Palliative Care Interventions Within ADAP
State ADAP programs are the primary source of HIV medications for persons eligible for CARE Act drug assistance services; funds supplied by other titles of the act provide nominal support. The availability of the drugs is central to establishing a palliative care approach to the delivery of medical care. Often, important clinical decisions and quality-of-life experiences are related to the mitigation of specific conditions or symptoms, such as the management of pain.
Not all State ADAPs cover drugs for common conditions that require palliative care: pain, nausea, diarrhea, or depression. Table 2 is a summary of State ADAP programs that cover one or more drugs in the four major categories.
| Drug Category | State ADAPs With Drug in Formularya |
|---|---|
| Pain: moderate/strong opioidsb | 18 |
| Nausea/vomitingc | 20 |
| Antidiarrheal agentsd | 23 |
| Major depressione | 24 |
a Includes all States and the District of Columbia, 51 jurisdictions total. Source: State ADAP information collected from National ADAP Monitoring Project Annual Report. Washington, DC: National Alliance of State and Territorial AIDS Directors; 2003. Available at: www.atdn.org/access/adap/. |
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As this review of recent ADAP programs shows, most States do not cover the most basic medications used in palliative care for symptom management. Only 17 States and the District of Columbia include a moderate-to-strong opioid agent in their formulary. Among the States that do cover medications, most do not cover all four categories or all drugs in the categories as listed above.
The availability of a range of therapeutic interventions is necessary to effectively manage advanced HIV disease. Important areas of coverage include management of pain (moderate to severe); constitutional symptoms, such as weight loss, fatigue, fever, and sweats; pulmonary and gastrointestinal symptoms; oral and dermatologic conditions; and psychiatric illness. The success of managing a client with one or more of those problems is highly dependent on the provider’s ability to prescribe specific medications and on the patient’s ability to access them. Given the generally limited access to medications for persons with HIV/AIDS, including some persons enrolled in Medicaid, the State ADAP can be crucial to ensuring access to palliative care treatment interventions.
Additional Resources
Information on the common symptoms in persons with HIV/AIDS and palliative care interventions are documented in A Clinical Guide to Supportive & Palliative Care for HIV/AIDS (HRSA, 2003). Refer to pages 20–23 and Chapters 4–10.
