Case Management Training Program

Medical Case Management is the provision of a range of client-centered activities focused on improving health outcomes in support of the HIV care continuum. Activities provided under this service category may be provided by an interdisciplinary team that includes other specialty care providers. Medical Case Management includes a variety of encounters including face-to-face, phone contact, or via another form of telehealth, etc.

Key activities include:

• Initial assessment of service needs
• Development of a comprehensive, individualized care plan
• Timely and coordinated access to medically appropriate levels of health and support services and continuity of care
• Continuous client monitoring to assess the efficacy of the care plan
• Re-evaluation of the care plan at least every 6 months with adaptations as necessary
• Ongoing assessment of the client’s and other key family members’ needs and personal support systems
• Treatment adherence counseling to ensure readiness for and adherence to complex HIV treatments
• Client-specific advocacy and/or review of utilization of services

In addition to providing the medically oriented activities above, Medical Case Management may also provide benefits counseling by assisting eligible clients in obtaining access to other public and private programs for which they may be eligible.

Program Guidance:

• Activities provided under the Medical Case Management service category have as their objective improving health care outcomes whereas those provided under the Non-Medical Case Management service category have as their objective providing guidance and assistance in improving access to needed services.
• Visits to ensure readiness for, and adherence to, complex HIV treatments shall be considered Medical Case Management or Outpatient/Ambulatory Health Services. Treatment Adherence services provided during a Medical Case Management visit should be reported in the Medical Case Management service category whereas Treatment Adherence services provided during an Outpatient/Ambulatory Health Service visit should be reported under the Outpatient/Ambulatory Health Services category.

Goal: Engage clients who face significant challenges to enter and maintain treatment for their HIV.

Objective: Assess client needs and develop a Comprehensive Treatment Plan (CTP) that provides guidance and assistance in improving health care outcomes for people living with HIV.

Key activities include:

• Initial assessment of service needs
• Development of a comprehensive, individualized care plan
• Timely and coordinated access to medically appropriate levels of health and support services and continuity of care
• Client-specific advocacy and/or review of utilization of services
• Continuous client monitoring to assess the efficacy of the care plan
• Re-evaluation of the care plan at least every 6 months with adaptations as necessary
• Ongoing assessment of the client’s and other key family members’ needs and personal support systems

Program Guidance:

NMCM Services have as their objective providing coordination, guidance and assistance in improving access to and retention in needed medical and support services to mitigate and eliminate barriers to HIV care services, whereas Medical Case Management Services have as their objective improving health care outcomes.

Goal: Enhance access to and retention in essential medical and social support service for people living with HIV. This is a human service approach that supports engagement and retention into medical care.

Objective: Assess client needs and develop an Individual Service Plan (ISP) that provides guidance and assistance in improving access to needed services. 

Linkage to care is a crucial early step in successful HIV treatment and is typically defined as the completion of a first medical clinic visit after HIV diagnosis. Linkage to care plays a key role in the HIV care continuum—it is a necessary precursor to antiretroviral therapy initiation and viral suppression.

Evidence clearly demonstrates that antiretroviral treatment significantly reduces the risk of developing HIV-related complications. In addition, antiretroviral therapy dramatically reduces HIV transmission to others. Without timely entry into care, individuals with HIV miss an opportunity to benefit from HIV treatment at the earliest stage feasible; rapid initiation of antiretroviral therapy after HIV diagnosis is a key pillar of the national initiative, Ending the HIV Epidemic: A Plan for America.

In addition, delayed linkage to care is a major barrier to “treatment as prevention” to reduce HIV transmission rates in the United States. Thus, identifying persons with HIV and successfully linking them to care plays a key role in the overall HIV epidemic, both from a treatment and a prevention standpoint.

The federal benchmark for successful linkage to care is completion of a visit with an HIV medical provider within 1 month (30 days) of HIV diagnosis and the federal years 2025 goal is to have successful linkage to care in at least 95% of persons newly diagnosed with HIV. 

• Peer support may help with coping with the challenges of living with HIV.
• Online support groups provide a convenient way to connect with others at a distance.
• It’s important to discuss any medical information from online support resources with a doctor or medical professional.

Peer support may help those with HIV cope with the challenges of living with this condition.

A 2015 review of studies found that participating in an HIV support group has many potential benefits. It may help:

• improve quality of life
• relieve physical symptoms
• reduce anxiety and depression
• decrease sleeping difficulties
• make it easier to stick to prescribed treatment

If it’s difficult or inconvenient to attend an HIV support group in person, an online support group or other support resources may help.

Many online support resources are available to help people with HIV connect with others with this condition. The following is a list of online support groups where individuals living with HIV/AIDS can connect, share experiences, and receive emotional support:

POZ Community Forums

• diagnosis
• treatment
• daily living
• community resources

Access the forums at any time of day to share questions and stories or to respond to posts from others.

The forums are moderated, and users may be banned for making inappropriate posts or sharing inaccurate medical advice.

Keep in mind that others can see posts, so choose a username wisely to remain anonymous if needed.

HIV/AIDS Therapy Tribe

Therapy Tribe is an online community that offers support to people coping with mental health and wellness concerns, including HIV.

The HIV/AIDS Tribe offers a space to connect with others who are going through similar experiences. Take part in discussion forums, send and receive friend requests, and find a variety of wellness tools. 

The Well Project

The Well Project is a nonprofit organization for girls and women living with HIV.

The organization hosts multiple moderated forums where girls and women around the world can connect to share information and support.

Visitors can read about the experiences of others on the organization’s blogs, including A Girl Like Me in English or the Spanish version, Una Chica Como Yo.

Positive Peers

Positive Peers is an online app for teenagers and young adults ages 13 to 34.

It helps youth with HIV find information and tools for managing the condition. It also helps them connect with other youth who have HIV.

Users need a smartphone and email address to register for the app.

NAMI Connection

People with HIV have an increased risk of mental health conditions, such as depression and anxiety.

Doctors may recommend medication, talk therapy, or a combination to treat mental health conditions.

It may also be helpful to join a support group for people experiencing mental health challenges. The National Alliance on Mental Illness offers in-person and virtual support groups in many states. Check for nearby support groups with the NAMI Connection search tool.

Social media groups

Many groups on Facebook and other social media platforms share information and connect people living with HIV.

One example is Healthline’s HIV Awareness Facebook group.

Social media groups are asynchronous, which means comments are posted at any time. Some groups also offer live videos or virtual events about specific topics and connections with others.

Some social media groups are run by medical professionals or patient advocacy organizations, while others are run by individuals. Choosing to join a group or multiple groups depends on preference.

financial assistance for hiv care

HIV care and treatment involves taking HIV medicine called antiretroviral therapy (ART) and having regular check-ups with your health care provider who will monitor your health status on an ongoing basis.

These things are important because with the proper care and treatment, you can reduce your viral load, protect your health, enjoy a long and healthy life, and prevent transmitting the virus to others.

But you might have concerns about how to pay for this. There are resources that can help you pay for the care you need.  The following are some of those financial assistance resources:

ADAP

AIDS Drug Assistance Program (ADAP) Directory

ADAP is a federal program administered by the HRSA HIV/AIDS Bureau that covers medication costs for people with HIV. This website provides information on ADAP coverage for each U.S. state and territory, including eligibility, application instructions, and formulary links. ADAPs also assist with insurance premium co-pays for people with HIV.

Manufacturer-based Programs

All listed medications are approved for treatment of HIV infection. Medications used in post-exposure prevention and pre-exposure prevention are also listed below.

Pharmaceutical Company Patient Assistance Programs and Cost-Sharing Assistance Programs

Fact sheets and reference tables compiled by NASTAD covering HIV treatment, prevention, and hepatitis B and C treatment. Includes eligibility and contact information.

PhRMA: Medicine Assistance Tool

Single database of most patient assistance programs with links out to the programs listed below. The site also features educational information for patients on a range of payment sources (Health Insurance Marketplace, Medicare, Medicaid).

HIV Pre-exposure Prophylaxis (PrEP)

See the AETC Prescribing PrEP Quick Guide for details.

Federal program to make all PrEP medication available at no cost.

Non-Profit Organizations

These projects assist with medication costs (including co-pays) for HIV prevention and care and other conditions.

• Patient Advocate Foundation Co-Pay Relief Program

Non-profit. Check for funding availability.

• Patient Access Network (PAN Foundation)

Non-profit. Check for funding availability.

• Good Days

Non-profit. Check for funding availability.

• Harbor Path

Non-profit providing medications for the uninsured. They also have a program to support people who are on their state's ADAP waiting list.

Get Help Paying for HIV Care

• Find out if you’re eligible for the Ryan White HIV/AIDS Program.

If you do not have health insurance or money to pay for health services, you might qualify for medical care and other essential support services.

• See if you qualify for disability benefits.

If you have HIV and cannot work, you may qualify for benefits from the Social Security Administration.

• Find out how to get Medicare drug coverage.

If you have Medicare, learn about what the drug plans cover and the costs you’ll pay.

• Get affordable health insurance.

See if you can enroll in or change plans and get answers to common questions.

• Learn about Patient Assistance and Expanded Access Programs.

Find prescription drug assistance information and learn about current expanded access trials.

Activities provided under the Medical Case Management service category have as their objective improving health care outcomes. In contrast, those provided under the Non-Medical Case Management service category have as their objective providing guidance and assistance in improving access to needed services.