Community health centers will need sustained funding and additional resources to support the Trump Administration’s newly announced initiative to stop new HIV infections in the United States by 2030, according to an analysis published today by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University Milken Institute School of Public Health (GW Milken Institute SPH).
The analysis estimates that community health centers serve 22 percent – more than one in five – of people in the U.S. living with HIV who are receiving care for their condition. The new Trump Administration initiative calls for a significant expansion of health care, including outreach to at-risk populations, services aimed at preventing new infections, and ongoing care and treatment for people living with an HIV diagnosis. In order to strengthen HIV-related care, community health centers nationwide will need to increase prevention, treatment and management services and remain sustainable, the researchers write.
“Community health centers are a critical part of the HIV/AIDS prevention and treatment system, and the feasibility of this initiative depends on the availability, accessibility, and quality of health care,” said Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy at Milken Institute SPH, one of the authors of the analysis. “Community health centers will play a major role, given the size of the patient population they serve, the scope of care they offer, and their accessibility in at-risk communities.”
The administration’s initiative calls for targeting high-burden states, counties, rural areas and cities. This includes seven states with substantial rural HIV burden and 48 highly burdened counties in 19 states, as well as Washington, D.C. and San Juan, Puerto Rico. While all community health centers will face some challenges in ramping up services, sustainable expansion will be especially difficult in the 10 states that have not adopted the Affordable Care Act Medicaid expansion, the authors conclude.
Thousands of low-income, at-risk people in these states – Alabama, Florida, Georgia, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, and Texas – may not be covered by Medicaid. This increases the risk of inadequate care and places additional burdens on health centers to identify sources of sustainable financing to support care. The analysis recommends a 10-year reauthorization of the Community Health Center Fund, with additional funding targeted to HIV/AIDS prevention and treatment efforts, as well as expanded Medicaid coverage in the 10 high-burden, non-expansion states. The current Health Center Fund expires at the end of Fiscal Year 2019.
“Extending the Health Center Fund will be a critical step, as will active efforts to encourage Medicaid expansion,” said Feygele Jacobs, DrPH, President and CEO of the RCHN Community Health Foundation, whose ongoing gift supports the Geiger Gibson Program.
The analysis, “Community Health Centers and the President’s HIV Initiative: Issues and Challenges Facing Health Centers in High-Burden States and Communities,” was authored by a team from the Milken Institute School of Public Health Department of Health Policy and Management including Rosenbaum, Jessica Sharac, MSc, MPH, Peter Shin, PhD, MPH, and Rachel Gunsalus, MPH.