.

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