Our understanding of quality in healthcare—how we talk about it and how we measure it—has evolved over time. However, the goal has remained the same: improving the health of people living with HIV. This means constantly challenging ourselves to do better. In essence, do quality improvement (QI) better.
The U.S. Food and Drug Administration has approved rilpivirine for use in adolescents 12 to 18 years of age; it is not recommended for younger children. As in adults, it is suggested for use in ARV-naive individuals with HIV RNA levels of ≤100,000 copies/mL. The dosage is 25 mg daily, to be taken with a meal, and of course in combination with other ARV medications.
Tenofovir alafenamide fumarate (TAF) is an investigational prodrug of tenofovir that in studies to date appears to have less renal and bone toxicity than the current tenofovir product, tenofovir disoproxil fumarate (TDF). This is because TAF is metabolized to tenofovir in lymphocytes and macrophages (as well as hepatocytes and some other cells), whereas TDF is converted to tenofovir in the blood. With TAF, levels of active tenofovir in plasma are about 90% lower, while levels in lymphocytes are higher.
The prevailing opinion among experts regarding the optimal CD4 T-cell count at which to start patients on antiretroviral therapy (ART) has shifted several times during the evolution of HIV treatment. These shifts reflect attempts to strike a balance between preventing HIV-associated illness and death and minimizing medication-related toxicity. Two large randomized controlled clinical trials, the START study and the TEMPRANO study, now demonstrate that earlier treatment with ART is most beneficial to boost immune recovery and prevent clinical events.
National Quality Center (NQC) has completed its evaluation of the in+care Campaign -- the largest HIV quality improvement initiative carried out at the national level. We are pleased to announce that the Campaign demonstrated significant improvements in national retention and viral load suppression (VLS) performance.
Annual meetings of the Centers for Disease Control and Prevention (CDC)-sponsored Elimination of Mother-to-Child Transmission of HIV (EMCT) Stakeholders Group and the Expert Panel on Reproductive Health and Preconception Care for Persons Living with HIV, held at the Washington, D.C. headquarters of the American College of Obstetrics and Gynecology (ACOG) the week of May 25th, 2015, provided an exciting and energizing opportunity to discuss challenging clinical and policy issues.
When incorporating best practices and guidelines for HIV care, clinicians must take into account their clients’ mental health and substance use needs. Approximately 30- 50% of people living with HIV/AIDS have current or past severe to moderate depression. At its highest estimate, that’s more than double the prevalence of the general population.
Rural Kentucky often evokes images of poverty and despair. While reaching out to providers in this area, SCAETTC (Southern Central AIDS Education Telehealth Training Center) can attest that poverty and limited resources are real and must be addressed. Disparities within this area remain unnoticed and the majority of Kentucky’s Appalachian counties are designated as medically underserved.
The U.S. Department of Health and Human Services has released new treatment guidelines for adults and adolescents, and these contain some important changes. Key among these is a major shakeup in the "Recommended Regimen Options" for initial therapy.