An inner-city HIV clinic in Baltimore has proved that a robust and dynamic health care practice can produce astonishing results even among the highest-risk populations. A recent 15-year study of patient outcomes at Johns Hopkins University's HIV clinic found that its primarily lower-income and African-American population enjoyed a life expectancy of 73 years.

The secret to the clinic's success is its multi-tiered approach to care. Primary care addresses lab tests and HIV treatment. Specialty care covers mental health and substance abuse counseling, among many other needs. And supportive care services focus on areas such as case management, transportation and treatment adherence.

According to the study's lead author and the director of the clinic, Richard D. Moore, MD, Johns Hopkins receives about $3 million in Ryan White CARE Act funding each year, the majority going to his group. That federal funding is a major reason for the success of the Hopkins program.

The outcome of the presidential election means that the Affordable Care Act will continue to roll out toward its full implementation in 2014. With the clock ticking, major players in the HIV policy field are working to ensure that Ryan White funding will continue to supplement the health coverage of people with HIV even as many move onto Medicaid and private insurance rolls.

Moore, for one, isn't worried about his own funding. “I think at the moment we're feeling that we'll continue to be able to provide the care to our patients as close to if not in the same fashion as we've been able to,” he said.

How can other health care providers achieve the success of Moore's program? And how can the country as a whole emulate the trailblazing achievement of Massachusetts, where 99 percent of the HIV population is in care? Robert Greenwald, a Harvard Law School professor and cochair of the HIV Health Care Access Working Group, says success depends on the following:

  • States must opt into the Medicaid program.
  • Health insurance exchanges must have strong patient outreach programs to help clients navigate the system.
  • Private insurance and Medicaid must provide essential health benefits to meet the needs of people with HIV.
  • The Affordable Care Act must promote proven models of HIV health care delivery.

“If all those things happen, that would mean we are providing the overwhelming majority of people living with HIV with early access to comprehensive, high-quality health care,” Greenwald said.