AIDS In 2012: The medical director of infectious diseases at United Medical Center tells Joanne Silberner that in addition to more frequent testing, more attention needs to be paid to keeping people with HIV under the care of a doctor. A transcript follows:
JOANNE SILBERNER: Dr. Fitzpatrick, you’re both a health care provider and a program developer, among other things. From your role as a health care provider, what are the policies in place that have helped you?
LISA FITZPATRICK: The local policy that’s helped me the most as a health care provider is the universal access to antiretroviral therapy. It’s really helped tremendously because patients, regardless of ability to pay for medications, have access to medications. The policy is called Treatment on Demand – before that it was called the Red Carpet Entry service – which means if someone is diagnosed with HIV, they have immediate access to a provider who can then prescribe HIV medications for them. It’s really been a bit of a game changer in Washington D.C. in getting people on treatment.
JOANNE SILBERNER: And are there any policies that you’d like to see put into place?
LISA FITZPATRICK: The policy I would most like to see put in place is health care providers should routinely screen for HIV. And I’m not just talking about doctors. I’m talking about nurses. I’m talking about nurse practitioners. I’m talking about physician assistants. Even dentists. We have so many people that are undiagnosed or who find out their diagnosis late. Any time someone interacts with the health care setting, they should be tested for HIV because this is a manageable, treatable disease, like diabetes. So if we are testing for diabetes or testing for high cholesterol, why not test for HIV? That’s the policy I would most like to see in the District and nationwide.
JOANNE SILBERNER: And what – 20 percent of people don’t know they are infected?
LISA FITZPATRICK: That is an estimate, but it’s difficult to know the exact number. I think we get that number based on people who find out they are HIV positive and then we calculate how many people found this to be surprise. But I think the important thing is that the community needs to know that they need to know their HIV status. So whether that message is coming from me as a health care provider or from people in the community, that’s the most important thing we could do to help people get into care, get on treatment, and live a long life with HIV.
JOANNE SILBERNER: There’s a lot of talk at the conference about a treatment cascade: How some people don’t know they are infected. Some people know they are infected, but don’t get into the medical system. Some who do get into the medical system, but don’t get effective treatment. Putting on your hat as a program developer, where would you break into that cascade?
LISA FITZPATRICK: We’re talking a lot about this treatment cascade these days. I think it’s important because it gives us a perspective on how much work we still have to do to get people in treatment and stay in treatment. I think the most critical elements of the treatment cascade, as you just described, is to identify people with infection, because, as you just said, 20 percent of the people – up to 20 percent – don’t know they are infected. So, if we can find everybody who is HIV positive and get them linked into care that would be a tremendous success.
The second place I would focus my efforts after the testing and getting them linked is figuring out how to get them to stay in care. So when they first come into care, really conducting an assessment – an in-depth assessment – asking them what all their challenges might be, and having them anticipate and participate in developing some sort of program or strategy to keep them in care. And I think we don’t spend enough time talking about that to people on the front-end so that we can anticipate: What are some of the barriers and the challenges that might keep you from staying in care or staying on your medication.
JOANNE SILBERNER: Is this conference going to make a difference?
LISA FITZPATRICK: I don’t know if this conference will make a difference, but what I hope is every time scientists, community activists, physicians come together at venues like this, that we go home with a renewed spirit and we’re re-energized and ready to do something different. Because clearly we still have a lot of work to do to end the epidemic. It is not just about giving people medications. There are many social issues that we have to address. There are many conversations that we need to have; policies that we need to implement. So my hope is that a conference like this will wake people up or give us an “ah hah” moment to say: We haven’t tried that before, so let’s go home and try that and stop doing some of the same old things that we’ve been doing over and over that haven’t worked.
JOANNE SILBERNER: Thank you very much.
LISA FITZPATRICK: Thank you for talking to me.