Q&A: HELP Act would repay loans for HIV workforce
Legislators in the U.S. House of Representatives introduced a bill last week that would authorize up to $250,000 in loan repayments to clinicians in the HIV workforce who provide HIV treatment in areas with health professional shortages or at Ryan White-funded sites.
Healio spoke with Melanie Thompson, MD, past chair of the HIV Medicine Association and principal investigator at the AIDS Research Consortium of Atlanta, about the legislation and the state of the HIV workforce. – by Caitlyn Stulpin
Q: What is the legislation?
A: The legislation is the HIV Epidemic Loan Repayment (HELP) Act, H.R. 5806. It was introduced by Rep. [John] Lewis on Friday, Feb. 7, in honor of National Black HIV/AIDS Awareness Day. Our HIV workforce is insufficient to care for all of the nation’s people living with HIV, half of whom are currently not consistently in HIV care. (Editor’s note: Click here to read our recent cover story about shortages in the HIV workforce.) The legislation would provide up to $250,000 in loan debt relief over 5 years for eligible HIV clinicians and dentists practicing in areas of need.
Q: What are the chances of it passing?
A: We are optimistic about passage. Historically, major legislative packages addressing the HIV epidemic have had strong bipartisan support, from the Ryan White Comprehensive AIDS Resources Emergency Act in 1990, to the President’s Emergency Program For AIDS Relief in 2003, to the new federal End the HIV Epidemic Initiative: A Plan for America in 2020. Support to end the epidemic should be bipartisan because, as a public health crisis, HIV challenges all of America, regardless of our politics. Although the early epidemic was concentrated in coastal urban centers, often considered Democratic strongholds, over half of people with HIV now live in the South, currently dominated by Republican elected officials. Passage of the HELP Act will be absolutely essential if we are to build up the workforce and end the HIV epidemic. I think our leaders from both parties will see its benefits.
Q: Who would be eligible for loan repayment?
A: Physicians, nurse practitioners, physician assistants and dentists are eligible if they provide HIV care in Ryan White programs or other underserved areas.
Q: What other avenues are being explored to bolster the HIV workforce?
A: Expanding the expertise of clinicians who are not HIV experts will be essential. Some of the End the Epidemic funding for CDC and the Health Resources & Services Administration could be used for this purpose. Although 2006 CDC guidelines recommended offering HIV testing to all adults in clinical settings, training clinicians to do this has never happened on a broad scale, thus we are missing a huge opportunity to decrease the number of people who have HIV but are not aware of their diagnosis. In addition, particularly in rural and other underserved areas, primary care physicians need more training in HIV prevention with pre-exposure (PrEP) and postexposure prophylaxis (PEP), as well as in the initial treatment of people newly diagnosed with HIV. Some of the End the Epidemic funding has been designated to go to expand PrEP in federally funded community health centers. Telemedicine projects like Project ECHO that connect primary care clinicians with HIV experts could bridge the gap in our HIV workforce in some areas. In addition, caring for people with HIV is best done as a team effort because of their complex needs. Every team member is important, including pharmacists, case managers, social workers and health system navigators. In addition to boosting the clinician workforce, we need to bring others into the field of HIV care. This could free up clinician time and also provide better care to people with HIV.
Q: Where are these clinicians needed the most?
A: Clearly, the South is the area where HIV is growing the fastest and the workforce is smallest, although rural areas across the country also are lacking in HIV clinical providers. In addition, because of societal factors including stigma, our patients often come to care later and have more complex medical and social issues requiring more time and more visits. Our Ryan White clinics are adding new patients every year, but there are not enough qualified HIV clinicians to provide timely care to all who need it. In addition, our care engagement rates are lower in the South, and bringing all of those patients back into care — in some cases as many as half of all people living with HIV in a jurisdiction — will require a substantial workforce expansion to even get patients in the clinic door and to see them in a timely manner. Whenever we make patients wait to be seen or push their appointments off for weeks, we risk losing them entirely. That is happening every day in the South.
I can’t end this discussion without mentioning that we must attract clinicians who look like the people they will be serving. In particular, we must focus on attracting black and Hispanic/Latino clinicians to HIV medicine, because these demographics are the leading edge of the HIV epidemic, especially in the South. They can make a tremendous difference in delivering culturally competent care and making our clinics more attractive to people who, for all sorts of good reasons, are reluctant to trust our medical system. And, because these clinicians often experience multiple barriers to get into medical school and to pay for it, I believe the HELP Act could particularly benefit this group of clinicians who are badly needed in our workforce.
HIVMA. IDSA and HIVMA support HELP Act providing loan repayment for HIV healthcare workforce. https://www.hivma.org/news_and_publications/hivma_news_releases/2020/idsa-and-hivma-support-help-act-providing--loan-repayment-for-hiv-healthcare-workforce/. Accessed on February 10, 2020.
Disclosure: Thompson reports no relevant financial disclosures.