Fayette County had a few dozen new cases of COVID-19 the past two weeks, but state restrictions pause elective surgeries and reduce restaurant capacity at 50%.

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Newswise — DALLAS – Jan. 8, 2020 – Providing multidisciplinary team consults for HIV patients while they are hospitalized to help address social and medical barriers reduces future infection rates and boosts participation in follow-up care, results from a study on how to reengage patients show.

A multidisciplinary inpatient team of HIV medical specialists, HIV case managers, and transitional care nurses assigned to help patients overcome care gaps improved viral suppression rates by 30 percent and increased engagement in care after discharge by 30 percent compared with those without interventions (for whom viral suppression increased 7 percent and engagement 11 percent), researchers at UT Southwestern Medical Center report in the journal AIDS Care.

Ank Nijhawan, M.D., M.P.H., associate professor of internal medicine, and of population and data sciences

“As we focus on national initiatives to Ending the HIV Epidemic: A Plan for America, it is important to remember that many people living with HIV continue to struggle with staying engaged in care – particularly youth, minorities, and people who live in the South. Solutions to this problem require a collaborative and adaptable approach,” says clinical researcher Ank Nijhawan, M.D., M.P.H., an associate professor of internal medicine, and of population and data sciences at UT Southwestern. “Our multidisciplinary approach of matching the type and intensity of intervention to the level of need resulted in significant improvement in the outcomes of patients with HIV.”

Fewer than half of people living with HIV receive consistent, ongoing medical care, while vulnerable populations such as African Americans, Hispanics, and uninsured patients are at an even higher risk of disengagement and uncontrolled HIV infection, researchers say.

In this study, the UT Southwestern infectious disease researchers reviewed electronic health records for 1,056 people living with HIV in the Parkland Health and Hospital System between September 2013 and December 2015 – a year prior to and after the multidisciplinary intervention team launched its program. The intervention program initiated in October 2014. Hospitalized patients with HIV received one of the following: (a) an HIV medical consultation (as requested by primary treatment team), (b) an HIV medical consultation plus transitional care nursing (based on readmission risk), or (c) no specialized intervention beyond care coordination from the HIV case manager. Of the patients who were studied, 68 percent were male, 55 percent were African American, 23 percent were Hispanic, 77 percent were single, and 38 percent had AIDs.

In addition, 85 percent who were seen by the transitional care nurse reported at least one barrier to continuity of care – most commonly mental health and substance use disorders – and more than a third (39 percent) reported three or more such barriers. Many had poor engagement in outpatient HIV care and low virologic suppression rates.

The success of the team’s multidisciplinary approach reinforced the importance not just of specialized medical care, but also the critical role of social determinants of health such as transportation, housing instability, and substance use disorders, the researchers say.

The study was funded by the National Institute of Allergy and Infectious Diseases (NIAID), National Institute on Drug Abuse (NIDA), and the Agency for Healthcare Research and Quality (AHRQ). The multidisciplinary teams were partially funded through a Centers for Medicare and Medicaid Services (CMS) 1115 waiver program. Other study authors include Mitu Bhattatiry, Matthieu Chansard, Song Zhang, Ph.D., and Ethan Halm, M.D., M.P.H., MBA, all of UT Southwestern. No conflicts of interest were reported.

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Delhi Commission for Women (DCW) chief Swati Maliwal on Monday wrote to the Centre and the Delhi government seeking the provision of sex reassignment surgeries in government hospitals.

In the letter to the Union and Delhi health secretaries, Ms. Maliwal said that the facility was available only in a few hospitals in the Capital which led to delays in the surgeries.

“The DCW had recently established a transgender cell to look into the complaints of violence, abuse, harassment and discrimination faced by the transgender community. After several rounds of community meetings of the cell, one of the most common issue that was brought to the notice of the Commission was a lack of proper government-sponsored sex reassignment surgeries in Delhi,” read a statement issued by the women’s commission.

Stating that free medical services should be provided, Ms. Maliwal said, “There are many transgenders in the Capital who suffer innumerable problems due to the lack of sex reassignment surgeries. Access to free and proper medical services is their right and must be guaranteed by the State. I appeal to the Centre and State governments to sex reassignment surgeries in all their hospitals to cater to the needs of the transgenders.”

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NEW DELHI:  The lack of sufficient number of sponsored Sex Reassignment Surgeries (SRS) in state-run hospitals and the delay in getting dates for treatment are the most common issues faced by the transgender community, said the Delhi Commission of Women (DCW).

The cost of sex reassignment surgery for male-to-female in private hospitals vary from around Rs 2 to 5 lakh, while the bill may come anywhere between Rs 4 lakh and Rs 8 lakh for female-to-male sex change surgery. The same surgeries are provided free of cost in government hospitals. The DCW, which had recently set up a Transgender Cell to look into complaints of violence, abuse, harassment and discrimination faced by the community, held a meeting where DCW chief Swati Maliwal learnt about the problems faced by the community.

Maliwal has written to the Delhi government seeking information about hospitals that provide free surgeries and those which charge. The Commission has also sought information on surgeries performed, successful surgeries conducted and pending cases. “Considering the immense stigma and trauma suffered by the community, it is imperative that the choice of sex reassignment is readily available. It is the duty of the state to provide for such basic necessity of a large but marginalised community,” she stated.

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In a case of discrimination, two major hospitals in Shillong — Shillong Civil Hospital and North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS) — have allegedly denied treatment to HIV-positive patients.

The incident came to light when the Meghalaya State Network for Positive People (MSNP) claimed that two women with HIV were denied treatment in the two government hospitals, reported the Shillong Times.

MSNP general secretary Barry Leslie Kharmalki told media that one of the women who required surgery was told to bring down her viral load or amount of HIV in her blood sample below 50, even though the WHO says that a standard of below 1,000 is considered normal for surgery.

I am not very sure what the relation between the viral load test and cyst operation is. Her viral load is around 516 and in the prescription, the doctor asked her to bring it down to 50, he told Shillong Times.

Barry Leslie Kharmalki said that he had raised the issue during the consultation meeting on HIV Act, 2017 and asked to submit a written complaint by Additional Chief Secretary, PW Ingty, but in vain. Even the Meghalaya AIDS Control Society has not done anything to address this issue, he said.

Kharmalki said the Shillong Civil Hospital has denied treatment to at least 13 HIV-positive people, by giving vague reasons.

He also alleged that the head of the gynaecology department of NEIGRIHMS also rejects patients with HIV.

The patient with the cyst problem was diagnosed in one of the private hospitals. She was referred to NEIGRHIMS since the treatment was too expensive. On reaching NEIGRHIMS, when she revealed that she had HIV, the doctors insulted her, Kharmalki alleged.

In another case, a patient who required surgery for gallstones, was denied first by Civil Hospital, Shillong and then by NEIGRHIMS three months back.

He also urged NGOs to play a pro-active role in bringing about a change of attitude towards patients with HIV.

According to the news daily, the state health minister, AL Hek, refused to comment on the matter, stating that such things have not come to his notice. He added that there has been no formal complaint.

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