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Outdated HIV HealthCare Models - high need, aging ignored
  Aging of HIV-Infected: a explosive and underestimated phenomena being ignored, needs attention - special support services for patients & clinics needed-lack of federal/state response - HCV too - Commentary by Jules Levin - (04/04/17)
Aging with HIV: Redesigning healthcare models - (09/13/17)
"Successful models often feature the use of care managers alongside primary care providers to identify and work with high-risk patients

patient navigators, nurse care coordination and home visits.......integrated behavioral health assessments and care ....... nurse care coordinators, clinical pharmacists, and clinical social workers as part of the care team.......specialized intensive outpatient clinics to serve as adult patients' medical homes or multidisciplinary special needs clinics for high-risk .....patients. Targeted toward individuals who had experienced multiple potentially avoidable inpatient admissions within one year, care teams in these clinics included a dedicated social worker and navigator, and teams were responsible for a limited number of patients. This clinic also worked closely with the Mental Health Center of Denver.......Over a one-year period, the system saw an approximately 2 percent reduction in expected spending
Aging With HIV: Expert Insights on Complications and Challenges - (09/11/17)
"Clinicians should focus on a patient-centered approach
using a geriatric care model, engage family and community support, focus on maintaining function and preserving health, and perform frequent reassessments of medical, access, and social issues that affect patients' life and care, as many of these variables are a moving target......Advocate fiercely for your patients and be cognizant that comorbidities can present earlier and at greater frequency in this population.....treat your aging patients with HIV as you would want your loved one treated....Social workers should consult with their gerontologic colleagues to become familiar with the aging services network, as most people are eligible for services when they reach age 60 years....transportation to appointments may be more difficult to arrange or afford in persons with fixed incomes, with a growing number of specialists caring for an increasing number of medical comorbidities
Sustained Participation in a Pay-for-Value Program: Impact on High-Need Patients
Caring for people with complex medical and social needs requires a holistic person-centered approach that recognizes non-medical factors such as housing, transportation, food insecurity, addiction, and social supports. To help patients address these underlying needs, many provider organizations are tapping the unique skill set of community health workers (CHWs).
Our healthcare system is broken, WHY?
Because the time allocated & quality of care has been drastically diminished. Particularly older HIV+ with accelerated aging, polypharmacy & multicomorbidity, suffering also with increasing frailty & disability need extra attention & time in visits from health providers, but the RWCA and HRSA & HHS & CMS have ignored this problem. This is a REAL problem that will only get worse with the aging of the HIV population in the us with now 80% over 40-45 yrs old, 50% over 50 and 25% over 60-65 already and increasing in age. This will not go away but will only get worse and more services needed, and better NIAID & ACTG research needed as well to better understand many important science patient oriented aging-related issues. As well, for sure advocates are ignoring this problem. The "pop culture" buzz words "End AIDS" and "cure" have sucked the air out of the room so there is no discussion or recognition & attention to this equally important problem: aging with HIV. This is shameful and a bad use of taxpayer money. Regarding "cure research", is eradication really possible? Well many cure researchers themselves say no after several years of studying this, and Tony Fauci in his talk at IAS said the same ! So as Fauci discussed in his talk at IAS and others say "functional cure" is the next direction. In many of these "cure" studies ART treatment interruption is utilized, but the way this has been handled has been very unethical. These studies have been "promoted" by all just like they all promoted back in the 1990s to early 2000s that interruption would be good for patients when it was clear it could only to harm, it was promoted almost "candy" like, and after years of studies and much money spent that was their conclusion, that it is harmful; but HIV politics, the "pop" culture and "buzz" words in HIV dictated those studies be done. The current situation is similar in cure research. The risks of ART treatment interruption are UNKNOWN, what is the long term risk of repopulating reservoirs & the body with virus, we do not know. Many researchers themselves and others working in this area including advocates do not understand all the risks and/or they do not inform study participants adequately, many potential participants & patients and advocates do not fully understand or appreciate all the risks, and again like interruptions in the 1990s it gets portrayed although not as much as "candy". All involved in cure research are promoting this effort & the studies in ways that do not reflect the reality of the risks & the potential harm to participants, this situation is not put into the bigger context of needs in HIV. Big grants are provided to researchers and advocates working in cure research. Cure research and enrolling studies is promoted. There are a lot of ethics questions here.

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