The Department of Veterans Affairs (VA) is the nation's largest single provider of health care to those infected with HIV (human immunodeficiency virus).  Approximately 62,000 veterans with HIV infection and AIDS (Acquired Immune Deficiency Syndrome) have been treated in VA since the disease was first recognized in the United States in 1981.  In 2007, approximately 23,000 patients with HIV infection were treated at VA facilities across the nation.  Mirroring the VA population as a whole, veterans with HIV are predominantly male (97 percent) with an average age of 52 years in 2007.  Veterans with HIV are seen at every VA facility, with the largest 30 sites providing care to 70 percent of all veterans with HIV.  Improving early diagnosis of HIV infection is central to VA’s approach to HIV/AIDS care.

Care and Treatment

Since their inception, VA has adopted the clinical guidance on management of HIV/AIDS from the Department of Health and Human Services' "Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents."  All medications approved by the Food and Drug Administration for treating HIV infection are available in VA.  In 2007, 78 percent of all veterans with a diagnosis of HIV infection at VA received anti-HIV therapy from VA, though not all patients are candidates for therapy.  Use of currently available anti-HIV therapy has resulted in improved survival and fewer disease-related complications for veterans living with HIV/AIDS.  Through the use of clinical software tools called the Clinical Case Registry and Clinical Reminders, VA’s Center for Quality Management in Public Health staff work to educate and train front-line HIV providers on how these tools can improve patient and population outcomes.

Policy and Oversight

VA's HIV/AIDS care programs take a comprehensive approach with increased emphasis on population management of veterans with HIV infection.  The National Office for Clinical Public Health Programs works with field clinicians, administrators and other national VA program offices to develop and implement national policies designed to provide all HIV-positive veterans equal access to state-of-the-art therapy.  Summary reports from the national Clinical Case Registry are used for targeted quality initiatives while this robust national database is used for ongoing patient safety oversight.

Training and Education

VA conducts frequent meetings, national training programs and teleconferences on issues related to HIV/AIDS clinical care and research, testing and counseling, prevention, patient health education and occupational exposure to blood-borne pathogens.  VA also employs newsletters, electronic news dissemination, email groups and web-based training to help HIV care providers keep their knowledge and skills in HIV/AIDS management up-to-date.  VA has a nationally recognized Web site devoted to HIV at www.hiv.va.gov.

Research

VA conducts wide-ranging research in HIV/AIDS, from basic studies of the mechanisms of AIDS to clinical trials and assessments of health services delivery.  Research is an integral part of VA’s efforts to improve the diagnosis, treatment and prevention of HIV infection.

VA’s large network of medical centers and clinics, its large patient population and its sophisticated research infrastructure provide a system for multi-center clinical trials investigating new HIV medication regimens or treatment strategy studies.

In seeking a better understanding of AIDS, VA also works closely with many other organizations.  These include VA-affiliated academic medical centers, the National Institutes of Health, the Centers for Disease Control and Prevention, the Department of Defense, the NIH-funded Community Program on Clinical Research on AIDS and AIDS Clinical Trials Group, the Food and Drug Administration, the Canadian Institutes of Health Research and the Medical Research Council of the United Kingdom.  Collaboration among these organizations enhances opportunities to discover new and better strategies for veterans and all people with HIV/AIDS.

More information can be found at www.hiv.va.gov and http://www.publichealth.va.gov.

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