The following guidance is offered in response to two issues raised at the April 17, 2009 Ryan White Part A provider's meeting - undetectable viral loads as proof of HIV positive status and the annual number of ambulatory care visits required to meet program requirements.
Undetectable Viral Loads
After responses from HRSA Officials, State HIV/AIDS Surveillance Representative and Local HIV Medical Specialists; all are in agreement that an undetectable viral load is not indicative proof of HIV positivity. Subsequently, providers in Charlotte-Gastonia-Concord-Rock Hill transitional grant area should use the following to document and verify HIV status. Please note that the following is an excerpt from "Client Eligibility Requirements posted on the Ryan White Part A Program's webpage.
Disease Status: Must ID client and provide evidence that the client is HIV +
- Western Blot
- Either RNA-PCR or Branched DNA (BDNA) test showing detectable viral load of HIV virus.
- An original letter signed by a referring physician on the physician's letterhead stating that the Eligible Client is HIV Positive (HIV+), has HIV Spectrum Disease or has AIDS.
Ambulatory Care Visits required to meet Programmatic Requirements
For the time being and as part each provider's annual fiscal and programmatic monitoring, we will continue to use "one ambulatory care visit within a 12-month period" as evidence of enrollment in ambulatory care. Providers should note however that the most recent guidelines for the treatment of HIV/AIDS established for the care of adult clients is "four medical visits in an HIV care setting in a measurement year". The HIV/AIDS Bureau advocates "routine monitoring visits at least every 4 months for all HIV infected patients who are clinically stable". The "take home message" is if providers are to meet national quality management standards they will have to eventually comply with the more rigid clinical performance measure.
With the implementation of CAREWare, Core Clinical Performance measures will be monitored to ensure agencies are submitting this data. One of those measures will include how many clients access medical care 2 or more times at least three month apart during the measurable year.
We hope that this information clarifies the two issues raised at the Ryan White Part A provider's meeting. If you have questions regarding this issues please contact your contract coordinator.
Thank you,
Ryan White Administration
