WASHINGTON Patients stepping into Johns Hopkins University's HIV clinic in east Baltimore don't just see a doctor or get prescriptions for their antiretroviral drugs; many also get help finding a place to live or bus fare to make it to their next appointment.
Such care that goes beyond the examination table and into patients' often challenging lives has been key to helping poorer HIV patients - particularly blacks and women - live longer, healthier lives, according to a 15-year study published on Thursday in the journal Clinical Infectious Diseases.
Researchers at the university followed 6,366 patients in the mostly black, low-income part of a city marked by abandoned buildings and plagued by an illegal drug trade that drew national attention on the gritty television series "The Wire."
From 1995 to 2010, doctors at Hopkins joined with social workers and other experts to treat HIV, the human immunodeficiency virus that causes AIDs, and address other aspects of care that can often derail patients, such as being able to fill prescriptions or access health insurance programs for the needy.
They found that with additional assistance, at-risk patients who contract the virus in their late 20s can expect to live to about age 73 despite their race, sex or drug use, compared with some earlier data that showed higher mortality rates among such groups.
"Just like over time we have developed medications that are easier to take, have fewer toxicities and are more effective, I think we've done exactly the same things in our ability to deliver quality care to this particular population," Dr. Richard Moore, the study's lead author, said in an interview.
Moore, a professor of infectious diseases and director of the university's clinic, said the program shows it is possible to counter the impact of economic disparities on healthcare.
Even though HIV medications have significantly improved since the virus emerged in the United States decades ago, accessing those medications, receiving consistent care and follow-up appointments for the chronic condition are key, he said.
HIV still hits certain populations harder than others, and rising infection rates among gay black men, for example, remain a major worry among public health experts.
Previous studies have shown that certain groups of HIV patients -- the poor, minorities, women and drug users -- tended to have worse outcomes and die earlier.
Moore found that more comprehensive care that addresses problems such as homelessness and a lack of reliable transportation can help an average 28-year-old with HIV live roughly 45 more years with no significantly higher risk of various infections or other complications.
Moore also credited the roughly $2 billion Ryan White CARE Act, the largest federal program solely aimed at paying for care for low-income HIV patients who are uninsured or have inadequate coverage. The program, which President Barack Obama extended in 2009, is up for renewal next year.
Michael Saag, head of the University of Alabama at Birmingham's Center for AIDS Research, said the new findings underscore the need to revamp the nation's healthcare system so that all people get quality care. HIV patients are lucky to have access to Ryan White funds, but others do not.
"This is likely a fundamental reason why the poor and disadvantaged in the United States have health disparities that cause disproportionately worse clinical outcomes than those with means," Saag said in an editorial accompanying the study.
Over the years, Moore said he and his colleagues have learned what tends to work, and what doesn't, when it comes to their patients.
Moore, who has worked at the Hopkins clinic for 24 years, said patients are immediately connected to a case worker who sometimes starts counseling them even before their first appointment.
Other clinics have also started similar efforts in recent year, but this more comprehensive type of care is not yet available nationwide.
"Medical care, particularly for a lot of people who aren't necessarily well-insured or living in a stable situation, you have to just as much deal with all that aspect of assisting them with their lives," Moore said. "I wish that wasn't the case."
(Editing by Leslie Adler)