Transcript TX_ADAP - Texas Department of State Health Services

Texas HIV Medication Program
Dwayne Haught, MSN, ACRN
May 31, 2007
Texas HIV Medication Program (THMP)
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Texas AIDS Drug Assistance Program
(ADAP)
Implemented 1987
RWCA Funded in 1990
4th Largest ADAP in the USA
Goal: “access to life sustaining medications
for low income Texans with HIV”
Texas HIV Medication Program
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Budget ~ $82 Million/year
Funding 60% Federal RW/40% State GR
14,909 clients served FY2006
Distribute meds through 450 community
pharmacies in Texas
Process > 1,000 prescriptions per day
Texas HIV Medication Program
Eligibility Criteria
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Texas Resident
HIV positive
Low Income - < 200% of FPL
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$20,420/year single person
Add $6,960 for each additional family member
Uninsured/Underinsured for prescription
medications
Demographics-Race/Ethnicity
THMP Clients Served in Q1 FY 2007
Compared to Persons Living with HIV/AIDS Texas
45%
40%
THMP
35%
Texas
30%
25%
20%
15%
10%
5%
0%
White
Source:
THMP-HIV 2000
Texas-Texas Epidemiological Profile, 2006
Black
Hispanic
Other or Unknown
Demographics-Gender
THMP Clients Served in Q1 FY 2007
Compared to Persons Living with HIV/AIDS Texas
90%
80%
THMP
70%
Texas
60%
50%
40%
30%
20%
10%
0%
Female
Source:
THMP-HIV 2000
Texas-Texas Epidemiological Profile, 2006
Note: Transgender excluded (less than 1% of population)
Male
Demographics
THMP Clients Served in Q1 FY 2007
3,500
3,000
2,500
2,000
1,500
1,000
500
0
White (Non-Hispanic)
Black or African American
(Non-Hispanic)
N=9,859 Note: Transgender excluded (less than 1% of population)
Hispanic or Latino (any
race)
Other
Female
Male
Drug Expenditures by Class
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Total Expenditures: $81,971,352 (FY 2006)
EI
1%
NNRTI & NRTI
18%
OI and PCP
2%
RTI
47%
PI
32%
Top Ten Drug Expenditures
$3,500,000
$3,000,000
$2,500,000
$2,000,000
$1,500,000
$1,000,000
$500,000
Quarter 1, Fiscal Year 2007
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Texas HIV Medication Formulary
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Limited in scope
Includes 43 medications in over 100
formulations/dosages
All FDA approved ARVs
10 of 14 PHS recommended drugs to
prevent and treat OIs
Issues and Trends
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17% of new applications for services are
coming from incarcerated populations
40% of new applicants report $0 income
73% of new applications report incomes of
less than 100% FPL ($10,210/yr)
Issues and Trends
Cost Containment
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More people alive with HIV today than
ever before
People staying on the program for much
longer periods than previously
Intense usage of the program/complex
regimens
Issues and Trends
Cost Containment
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Newer drugs with convenient dosing
schedules, improved side effects, and
different resistance profiles are brought to
market at much higher prices
Older drugs continue to rise in cost
annually at twice the rate of inflation
New classes of drugs have been much
more expensive
Issues and Trends
New Drug Classes
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Two new powerful ARV drugs are
scheduled for release this year
Both are
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New classes
 Integrase Inhibitor
 CCR5 Antagonist
Both are oral
Expect that they will have a huge impact
on treatment regimens
Issues and Trends
Resistance
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Resistance can be considered a natural
response to the selective pressure of a
drug
Resistance forces changes to 2nd and 3rd
line drugs/regimens
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$$$$$ more costly
Limits future treatment options
Some clients have run out of treatment options
Drug resistant HIV is transmissible
Resistance
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HIV creates billions of new viruses in the
body each day
The goal of multi-drug tx is to reduce the
amount of HIV in the body as low as
possible
Combination tx with a minimum of three
drugs has been shown to be most
effective
Resistance
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With billions of viruses being made every
day, many random differences…. like
mistakes can happen when any new virus
is being made
The mistakes/differences are mutations
Mutations that change the parts of the
virus where ARVs are meant to work can
cause the virus to resist the drug
Resistance
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Drug resistance doesn’t happen because
HIV is smart and figures a way to get
around the drug
Resistance mutations happen randomly
Potent ARV combinations can reduce the
amount of HIV in the body to very little
Resistance
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The less HIV being made in the body
The less chance of random mutations
happening
The less mutations happening
The less likely a drug resistant mutation
will occur
Adherence
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Basically adherence is taking your drugs as
prescribed
Many studies are looking at the
relationship between drug adherence and
resistance
If you take your drugs as scheduled can
you develop resistance?
How adherent do you need to be to
prevent resistance?
Web Sites
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http://www.dshs.state.tx.us/hivstd/meds
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http://aidsinfo.nih.gov/guidelines/