At-Home Diagnostic Testing
3 Ways to Use Ryan White Grant Rollover Funds
As the government fiscal year ends, cities, states, counties, and community-based groups that received Ryan White grant money should consider how to utilize rollover funds. How can your public health entity, federally qualified health center, or community based organization meet funding purposes for Part A, B, C, D, and F and deliver crucial care? The expansion of telemedicine services like video chat have made it easier than ever to reach patients, and government entities can use rollover funds to implement the latest healthcare advancements; including HIV care through telemedicine, HIV screening with remote diagnostics, and PrEP medication adherence with at-home testing.
Expand HIV care through telemedicine services
FQHCs, government entities, and CBOs who have not yet adopted telehealth should consider using Ryan White funds to set up telemedicine services to meet funding purposes for Part B, C, or D. The American Journal of Preventive Medicine published a case study in 2021 that explored telemedicine solutions to expand HIV care access in 12 Georgia health districts. The study concluded HIV services through telehealth were “successful at bridging gaps in patient care and in training local providers to offer comprehensive HIV care.” The method targeted Ryan White HIV/AIDS Program clients. Of the 6,977 Ryan White HIV/AIDS Program clients, “1,041 had a telehealth visit, of whom 1,035 (99.4%) were prescribed antiretroviral therapy, and 951 (91.4%) were virally suppressed.”
Telemedicine, in general, is a proven way to link marginalized people to care. Telemedicine Journal and e-Health published an article about improvements to primary care completion rates for Black people in the context of the COVID-19 pandemic. It concluded that telehealth “narrowed” care gaps between Black and non-Black patients significantly, and improved both primary care for Black and non-Black patients. (Across 1,947,399 appointments, differences in appointment completion rates between Black and non-Black patients improved in all time periods.”) While this study addressed primary care, Ryan White fund recipients might consider using rollover funds to build up telehealth as a method to improve “the quality of and access to HIV health care and support in the U.S.'' for Black patients. In particular, this meets Ryan White HIV/AIDS Program Part F funding goals to “improve access to HIV care and health outcomes for racial and ethnic minority populations disproportionately affected by HIV.”
Set up at-home diagnostic testing to screen for HIV
At-home diagnostic testing helps enhance telehealth offerings, links patients to care, and is a wonderful tool for public health campaigns to meet grant requirements for Ryan White Part A or B. Government entities like boards of health and public health departments can launch programs with the support of remote diagnostics to screen for HIV. The American Journal of Preventive Medicine published an article outlining the District of Columbia Department of Health launch for point-of-care testing through GetCheckedDC.org. District of Columbia residents ordered home-based oral HIV antibody tests and urogenital, pharyngeal, and rectal chlamydia and gonorrhea tests, and “testing was readily taken up among high-priority demographics within a diverse, urban, high-morbidity jurisdiction during the COVID-19 pandemic.” However, while these OraQuick tests exhibit an expected performance of approximately 92% for test sensitivity, they fail to link patients to care unless those patients self-report to public health departments.
Remote diagnostics can screen for HIV within existing care frameworks that notify public health departments and ensure linkage to care with local health centers, START coordinators, or any custom care flow that works for your organization. Public health entities can distribute self-collection kits to patients online or in-person, patients then self-collect samples at-home and use the pre-paid return label to send the completed kit back to the lab. With consent, both patients and local providers are able to access their results via an online portal. Our partner, Fulton County Board of Health, launched at-home diagnostic testing through their STOPHIVATL campaign to combat the HIV epidemic. The program provides access to free at-home HIV/STI testing services for Atlanta area residents and, in particular, “historically underserved communities.”
Offer PrEP and PrEP adherence with remote diagnostics
FQHCs and CBOs should consider using Ryan White funds to enable remote diagnostics that support PrEP adherence. PrEP use increased 73% in the United States since 2012, but only two in five people keep taking PrEP two years after starting. At-home PrEP testing makes PrEP more accessible by allowing individuals to to perform the required initial and quarterly renewal tests for HIV, STIs and kidney function without visiting an in-person lab. This can be a game changer for shift workers, busy parents, and individuals without access to traditional healthcare services.
PrEP patients are tested for a combination of 3-site gonorrhea and chlamydia, HIV, hep B, syphilis, and creatine using collection devices such as a Dried Blood Spot card card mailed to their house by a provider at a FQHC or CBO. This a useful long-term medication adherence strategy, especially considering that the Health Resources and Services Administration' s HIV/AIDS Bureau (HAB) “strongly encourages Ryan White HIV/AIDS Program (RWHAP) recipients and providers to leverage the RWHAP infrastructure to support PrEP services within the parameters of the RWHAP legislation.”
Ash Wellness works with a number of public health organizations to customize testing programs based on their funding objectives and patient populations. Ryan White is not the only funding that can be used to support testing initiatives for patients; other funding has come from 340B, Ending the HIV Epidemic Funding, or local / state grants. Reach out to learn more about how you can better reach your patient and meet your funding objectives.
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