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Identification & Description of Ancillary Service
Because HIV care for marginalized populations often entails combining medical services with ancillary or social services not only to stabilize life situations but also remove barriers to care (Chin et al., 2009), the present paper aims to critically discuss one of such ancillary services within the realms of HIV/AIDS care, known as case management.
Case management is primarily concerned with the provision of numerous functions, including stabilizing life situations for people with HIV/AIDS, removing barriers to ensure more consistent participation in medical care, linking HIV-positive patients to other critical services, and enhancing physical and mental health-related quality of life indicators for people living with the disease (Chin et al., 2009). Additionally, as suggested in the literature, case management is often seen as beneficial in supporting integrated care for people with HIV/AIDS owing to its fundamental objective of helping “clients in negotiating, gaining, and maintaining access to health care and social service systems as their disease progresses” (Magnus et al., 2001 p. 137). The key personnel involved in running case management programs include case managers, medical doctors, nurses, social workers, community workers, psychologists, and behavior change experts (Conover & Whetten-Goldstein, 2002; Magnus et al., 2001).
Within the domain of people living with HIV/AIDS, it can be argued that the HIV/AIDS case management department is often supported by departments providing other ancillary services such as peer advocacy and counseling (Naar-King et al., 2007), departments providing social services such as ceasing substance use and entering stable housing for people with HIV/AIDS (Chin et al., 2009), and also by departments providing clinical care in the context of monitoring CD4 cells (viral load), treating infections as well as providing reproductive care and primary care (Naar-King et al., 2007). These support systems are complimentary, implying that the case management department also supports the other mentioned departments with critical data and best practices in management paradigms used on people with HIV/AIDS.
Trends having an Impact on Case Management
One of the most significant trends affecting case management programs for people living with HIV/AIDS is that retention into these programs has been found to decrease with age, suggesting that young adults are most at risk (Naar-King et al., 2007). Although little has been published about the retention in care of HIV-positive youth, a study reported by these authors found that “HIV-positive youth attended approximately 66% of appointments in a comprehensive adolescent HIV clinic over a three- to six-month period” (p. 248). Retention into case management programs has also been found to be gender-specific because the needs of HIV-infected women are substantially diverse from those of their male counterparts (Magnus et al., 2001). The second trend having a direct impact on case management programs for people with HIV/AIDS concerns the fact that comprehensive care is now needed more than ever before not only due to the increasing complexity of the disease but also because of the fact that classification of HIV has shifted from a terminal illness to that of a chronic infectious disease (Magnus et al., 2001).
Impact of the Trends on Case Management
The impact of the first trend, which relates to the low retention levels depending on age group, is that young adults are most at risk owing to low retention levels in HIV/AIDS case management programs (Naar-King et al., 2007). Available literature demonstrates that case-managed HIV-positive individuals have fewer hospital admissions, lower costs related to HIV management, and report satisfaction in the way their needs are met in healthcare settings (Magnus et al., 2001). Consequently, it can be argued that the youth will continue to be adversely affected by HIV/AIDS because the case management approaches currently available do not support or encourage sufficient retention levels among the youth.
The impact of the second trend, which is the increasing complexity of the disease coupled with the fact that the classification of HIV has shifted from a terminal illness to that of a chronic infectious disease (Magnus et al., 2001), lies in increased budgetary allocations to treat and manage the ever-increasing population of HIV patients particularly in the developing countries (Lo et al., 2002), and the resurgence of higher HIV infection rates as infected persons are now living much longer (Chan et al., 2002). Owing to the many success stories in HIV/AIDS case management not only in the United States but also globally, governments and health agencies are expected to commit more financial resources to provide for the ever-widening population of HIV-infected persons. However, the dark side of the success stories is that many people may be at increased risk of contracting HIV if adequate measures are not put in place because HIV/AIDS is no longer a terminal illness but rather a chronic infectious disease.
Improving Operation & Bottomline Performance
To enhance the retention of young adults in case management services, Naar-King et al (2007) suggest that this ancillary service should be age-specific as “youth in a comprehensive, youth-specific program may have better retention than youth in adult services” (p. 250). Consequently, as a healthcare administrator, it is imperative that case management services for people living with HIV/AIDS be developed around the needs of specific age groups of the population. Using this approach, it is possible to capitalize on this trend with the view to developing a case management program/unit that meets specific perceived and unmet needs for diverse groups of the population. For example, to enhance the bottom line performance of HIV/AIDS case management programs, relevant stakeholders could develop age-specific priorities that should be used to encourage various groups of the population not only to join but also to follow through the programs. This way, more people across various age-groups and gender will be able to demonstrate higher retention levels and thus benefit directly from the case management programs in terms of increased access to care, linking families to available resources in the community, and empowering HIV-infected persons to become self-sufficient (Magnus et al., 2001; Lo et al., 2002).
Available literature demonstrates that “HIV disease is no longer a critical short-term illness but a chronic condition giving rise to more clients requiring ongoing medical care” (Chan et al., 2002 p. S73). Because there have been steady advances in the management and treatment of HIV, hence delaying disease progression and prolonging survival rates of HIV-infected persons, it is possible to capitalize on this trend by introducing targeted case management approaches that ensure participants are educated on preventing new and repeat infections. Additionally, to improve the bottom line performance of available case management strategies, it is important to liaise with relevant government agencies as well as donors to increase their budgetary allocations for these programs to coincide with the increasing number of HIV-infected persons requiring case management services. In the context of this particular trend, it is important to trigger positive behavior change among HIV-positive individuals in case management programs to ensure the prolonged survival rates of already infected persons do not translate into new infections.
Chan, D., Absher, D., & Sabatier, S. (2002). Recipients in need of ancillary services and their receipt of HIV medical care in California. AIDS Care, 14(1), S73-S83.
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.
Naar-King, S., Green, M., Wright, K., Outlaw, A., Wang, B., & Liu, H. (2007). Ancillary services and retention of youth in HIV care. AIDS Care, 19(2), 248-251.