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Issue #143: September 21, 1997
FASTFAX is available by fax in the 215 and 610 area codes at no cost, or by mail anywhere for $20.00 per year, by calling 215-545-6868, and by E-mail by contacting and type the message SUBSCRIBE in the message section. Sources for some information in this issue include Chicago Defender, Journal of the AMA, Minneapolis Star Tribune, Proceedings of the National Academy of Sciences, Reuters, Wall Street Journal.
New AIDS hospice plans November start, fills gap left by Betak closing
$175G in new funding offered by TPAC
CDC confirms AIDS increase among women
Severe herpes linked to low CD8 levels
Researchers discuss dual protease use
Many docs won't recommend their own HMOs
SUPPORT WE THE PEOPLE THROUGH THE 1997 AIDS WALK!
New AIDS hospice plans November start, fills gap left by Betak closing
Keystone Hospice House, a new facility to provide personal care and hospice services to people living with AIDS, is set to open in November after a year-long process aimed at replacing services lost to the AIDS community with the closing of Betak late last year.The new facility will emphasize care for very ill and terminally ill people with AIDS. Other than Calcutta House in North Philadelphia and Gift of Mary, a group home in Delaware County, no other residential care programs of this type have existed in the region since Betak's closing.
The project will be financially supported by a grant from the city's Office of Housing and Community Development and state health department money awarded through the AIDS Activities Coordinating Office (AACO). It will be operated by Keystone Home Health Services, which has provided home and hospice care to people with AIDS for many years.
Betak, the state's only skilled nursing facility specifically designed for people with HIV/AIDS, was closed by Mercy Health Corporation after its effort to negotiate a massive infusion of funding from the Pennsylvania Medicaid program failed last year.
Once finally shut down in late 1996, skilled nursing services for people with AIDS were transferred to a unit at Girard Medical Center in North Philadelphia. The personal care facility at Betak was not continued, however, and Keystone, a Montgomery County-based company, stepped forward with a plan to develop a new program.
Keystone is an independent corporation and is not affiliated with Keystone/Mercy Health Plan, a local HMO.
Keystone president Joan Reese and its vice president of clinical care, Gail Inderweiss, have been working with city and state officials since early this year to develop a new facility which will combine personal care and hospice services for symptomatic and terminally ill people with AIDS. The biggest obstacle to opening the new facility turned out to be locating an appropriate site, especially after a recent decision by Philadelphia Mayor Ed Rendell to discourage the development of new programs in Philadelphia neighborhoods which have been heavily impacted by social programs and special needs housing.
After several false starts -- potential locations in West Philadelphia, North Philadelphia, Logan and Germantown were dropped after indications of neighborhood opposition or high cost -- Keystone and city officials agreed on a site at 8765 Stenton Avenue, in Wyndmoor, just outside the city line in Delaware County. The site is already licensed as a personal care home and was previously used for a mental health residential program.
The site will originally be leased, utilizing Housing Opportunities for People with AIDS (HOPWA) funding, in the hope that a more centrally located facility can eventually be located. Initial funding for services at the facility is expected from a special grant from the Pennsylvania Dept. Of Health, from funds which had formerly been allocated to Betak.
The November start date may be delayed while state officials work out the details of the funding with the city's AIDS Activities Coordinating Office, which will be responsible for monitoring the use of the funding.
Between ten and twenty people with AIDS will be able to receive services at the facility.
Inderweiss told fastfax that the organization is sponsoring a day-long cleanup of the facility on Saturday, September 27th, to help prepare the building for the opening. The event will begin at 8:30 a.m. with breakfast; at 9:45 a.m., a "dedication and blessing" honoring the late Mother Teresa will be held; and beginning at 10:15 a.m., volunteers will go through the house to begin the moving in, clean up and landscaping that is needed to get the facility ready for patients.
"After its opening in November, there will be very little opportunity to see this magnificent facility, since dying patients' privacy must be respected," Inderweiss said.
Inderweiss said that Keystone has already called on its broad network of volunteers and supporters for help in operating the program, and is seeking private funding to assure that financial problems which plagued Betak will not be duplicated at the new facility.
$175G in new funding offered by TPAC
The Commonwealth of Pennsylvania has informed the Philadelphia AIDS Consortium, the state's Title II HIV Planning Coalition, that approximately $216,000 in new funding will made available to the five counties of Southeastern Pennsylvania for targeted prevention efforts in minority communities.The organizations to be targeted for funding include grassroots and other community based organizations that serve communities of color. "In an effort to target as many new organizations as possible and assure that all applicants are on a level playing field when applying for funds, approximately $20,000 has been allocated to provide technical assistance in areas such as grant writing, budgeting and evaluating prevention programs," according to Larry Hochendoner, the organization's executive director.
Approximately $175, 000 will be allocated through an RFP process to organizations in the City of Philadelphia and the four surrounding Pennsylvania suburban counties. The exact percentage distribution of these funds between the city of Philadelphia and the suburban Pennsylvania counties will be determined by the Board of Directors, or another group that the Board deems appropriate, at a later date.
The remaining funds have been set aside to cover the administrative costs for the grant and the allocation of these funds through an Independent Review Panel Process.
Services contracted for must demonstrate development and/or use of effective prevention methods which create behavior change appropriate to the target population, must target racial and ethnic minority persons at risk for HIV infection and must creatively allow and afford linkages with minority community-based providers and/or services. The start date for these new funds is expected to be in January, 1998.
Allocations will be made through a competitive RFP process, the details of which will be announced shortly by TPAC, according to Hochendoner. For more information, call 215-985-6200.
CDC confirms AIDS increase among women
There was a 63 percent increase in the number of women diagnosed with AIDS in the United States from 1991 to 1995, according to a report issued by the U.S. Centers for Disease Control and Prevention.By the end of 1995, 67,400 women had been diagnosed with the disease, almost 20 percent of the total AIDS cases in the United States, the CDC report said.
The greatest increases were among women who acquired the disease through heterosexual contact, added the study, published in the Journal of the American Medical
Association.
"Young women are at risk for HIV infection at an earlier age than young heterosexual men ... adolescent women are becoming infected by older sexual or needle-sharing partners," the report said.
"A recent study reported that adolescent women were less likely to use condoms with older heterosexual male partners than with same-age partners," it added.
The study suggested that successive groups of younger women will continue to be at risk for AIDS "as they reach adolescence and young adulthood. Prevention programs must reach young women before they initiate sexual activity and drug use."
Severe herpes linked to low CD8 levels
The severity of herpes simplex virus infection in HIV-positive individuals is primarily affected by their levels of CD8 cells, according to new research published in the Sept. 15 issue of the Proceedings of the National Academy of Sciences.Dr. Christine M. Posavad of the University of Washington and colleagues found "significantly lower" levels of HSV-specific CD8 pCTL and proliferative precursors in HIV-positive patients compared to HIV-negative patients. Additionally, the team reported that "HIV-positive patients with more severe genital herpes recurrences had significantly lower HSV-specific CD8 pCTL frequencies than those patients with mild recurrences." The report noted that HIV-positive individuals with HSV may find enhancement or restoration of specific cellular immunity a beneficial procedure, and suggested adoptive immunotherapy as a possible method.
Merck pushes two-drug combo
Preliminary results reported by DuPont Merck researchers at the annual meeting of the Infectious Disease Society of America in San Francisco, California, indicate that DMP 266 (efavirenz, Sustiva), combined with indinavir (Crixivan), may suppress HIV load as well as three-drug antiretroviral combinations.DMP 266, a nonnucleoside reverse transcriptase inhibitor, administered for 48 weeks in once-daily doses, in conjunction with the protease inhibitor indinavir, reduced viral load to undetectable levels in about 80% of 59 subjects, according to The Wall Street Journal. Side effects of the regimen included rash, dizziness and flu-like symptoms in some patients.
"Sustiva's principal benefit is that it is a very potent drug, as shown by the fact that it can be given just once a day," Paul Friedman, president of DuPont Merck's research operations, commented. "We are moving as fast as we can to get it approved."
Meanwhile, an expanded access program for DMP 266 has been established. The Wilmington, Delaware-based company will provide the drug free to eligible HIV-positive patients--those failing current therapy and with CD4 counts below 50/microliter--for combination use with another antiretroviral to which they have not been exposed.
Researchers discuss dual protease use
Emerging data on the use of double protease inhibitor therapy for HIV infection may lead to a revision of treatment guidelines issued earlier this year.At an informal session at this year's annual meeting of the Infectious Diseases Society of America, Drs. Constance Benson of the University of Colorado and Ann Collier of the University of Washington hosted a discussion of treatment and prophylaxis guidelines for patients with HIV/AIDS. Participants quickly turned to the topic of dual protease inhibitor therapy as a routine regimen.
"Even though you're giving two drugs, I think what you are accomplishing is a single class, single drug outcome...that allows you to achieve levels that are in excess of suppressive levels," Dr. Collier said.
Ritonavir inhibits metabolism of saquinavir in the gut mucosa and causes much higher doses of saquinavir to be achieved. Dr. Collier said that one-year, unpublished data indicate that a combination of ritonavir and saquinavir achieves 80% initial suppression of viral replication over baseline.
The moderators cited data that indicate that there also appears to be an interaction with a combination of nelfinavir and saquinavir, such that levels of saquinavir are increased five-fold. However, they quickly added that safety and efficacy questions remain over this drug combination and that there are more data available for the combination of ritonavir and saquinavir.
Dr. Collier said there are not enough data for her to be comfortable offering dual protease inhibitor therapy as first-line therapy for all patients with HIV/AIDS, "...but there certainly are selected patients for whom I offer that." These included patients with peripheral neuropathy and patients who have difficulty following complicated regimens. Dr. Benson noted that the protease inhibitors are attractive because they are given b.i.d. rather four or five times a day as with the nucleosides.
"Dual protease inhibitor combination is attractive in patients who have failed initial protease inhibitor therapy, but the strength of any data to support that is very limited at this point," Dr. Benson said.
The professors said there is not enough data to make an informed decision on which protease inhibitor to choose as first line therapy, and that resistance patterns need to be watched. Dr. Benson noted that indinavir and ritonavir show overlapping resistance.
The AIDS experts concluded by emphasizing that it is important to avoid suboptimal doses of protease inhibitor therapy, or any other antiretroviral drug, in order to minimize risk of developing drug resistance. For a patient who is unable to tolerate medications or is unable to absorb them, it is better to stop treatment altogether rather than reduce dosage until symptoms subside.
Many docs won't recommend their own HMOs
A large percentage of Minnesota physicians admitted that they wouldn't recommend the health plan they work for to a member of their own family, a University of Minnesota survey appearing in the Journal of the American Medical Association has reported.According to Drs. Nicole Lurie and Steven Borowsky, the lead authors of the study, it "is one of the first in the country to try to measure quality of care through the eyes of physicians." Dr. Lurie said, "We've got to get away from this us-vs.-them stuff between doctors and health plans. I hope this will send a strong message to doctors that you have some obligation to push your plans to change in the areas where they need to improve."
Overall, approximately 75% of the doctors gave health networks relatively high ratings in two of the areas where managed care is often criticized: access to specialists and time spent with patients. However, only 37% said they could strongly recommend plans to their family members. Physicians working for staff-model HMOs tended to give them the highest marks; the lowest marks were given to Blue Plus, a Blue Cross and Blue Shield of Minnesota HMO.
Only six percent called mental health care excellent, and almost a third said patients who need it often can't get it. In addition, 16% of the doctors feared negative repercussions if they criticize the health plans. The physicians were also skeptical of claims that managed care is improving patient care with better prevention and new treatment guidelines.
Just seven percent to 10% of doctors agreed that these guidelines were helping patients.
"The overall quality of primary and specialty care were rated as excellent by 22% and 29% of plan physicians, respectively," the study reports. Emergency care was rated as excellent by 23% of the doctors.
Ramses to stop condom claims
The Federal Trade Commission has announced that the nation's second largest condom manufacturer has agreed to stop making claims its Ramses brand is 30 percent stronger than the leading brand.The implication was that Ramses condoms were less likely to break.
The FTC said the agreement settles charges that the claims were unsubstantiated and deceptive.
The commission said the Georgia-based manufacturer, London International, has also agreed that it will not renew such claims until it has some data to back them up -- which the FTC says was absent in this case.
The director of the FTC's Bureau of Consumer Protection, Jodie Bernstein, said in a statement that "Consumers need reliable information about this product to make informed personal choices."
SUPPORT WE THE PEOPLE THROUGH THE 1997 AIDS WALK!
The annual Philadelphia AIDS Walk takes place on Sunday, October 19, 1997 and is a great opportunity for everyone to raise money to support and fund AIDS services in the Philadelphia region.We The People Living with AIDS/HIV of the Delaware Valley would love it if you would join our team, whether you're a member of We The People, a friend of people living with HIV/AIDS, or just someone who'd like to help.
The AIDS Fund, which sponsors Philadelphia's annual AIDS Walk, last year raised $35,000 for We The People's LifeSavers Fund, which provides emergency assistance to people living with HIV/AIDS, and another $55,000 for our ongoing support services for low-income and homeless people with HIV disease. Over a million dollars was raised for over sixty other critically-needed AIDS services in the Philadelphia region as well.
Won't you help? We're Team #33, and you can register NOW at We The People's Life Center, 425 South Broad Street, or on the web at http://www.CritPath.Org/aidsfund/indreg.html.
And if you can't walk, please make a donation anyway. Checks can be written to the "AIDS Fund" and sent directly to the AIDS Fund office at 1227 Locust Street, Philadelphia, PA 19107. Please remember to mention We The People or Team #33 on your check.
If you do want to walk, the event starts (rain or shine) at the Eakins Oval on the Ben Franklin Parkway in Philadelphia. Sign-in and Opening Ceremonies begin at 9 AM; the Walk starts promptly at 11 AM.
Register NOW to walk and raise money to fight AIDS and support people with HIV or AIDS! For more information, call 215-545-6868 or email aidsfund@critpath.org or wtp@critpath.org.
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