HAART is cost-effective and improves outcomes

An agenda for health care reform is well beyond the scope of this column. However, the agenda for providers of HIV care in managed care settings is clear. On a programmatic level, we know many of the solutions already. For example, there are published data supporting the role of experienced providers for HIV care. Outcomes are improved when patients with HIV receive care from "experts" (i.e., providers with experience in managing the disease). HAART improves outcomes; patients live longer and have more sustained viral load suppression, and costs of care are lower. Adherence to HAART is also beneficial and results in the same improved outcomes. The use of newer technologies to select these expensive antiretroviral regimens also results in these improved outcomes. Early treatment to which patients are adherent, access to experienced HIV providers, and a multidisciplinary program that delivers that care and the needed wraparound services make sense. In the era of HAART, it is often said that HIV is a chronic, manageable illness. Unfortunately, this applies to only a segment of the HIV-infected population. The findings of Freedberg and Bozzette and their colleagues continue to support a model of well-timed, well-coordinated HIV care. While this model of care is expensive, it is less expensive than inpatient care or the resultant poorer outcomes in the underserved, in nonadherent patients, or in those whose care is delivered by less experienced providers. There is no price to be placed on improved quality of life.