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1 Introduction
Pages 27-40

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From page 27...
... Act (RWCA) provides funding to cities, states, and other public and private entities to provide care and support services to medically underserved individuals with HIV disease (Ryan White CARE Act.
From page 28...
... territories to improve the quality, availability, and delivery of health care and support services for individuals with HIV disease. Title II provides states with funds to provide access to HIV medications through the AIDS Drug Assistance Program (ADAP)
From page 29...
... Since the first reauthorization in 1996, significant advances have been made in diagnosing and treating HIV disease. At the same time, research has shown that a large proportion of HIV-infected persons were not in care, and that others were not receiving appropriate treatment or support services (Bozzette et al., 1998; Shapiro et al., 1999)
From page 30...
... ) .2 The legislation also authorized the IOM to assist the Secretary in assessing the readiness of states to produce adequate and reliable HIV case-reporting data, determine the accuracy of using HIV cases within the existing allocation formulas, and establish recommendations regarding how states could improve their HIV casereporting systems ((Ryan White CARE Act.
From page 31...
... recommendations regarding the manner in which the State can improve the system." Information for Estimating Severity of Need for Resources ·"Existing and needed epidemiological data and other analytic tools for resource planning and allocation decisions, specifically for estimating severity of need of a community and the relationship to the allocations process." Quality-of-Care Measures ·"The availability and utility of health outcome measures and data for HIV primary care and support services and the extent to which those mea sures and data could be used to measure the quality of such funded services"; and ·"other factors determined to be relevant to assessing an individual's or community's ability to gain and sustain access to quality HIV services." NOTE: The Ryan White CARE Act Amendments of 2000 also directed the IOM to study the public financing and delivery of HIV care. HRSA commissioned a separate IOM study to address those issues.
From page 32...
... . existing and needed epidemiological data and other analytic tools for resource planning and allocation decisions, specifically for estimating severity of need of a community and the relationship to the allocations process" (Ryan White CARE Act.
From page 33...
... ) .3 To further that goal, Congress charged the Committee with examining: · "The availability and utility of health outcome measures and data for HIV primary care and support services and the extent to which those measures and data could be used to measure the quality of such funded services"; and · "other factors determined to be relevant to assessing an individual's or community's ability to gain and sustain access to quality HIV services" (Ryan White CARE Act.
From page 34...
... The Committee reviewed RWCA programmatic efforts, as well as HIV/AIDS surveillance data collection and analysis. The Committee reviewed data from HRSA and CDC on Title I and II allocations and HIV and AIDS cases, and analyzed the potential impact of including HIV data and other changes in the formulas on allocations.
From page 35...
... Disagreements exist over which clinical conditions, which interventions, provided under what circumstances, and with what attendant burdens should be of concern. The resolution of these questions has critical implications, given widespread acceptance of the moral claim that all citizens should have access to basic medical care, that need should dictate access, and that disparities in access to clinical care by those with similar medical conditions represents an inequity (President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, 1983; Beauchamp and Childress, 2001)
From page 36...
... In this report, the Committee highlights the pros, cons, and tradeoffs implicit in any allocation process, given that RCWA resources have from the outset been insufficient to address the unmet needs of all individuals with HIV and AIDS. Within the context of constrained resources, and cognizant of competing conceptions of equity, the Committee's work was informed by the belief that all individuals with HIV infection should receive the highest-quality care possible regardless of where they live and their personal circumstances.
From page 37...
... While federal policy makers may wish to establish proper incentives for states and localities to fund HIV/AIDS care, some also want to ensure high-quality care even when states and localities fail to provide adequate resources. Knowing these preferences, state and local policy makers may limit funding for basic HIV medications, services, and care because federal funders will cover all or some of the resulting shortfall.
From page 38...
... ORGANIZATION OF THE REPORT Chapter 2 provides an overview of the HIV/AIDS epidemic, financing of HIV/AIDS care, legislative history of RWCA, and its current structure. Chapter 3 provides background on public health and HIV/AIDS surveillance and provides context for how surveillance data are used in the allocation formulas.
From page 39...
... 2003b. The AIDS Epidemic and the Ryan White CARE Act Past Progress, Future Challenges 2002-2003.
From page 40...
... Ryan White Comprehensive AIDS Resources Emergency (CARE) Act: Needs Assessment Guide 2003 Version.


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