Florida: Getting People HIV Meds the Same Day as diagnosis

[Jim Allen]

This is a good effort, the program also reinforces safer sex and routine testing.
I do hope that in the future we can see more states and other nations moving in a similar direction.

Getting People HIV Meds the Same Day They Test Positive

It’s part of the Florida Department of Health’s latest efforts to “test, treat and beat HIV” in a hard-hit county.

May 12, 2017

The Florida Department of Health in Broward County launched a new HIV program called Test and Treat this month, with the goal of getting medication to people who are newly diagnosed with HIV or returning to care, reports CBS Miami. Public awareness ads for the program feature the tagline “Test, Treat and Beat HIV.”

“We want to close the loop and take that patient right over to be linked to care and get started on medication the same day,” said Deberenia Allen, MD, medical director for Memorial Healthcare System’s Rapid HIV Testing program.

To that end, the health department is partnering with HIV testing sites, the Broward County Ryan White Part A office, Ryan White HIV primary care providers and hospitals and private doctors. Physicians are invited to join the program, and several AIDS service organizers have already agreed to participate in the Test and Treat program.

People without insurance or with inadequate coverage can still receive medication the same day.

Story: https://www.poz.com/article/getting-people-hiv-meds-day-test-positive-video

[Almost2late]

Wonderful news, proud of them for doing this.. For a few years now I noticed these PSA that run during local news and there's a few of them.. Just this past weekend a family member told me that he went to get tested along with all the other STD test and he seemed quite proud of himself for doing it.. I asked him what made him test and he told me about the commercial, he then said you should to.. I never told him my status so I just said okay.. I'm just glad the word is getting around and now people could just get treatment right away if they are positive.. Go Broward!

Thanks for sharing this, should be like this throughout the world.

[leatherman]

the only bad thing to treating on the same day as diagnosis is that it gives no time for a genotype type. This far into the epidemic there is an amount of HIV being transmitted that has developed resistance to some meds.

[mecch]

Its kind of hard to swallow that an MD and HIV specialist wrote this sentence:

“We want to close the loop and take that patient right over to be linked to care and get started on medication the same day,” said Deberenia Allen, MD, medical director for Memorial Healthcare System’s Rapid HIV Testing program.

Maybe its been mangled in translation to print or maybe the Health Department sees value in a simple and clear statement that helps with all the anxieties around unknown HIV status and then diagnosis.

I don't see how it was mangled, though. It repeats:
"People without insurance or with inadequate coverage can still receive medication the same day."

I get a sort of unspoken condescending feeling to this sort of game plan.

Maybe medical science has recently changed best practice on genotype testing?

[bocker3]

There is still plenty of time to have a genotype test DRAWN.  They won't get the RESULTS before they start meds but, If they start someone on a drug to which their virus has resistance, they can change. 

The bottomline is that the science has been moving to the importance of getting people on treatment as soon as possible and the vast majority of people are not going to be dealing with resistance, so why wait for a result? 

I'm having trouble understanding the Debbie Downers here??

Mike

[Almost2late]

There is still plenty of time to have a genotype test DRAWN.  They won't get the RESULTS before they start meds but, If they start someone on a drug to which their virus has resistance, they can change. 

Exactly.. I was started on atripla soon after my dx, no geno till a month later but they continued to monitor my vl which was going down.. maybe they're speaking of people who are at an advanced stage.

[leatherman]

so why wait for a result?

it's not like I'm talking about waiting till someone is at 200 or 350 cd4s or waiting for months. I'm talking about waiting a week or so (which often gives time to get financing in place to cover meds) to avoid side effects or wasted medications after a quick prescription change. Waiting a short time can result in savings for the consumer (not having possible side effects from the medication which may not even be dealing with the HIV) and savings to the system (not giving out a month's worth of a prescription and then filling another prescription in two weeks)

[bocker3]

it's not like I'm talking about waiting till someone is at 200 or 350 cd4s or waiting for months. I'm talking about waiting a week or so (which often gives time to get financing in place to cover meds) to avoid side effects or wasted medications after a quick prescription change. Waiting a short time can result in savings for the consumer (not having possible side effects from the medication which may not even be dealing with the HIV) and savings to the system (not giving out a month's worth of a prescription and then filling another prescription in two weeks)

I get your point -- but the small number that would require a med change does not warrant the wait, IMO.  I mean, I started before my results were in -- and despite having some level of resistance to almost every Nuke, I remained on my original meds.  I think this worry of resistance is simply not significant enough to warrant a delay.  Reasonable minds may disagree.  I applaud Florida for this move in the right direction of getting people on treatment ASAP.  Public policy can't be dictated based on outliers.

M

[leatherman]

outliers

I wonder if there is data about this issue. Through my peer counseling work, I know a number of people who, this far into the epidemic, were infected with a strain that had already developed resistant. However, I've never seen data about exactly how many new infections fit this category.

I certainly wouldn't want to start meds that wouldn't work and have had genotypes done a few times throughout my 25 yrs of meds whenever I had issues and had to change regimens. I can only imagine the stress and confusion starting off with the wrong meds could have on someone newly diagnosed.

Clearly, early treatment is the best; but our definition of "ASAP" is obviously different. I just don't think that waiting a week or so for a genotype would make that much difference in the outcome of suppressing HIV or in terms of reducing long-term inflammation issues.

[harleymc]

The push here in New South Wales is for same day prescribing. our PLWHA organization, Positive Life, is one of the major advocates of this approach.

Genotyping is done at the diagnosis day so, the initial prescription is for a month with the understanding that the medications may be switched after the first month.

[CaveyUK]

Just to chip in on this with another scenario - that where someone is diagnosed at <200 CD4s and will require Bactrim/Septrim as prophylaxis treatment. Due to the possibility (and danger) of side effects on sulpha based antibiotics, I understand that it's good to stagger the start of those and the HIV meds, to avoid confusion if serious side effects are seen (ie. the doctor will know what drug is causing the problem). May only be talking a week or so.

Not that I think it's a bad thing what they are doing, just an additional observation.

 

[Almost2late]

Maybe Florida is just trying to change it's reputation as the HIV state.. use to be known as the sunshine state ya know..

[Jim Allen]

To be honest personally I think the benefits do out way any cons on this one.
Antibiotic side effects are well known and on the resistance front switching down the line for the few cases can be done. I think vast majority will benefit from starting now. 

Jim