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The State of Care for Veterans with HIV/AIDS: Summary

for Health Care Providers

Executive Summary

The U.S. Department of Veterans Affairs (VA), Veterans Health Administration (VHA) is the largest single provider of HIV care in the United States. To date, nearly 64,000 Veterans with HIV have received care in VHA. In 2008, over 23,000 HIV infected Veterans were seen by VHA clinicians; their care was delivered in every one of VHA's 21 Veterans Integrated Service Networks (VISNs) across the United States. Overall, 5.6 million Veterans were treated by VHA in 2008, thus about one of every 250 Veterans in care at VHA is living with HIV/AIDS. The number of HIV-infected Veterans in care has been relatively stable over the past 5 years with approximately 9% entering VHA care and approximately 9% leaving (including deaths) VHA care in a given year. VISN caseloads range from 354 to 3,100 HIV infected Veterans while local healthcare systems care for between 2 and 1,200 such Veterans. The typical Veteran with HIV/AIDS is male (97%), 53 years old, and is receiving antiviral medications to treat HIV (80%). VHA is at the forefront of managing persons with HIV/AIDS who have conditions associated with advancing age including heart disease, diabetes and cancers. The most common co-morbidities in Veterans with HIV/AIDS in 2008 were depression (51%), hypertension (49%), and dyslipidemias (43%). One out of four had chronic hepatitis C virus infection and 7% had chronic hepatitis B virus infection.

Nationally, Veterans with HIV/AIDS receive high quality care at the VHA as reflected in rates of guideline-concordant HIV-specific care, recommended prophylaxis, vaccination, and screening for conditions important to public health, although room for improvement exists. National rates of adherence to specific recommendations for care in VHA for Veterans with HIV/AIDS receiving care in 2008 include: hepatitis C screening 96%, Pneumocystis jiroveci pneumonia (PCP) prophylaxis 86%, routine CD4+ lymphocyte count and HIV viral load testing 79%, hepatitis B screening and vaccination 77%, Mycobacterium avium complex (MAC) prophylaxis 75%, pneumococcal vaccination 72%, influenza vaccination 59%, tuberculosis screening 59%, and annual syphilis screening 48%. Geographic variability (across VISNs and local healthcare systems) is limited for most of these rates; however enough variation exists for some rates to merit further investigation.

This document provides a descriptive report; it is not meant to be exhaustive nor provide the type of statistical analyses that allow inferences to be drawn. The VA's Public Health Strategic Healthcare Group (PHSHG) uses this data to understand care regionally and locally in order to design targeted interventions and identify topics requiring additional investigation about care delivery, thus assisting to improve care for our nation's Veterans.