Daoud Omar, Gladstein Jay E, Brixner Diana, O'Brochta Stuart, Naik Sarjita
Pharmacy Community Health Plan of Washington, Seattle, WA.
APLA Health Center, Mid-Wilshire and Cedars-Sinai Medical Center, Los Angeles, CA.
Am J Manag Care. 2025 Feb;31(1 Suppl):S3-S12. doi: 10.37765/ajmc.2025.89687.
The US HIV/AIDS Strategy and Ending the HIV Epidemic (EHE) initiatives aim to reduce HIV transmission by 90% by 2030 through targeted care and prevention initiatives such as the Undetectable = Untransmittable strategy. Effective HIV management involves implementation of widely available testing to ensure early diagnosis, immediate or early initiation of antiretroviral therapy (ART), patient adherence to medication, and retention in care to achieve viral suppression and improve clinical outcomes. A disproportionate burden of HIV incidence is experienced by certain populations that include Black/African American and Hispanic/Latinx people, transgender individuals, those who inject drugs, older adults, and people living in the southeastern US. People with HIV (PWH) in vulnerable and underserved populations are more likely to be affected by the negative impacts of structural and social determinants of health-such as experiencing HIV-related stigma, poverty, and homelessness-resulting in barriers to accessing HIV care and achieving favorable treatment outcomes. Suboptimal HIV care negatively impacts outcomes for both individuals and society. Overall and comorbidity-free life expectancies are lower for individuals who start ART late than for the overall PWH population, and a lack of viral suppression increases community transmission rates. These poor outcomes increase costs for both patients and health care systems. Maintaining access to high-quality care by optimizing ART regimens, decreasing delays in ART initiation, and engaging patients in care by building trust and empowering patient choice will improve individual and population-level outcomes and support the EHE initiative. This manuscript examines strategies to improve HIV care access and outcomes for underserved populations, focusing on social determinants of health, stigma, geographic disparities, and treatment adherence, while highlighting the role of national initiatives and managed care programs in advancing health equity.
美国的《艾滋病毒/艾滋病战略》和“终结艾滋病毒流行”（EHE）倡议旨在到2030年通过诸如“检测不到=不传播”战略等有针对性的护理和预防举措将艾滋病毒传播减少90%。有效的艾滋病毒管理包括实施广泛可用的检测以确保早期诊断、立即或尽早开始抗逆转录病毒治疗（ART）、患者坚持服药以及持续接受护理以实现病毒抑制并改善临床结果。包括黑人/非裔美国人、西班牙裔/拉丁裔、跨性别者、注射吸毒者、老年人以及美国东南部居民在内的某些人群承受着不成比例的艾滋病毒感染负担。弱势群体和服务不足人群中的艾滋病毒感染者（PWH）更有可能受到健康的结构和社会决定因素的负面影响，例如遭受与艾滋病毒相关的耻辱感、贫困和无家可归，这导致他们在获得艾滋病毒护理和取得良好治疗结果方面面临障碍。艾滋病毒护理不佳对个人和社会的结果均产生负面影响。开始ART较晚的个体的总体预期寿命和无合并症预期寿命低于整个PWH群体，并且缺乏病毒抑制会增加社区传播率。这些不良结果增加了患者和医疗保健系统的成本。通过优化ART方案、减少ART启动延迟以及通过建立信任和赋予患者选择权让患者参与护理来维持获得高质量护理的机会，将改善个体和人群层面的结果，并支持EHE倡议。本手稿探讨了改善服务不足人群获得艾滋病毒护理及护理结果的策略，重点关注健康的社会决定因素、耻辱感、地理差异和治疗依从性，同时强调国家倡议和管理式护理计划在促进健康公平方面的作用。
