What started as a small clinic caring for people with HIV in the early ’90s, the McAuley Clinic ─ now known as the Mercy Health Infectious Disease McAuley Program ─ has become one of the nation’s highest-achieving treatment centers for people living with HIV. As the largest clinic on the west side of the state, the McAuley program treats more than 1,000 patients each year with excellent results, thanks to Ryan White Grant funding and steadfast high quality clinical care.
Celebrating 25 years of receiving Ryan White grant funding in October 2015, the McAuley Program has received millions of dollars from this grant, enabling the clinic to employ a full-time pharmacist, four board-certified infectious disease physicians, a nurse practitioner, medical assistants, nurses, and four case managers whose roles focus on the socioeconomic barriers faced by people living with HIV.
One of the clinic’s priorities, discussed at all patient clinical visits, is adherence to taking his or her medication. Adherence, which is sticking to the plan of care as developed by the patient with their provider, is essential to long term treatment success.
“Our pharmacist works one-on-one with patients on medication adherence, finding out what barriers there might be for patients who do not take their medications on a regular basis,” said Sarah Sheldon, manager of McAuley Program. “Management of HIV is dependent upon how diligent the individual is at taking their medication, and we work with them to make sure that they have everything they need to be successful in managing their condition.”
Adherence results in driving the virus from a patient’s blood, a condition called viral suppression. Complete viral suppression results in achieving long life expectancies that begin to approach those of uninfected persons. This has led to 88% of patients in the McAuley program achieving viral suppression, according to CareWare, the National HIV data registry.
HIV has gone from a death sentence to a chronic disease over the past 25 years.
“People with HIV are living longer than ever, now that we are able to suppress the virus,” said David Baumgartner, MD, the Infectious Disease specialist who started Grand Rapids’ first clinic for HIV and AIDS patients with Saint Mary’s in 1989. “When I first began treating people with HIV and AIDS, medicine only allowed them to live for two years. As clinical breakthroughs have occurred, such as AZT in 1986, people began living longer, then protease inhibitors in the mid-’90s dramatically increased survivorship. Now people with HIV can often live a normal lifespan, and some of my patients have even crossed the threshold into needing geriatric care.”
What began as a palliative care model years ago has since shifted into a comprehensive model at the McAuley Program. Funding from the Ryan White Foundation has helped the program create care teams with nurses and medical assistants, and allows for a dietitian to consult with patients a half day each week.
“Everyone on our team strives to remove the obstacles that often keep people from receiving care: cost, lack of insurance, lack of housing, need for acceptance and emotional support, education, access to care for other conditions, such as other medical problems, mental health issues, or substance abuse, ” said Sheldon. “The relationships that we establish with our patients are truly amazing.”
What is in future for the program and for HIV?
“HIV in our community is not going away; rather, it is becoming a ‘silent disease.’ Since people are not dying from it, people are not talking about it, including those who are living with it,” said Sheldon. “However; with our program treating 1,000 patients in West Michigan, and 80-90 new patients coming to our doors every year tells us that not only is HIV not going away, it is still on the rise.”
Despite the number of people living with HIV being on the rise, through the Affordable Care Act, fewer are living without insurance. In 2013, 22% of McAuley patients were uninsured, while recent statistics show that the uninsured have been cut in half to 10.5%. However; those without insurance are still cared for, partly through Mercy Health’s Saint Mary’s community benefit ministry, and through programs through the state of Michigan that commit to covering the cost of drugs and treatment for people with HIV in Michigan.
There is hope for those who are at risk for HIV or who are HIV positive.
“The availability of a drug to prevent HIV infection, and intervention called Pre-Exposure Prophylaxis (PrEP) could help avert HIV infection to those who are at risk,” said Minerva Galang, MD, Medical Director, Mercy Health Infectious Disease McAuley Program. “We are now caring for people who are at risk to have HIV and help them remain HIV-negative.
“One goal for our community is to engage with primary care providers to routinely screen patients per the CDC guidelines, so we can identify those who have HIV and get them the care they need,” continued Galang. “The concept of ‘Treatment is Prevention’ is huge; if we could only identify all HIV-positive people and get them to be suppressed on medications, then we are also preventing transmission of the virus in the community.”
Another proof point for the McAuley Program has been its participation in “Getting to ZERO,” an international campaign to completely eliminate perinatal HIV transmission.
“We continue our involvement with all care teams caring for a pregnant woman and her child to ensure that we prevent another HIV case in a newborn. Our HIV screening rate for our pregnant women is at 95%,” said Galang. “Our hope is to achieve a generation free of HIV.”
For information on how to get tested, please visit the Kent County Health Department or see your primary care provider.
Facts About HIV Locally (information from CareWare, the National HIV data registry):
– Each year, Mercy Health Infectious Disease McAuley Program sees 80-100 new patients with HIV
– 79 of Michigan’s 83 counties report people living with HIV
– 872 people live in Kent County with confirmed HIV; another 230 are estimated to be HIV-positive, but simply do not know it yet
– 20% of the patients the program sees are over the age of 65, now creating a geriatric HIV population that requires extensive specialty needs, including urology, cardiology and more.
– The incidence rate of Hispanics contracting HIV is on the rise. One in five new cases of HIV is a Hispanic person.
– For those who can’t afford their medications, Mercy Health works with them on finding 340b drug pricing, and the state pays for any uninsured patients who have difficulty paying for care.