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Texas HIV Medication Program

Texas HIV Medication Program. Dwayne Haught, MSN, ACRN May 31, 2007. Texas HIV Medication Program (THMP). Texas AIDS Drug Assistance Program (ADAP) Implemented 1987 RWCA Funded in 1990 4 th Largest ADAP in the USA

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Texas HIV Medication Program

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  1. Texas HIV Medication Program Dwayne Haught, MSN, ACRN May 31, 2007

  2. Texas HIV Medication Program (THMP) • 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”

  3. Texas HIV Medication Program • 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

  4. Texas HIV Medication ProgramEligibility Criteria • Texas Resident • HIV positive • Low Income - < 200% of FPL • $20,420/year single person • Add $6,960 for each additional family member • Uninsured/Underinsured for prescription medications

  5. Demographics-Race/Ethnicity THMP Clients Served in Q1 FY 2007 Compared to Persons Living with HIV/AIDS Texas Source: THMP-HIV 2000 Texas-Texas Epidemiological Profile, 2006

  6. Demographics-Gender THMP Clients Served in Q1 FY 2007 Compared to Persons Living with HIV/AIDS Texas Source: THMP-HIV 2000 Texas-Texas Epidemiological Profile, 2006 Note: Transgender excluded (less than 1% of population)

  7. Demographics THMP Clients Served in Q1 FY 2007 N=9,859 Note: Transgender excluded (less than 1% of population)

  8. Drug Expenditures by Class • Total Expenditures: $81,971,352 (FY 2006)

  9. Top Ten Drug Expenditures Quarter 1, Fiscal Year 2007

  10. Texas HIV Medication Formulary • 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

  11. Issues and Trends • 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)

  12. Issues and TrendsCost Containment • 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

  13. Issues and TrendsCost Containment • 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

  14. Issues and TrendsNew Drug Classes • Two new powerful ARV drugs are scheduled for release this year • Both are • New classes • Integrase Inhibitor • CCR5 Antagonist • Both are oral • Expect that they will have a huge impact on treatment regimens

  15. Issues and TrendsResistance • Resistance can be considered a natural response to the selective pressure of a drug • Resistance forces changes to 2nd and 3rd line drugs/regimens • $$$$$ more costly • Limits future treatment options • Some clients have run out of treatment options • Drug resistant HIV is transmissible

  16. Resistance • 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

  17. Resistance • 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

  18. Resistance • 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

  19. Resistance • 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

  20. Adherence • 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?

  21. Web Sites • http://www.dshs.state.tx.us/hivstd/meds • http://aidsinfo.nih.gov/guidelines/

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