Gallant’s Essential Components of Effective HIV Care article dovetails nicely with class conversations facilitated by Dr. Gene Farber last week wherein he (and his assigned reading) underscored the importance of addressing the multifactorial needs of HIV/AIDS patients. The introductory discourse of this week’s article reinforces the idea that anti-retroviral therapy (ART) and proper case management have revolutionized HIV care, but that the continuation and frequent quality monitoring of integrated care will be paramount as care providers tackle new and existing cases of HIV. The article puts forth as the goals of HIV care, “earlier and greater engagement in care, effective viral control, improved immune state, near-normal life expectancy, enhanced quality of life, and prevention of HIV transmission,” and identifies as the per-patient leaders to execute these goals an HIV expert, a care coordinator (often a qualified nurse), a clinical pharmacist, and “a range of other specialists” including but not limited to providers of mental health and substance abuse treatment. This thorough and interdisciplinary outline prompted my wondering what the “best” bench research team would be for creating an effective HIV vaccine.
Collaborative efforts absolutely exist in the current molecular research of HIV, but a single scientist–or even on a larger scale, a single lab–can mire him/herself in the understanding of one protein or one pathway or one phenomenon so as to prevent synthesizing that knowledge in the context of other proteins or other pathways or other phenomena. HIV encodes nine genes, but my dissertation research examines only one of them in isolation, env. Invariably, HIV’s genes affect each other, and I’ve received questions to this effect when giving talks: “While all of this is going on in env, what’s happening in gag?” and I have to answer, “I don’t know,” or “We haven’t looked into that.” It has taken almost two years of active research for me to define a single neutralizing antibody target in a single subtype A HIV-1 patient from Kigali, Rwanda, and while this knowledge is valuable and can now be compared against the other subtypes to pinpoint shared viral vulnerabilities, the scope of my project is admittedly infinitesimal. Reading about integrated care made me desirous of more crosstalk among scientists from the different branches of HIV research.
Where Gallant et al. proposed a feasible and united but somewhat abstract plan, Resch et al. and Hongoro et al. expounded on concrete instances of current or pilot treatment infrastructures. The most significant commonality between these two latter articles was providing sound economic evidence that such implemented programs possess tangible (and often monetary) merit. Would treating patients in need of palliative care at home, frequently immersed in the comfort of a family environment, reduce costs as compared with those accrued during comparable hospital stays? According to the N’Doro South African study in Hongoro et al., yes. This echoes similar results collected in Spain, Italy, the United States, and the United Kingdom. Will efforts sponsored by the Global Fund to Fight AIDS, Tuberculosis, and Malaria to treat 3.5 million people across 98 countries with ART be proven worthwhile? In terms of “restored labor productivity amongst workers with AIDS, orphan care expenditures avoided because parents remain alive on ART, and delayed end-of-life care costs associated with death from AIDS,” the answer was a resounding yes. Overall, Resch and Hongoro examined the financial benefits attached to specific HIV intervention strategies. To some, their analyses may have appeared callous, but such studies are incredibly important because they inform policymakers and potential government, public, or private funders that representative programs are positively impacting the epidemic.