Fenway Health Quarterly Interprofessional HIV Case Conference -  HIV & Social Determinants of Health, facilitated by Jennifer Reske-Nielsen MD MPH on May 19, 2022.

Objectives:

1. Identify resources available for patients with HIV and housing instability
2. Recognize ways that the intersection of social determinants of health impact and individuals ability to manage their HIV
3. Learn ways to re-engage patients in their HIV care

Case: Rachel

Rachel is a 48 year old woman of trans experience who presents for follow-up of her HIV.  Rachel reports she lost her job last month and has been unable to find another and has also lost her housing.  She is staying with a friend on their couch.  She reports difficulty with affording her medications.  She has been rationing her medications so they last longer and taking them 3 days a week.  She denies any physical complaints right now.  She reports her mood is down and she has been feeling more anxious with all of these life stressors.  Her last visit was 1 year ago. She hasn’t followed up since because she didn’t have insurance and was worried about the cost of visit and labs.

DISCUSSION QUESTIONS

Everyone:

• Think about the last unstably housed person you worked with. What barriers did you run into trying to connect them with housing?  What ways did a lack of stable housing impact their ability to manage their health conditions?

MCM:

• What resources can we connect Rachel with for her lack of insurance? How does someone get on sliding scale? Or free care or Ryan White? What are the differences between those various plans and what limitations do they have internally as well as for referring outside of Fenway for specialists?
• What resources can we connect Rachel with regarding her food insecurity?
• What resources are available for connecting her to housing options?
• What community resources are available to help Rachel with looking for new work?
• What is the Boston Living Center and how can it be a resource?
• What other community resources would be helpful to connect her to
• We do the SDOH form for patients (most of the time) what happens with the answers to that?
• What are the legal services available to HIV+ patients?

Nursing:

If a patient is rationing their meds, how do you counsel them on this not being a good idea? What would you recommend instead for HIV medications if they cannot afford medications?

What types of requests and needs do patients in Rachel's situation ask of you? Do you know the right people to direct the patient to?

Patient Services:

What barriers do you run into outreaching to patients? Are you able to connect with them via phone?

What do you do if a patient tells you they don't’ have insurance so can’t come in? Do you notify the team nurse or provider? Do you connect them with financial services or MCM?

Financial services

What are options for someone with HIV who does not have insurance to get care with us?

Pharmacy:

How do you find out about a change in a patient’s insurance status? Do you notify the team MCM if they don’t have insurance?

If we know that someone is not adherent to daily medications, which HIV medications should we use if any?

Behavorial Health

This patient is experiencing an increase in depressive and anxious symptoms in the setting of life stressors. Does that mean she has depression and/or anxiety? Should we treat with medications for it?

Providers:

After someone has been out of care for a year and they come back in, how do you address all of the medical issues on your list in the setting of their housing instability and lack of income and insurance?