Case Management for HIV/AIDS Patients

Overview of the Case Management Ancillary Service

As already seen in the review of the literature for the previous assignment, case management is essentially concerned with stabilizing life situations for people living with HIV/AIDS, removing barriers to ensure they have access to care, linking them to other critical health care and social services, as well as supporting integrated care for this group of the population (Chin et al., 2009; Magnus et al., 2001). One seminal study cited in Lo et al (2002) found that the utilization of on-site case management programs targeting people with HIV/AIDS was substantially associated with receipt of routine medical care as well as other types of services. These authors are categorical that as medical technologies become more sophisticated, hence necessitating HIV-positive persons to prolong their lives much longer, ancillary services such as case management programs and units become more fundamental as a form of intervention for individuals living with this disease.

Interview, Trends & Challenges

The interview was conducted with one of the case managers in the HIV/AIDS case management unit at a local health facility providing health care services to Black Americans and Latinos in the community. The case manager was a qualified community nurse with a Master’s level education in Community Nursing, and also had other qualifications in counseling psychology and HIV/AIDS care. She had acted as the lead case manager for women at risk (vulnerable women) in the department for the past three years. Upon further interactions with her in work-related settings, it was observed that vulnerable women are a subset of women living with HIV, but who may be financially dependent on welfare, homeless, commercial sex workers, or victims of domestic violence.

The interview revealed that the case management ancillary service was being impacted by several trends. First, it was found that the demographic shifts (age) to a large extent influenced the retention levels of vulnerable women involved in the program, with older women demonstrating more retention capacity than younger women and adolescents. The next trend observed within the service was that of personal health practices, where it was noted that vulnerable HIV-positive women engage in more destructive behaviors (e.g., alcoholism and drug abuse) than their counterparts in the general population. The third trend was related to budgetary regulations, where it was observed that that case management unit was experiencing difficulties in meeting its obligations due to financial constraints necessitated by the fact that it was supporting more women for longer durations of time than previously anticipated.

The adverse effects arising from the demographic trend, according to the interviewee, were being mitigated by using the older HIV-positive women in the case groups to reach out to their younger counterparts in the neighborhoods, with the view to reinforcing retention. Education on health-seeking behaviors was given to members to enable them to develop positive habits. Additionally, mentorship programs were used to reinforce positive behavior change among the vulnerable HIV-positive women attending the case management forums. The adverse effects related to the third trend (budgetary constraints) were normally dealt with by reaching out to donors and government agencies to support the unit, as well as exercising strict accountability protocols to support the increasing number of members using the limited resources available.

Similarities & Differences in Trends

Similarities Differences
Age – retention in HIV/AIDs case management programs was found to decrease with age in the literature review and also in the interview, with young people showing less retention capacity than older individuals. Upon undertaking comprehensive research, it was found that retention into case management programs is gender-specific because the needs of HIV-infected women are substantially diverse than those of their male counterparts (Magnus et al., 2001). However, the interview showed that retention into case management programs is influenced by age and unique personal health practices/behaviors demonstrated by HIV-positive vulnerable women
The increasing complexity of the disease and the shifting of classification of HIV from a terminal illness to that of a chronic infectious disease have acted to induce budgetary and regulatory constraints in HIV/AIDS case management programs. The interview demonstrated that mentorship programs can be used to aid positive behavior change for HIV-positive individuals in need of case management services. This information was not reinforced in the review of literature
The comprehensive review of the literature and the interview stressed the education of HIV-positive patients as critical to reinforcing retention. The interview emphasized the importance of practicing strict accountability measures with the view to supporting the increasing number of members using the limited resources available. This information was not emphasized during the review of relevant literature.
The role of donors and government agencies in providing adequate funding to support case management programs has been stressed in both the interview and review of the literature.

Analysis & Evaluation of the Two Most Salient Trends

Trend A: Demographic Factors in Retention

Identification: Available literature shows that retention in case management programs for people living with HIV/AIDS has been found to decrease with age, suggesting that young people are most at risk (Naar-King et al., 2007). These authors further acknowledge the findings of one particular study, which concluded that “HIV-positive youth attended approximately 66% of appointments in a comprehensive adolescent HIV clinic over a three- to six-month period (p. 248). Further afield, there is evidence showing that retention into case management programs is gender-specific because the demands of HIV-positive women are substantially diverse from those of their male counterparts in the population (Magnus et al., 2001). The interview has reinforced this trend by demonstrating that age influences the retention levels of vulnerable HIV-positive women in these programs, with older women demonstrating more retention capacity than younger women and adolescents.

Impact: According to the literature reviewed as well as the results of the interview, the major impact of this trend on the case management ancillary settings revolved around increasing the health risks facing young people due to low retention levels in HIV/AIDS case management programs.

Trend B: Enhanced Life Expectancy for People with HIV/AIDS

Identification: The assessed literature shows that comprehensive care is now needed more than ever before not only due to the increasing complexity of the disease, but also because the classification of HIV has shifted from a terminal illness to that of a chronic infectious disease (Conover & Whetten-Goldstein, 2002; Magnus et al., 2001), hence infected people are living longer. In the interview, it has been observed that financial constraints were being experienced in the case management unit due to incapacity to meet the obligations of the many HIV-infected persons, who are now living longer than previously anticipated.

Impacts: The two foremost impacts arising from this trend include (1) resurgence of higher HIV infection rates as HIV-infected persons are now living much longer, and (2) more people particularly in the developing world are likely to go without the needed services owing to the budgetary constraints occasioned by increased life expectancy for people living with HIV/AIDS.

References

Chin, J.J., Botsko, M., Behar, E., & Finkelstein, R. (2009). More than ancillary: HIV social services, intermediate outcomes and quality of life. AIDS Care, 21(10), 1289-1297.

Conover, C.J., & Whetten-Goldstein, K. (2002). The impact of ancillary services on primary care use and outcomes for HIV/AIDS patients with public insurance coverage. AIDS Care, 14(1), S59-S71.

Lo, W., MacGovern, T., & Bradford, J. (2002). Association of ancillary services with primary care utilization and retention for patients with HIV/AIDS. AIDS Care, 14(1), S45-S57.

Magnus, M., Schmidt, N., Kirkhart, K., Schieffelin, C., Fuschs, N., Brown, B., & Kissinger, P.J. (2001). Association between ancillary services and clinical and behavioral outcomes among HIV-infected women. AIDS Patient Care and STDs, 15(3), 137-145.