Thanks to a recently received grant, the UNMC/Nebraska Medicine Specialty Care Center will team with the Nebraska Medicine Grand Island Health Center to provide long-acting, injectable HIV treatment to patients in greater Nebraska.
“Long-acting injectable antiretroviral therapy, which was first approved for use in 2021, allows patients to come into clinic and get a set of injections every other month; this is the first treatment of its kind to replace the need for daily, lifelong oral medication for treatment of HIV disease,” said Jen O’Neill, coordinator for long-acting injectable therapy in the UNMC Division of Infectious Diseases and the Nebraska Medicine Specialty Care Center.
There can be several advantages to long-acting injectable therapy for some patients over its alternative, daily oral pills, O’Neill said. “With the treatment of HIV disease, adherence to medications is important – it controls the virus, prevents medication resistance from developing, and prevents transmission.”
However, patients can face many barriers to adherence, such as pill burden and fatigue, privacy concerns, stigma, food and housing insecurity, and mental health diagnoses.
“Being able to help a patient adhere to six doses of treatment per year instead of 365 can be a powerful tool to offset the barriers to treatment.”
Also, delivering the injections in Grand Island removes a barrier for Nebraskans who might otherwise have to travel more than 100 miles to be treated at the Omaha-based Specialty Care Center, whose patients come from west-central Nebraska, southwest Iowa and other locations.
Currently, the long-acting program established at the Specialty Care Center serves about 75 patients who all come to Omaha for treatment, O’Neill said. However, staff recognized the need to make the treatment option more accessible outside Omaha.
“In order to provide equitable access to injectable therapy for all of our patients, we realized we needed to look at how to decrease the travel burden for anyone who was traveling to us from outside of the Omaha metro area,” she said.
The grant of more than $400,000 from ViiV Healthcare, received by UNMC’s Nada Fadul, MD, professor in the UNMC Department of Internal Medicine’s Division of Infectious Diseases and medical director of the Specialty Care Center, will allow the clinic to enroll 40 new patients from outside of the Omaha metro area into the long-acting therapy program.
“These patients will have the choice to either continue to come to the Specialty Care Center in Omaha or go to the Grand Island Health Center to receive their treatment,” O’Neill said.
Ali Vanis, the Nebraska Medicine clinic manager in Grand Island, and Amy Djernes, the ambulatory supervisor in Grand Island, have been important partners in the efforts to make the long-acting medication available in Grand Island. (Infusion nurses Dawnielle Strong and Marilyn Arnold round out the Grand Island team.)
Said Vanis, “Growing up in a rural area, I know the challenges people may face to receive advanced medical treatment so close to home. It brings me joy to be able to offer these injections to our patients without them having to rearrange their entire day for the commute to Omaha.”
Dan Cramer, APRN and assistant director for digital health at the Specialty Care Center, also has worked with Vanis to establish a telehealth clinic in Grand Island, enabling patients to consult with HIV providers in Omaha for their six-month follow-up visits while working with the Grand Island nursing and support staff to deliver on-site tests and treatment when possible.
The grant does not provide the medication or pay for the treatment, O’Neill said, but has allowed staffing to build the program, assess and address patient barriers to treatment, and assess the feasibility of the long-acting injectable and telehealth model – in essence, to create the program and review its effectiveness.
“When the grant is done after two years, the model will be self-supporting and perhaps replicable in other locations in the state,” O’Neill said. “All along the way, we’ll be asking for feedback from the staff, the providers, the patients. We know that people in rural areas can have unique barriers to care, so studying the implementation process is important. What we learn from this pilot program will enable us to expand into greater Nebraska more effectively.”
O’Neill said she knows the program will not appeal to everyone, nor is the treatment appropriate for all patients.
“We know some people just don’t like injections,” she said. “But for the people who want to and can receive therapy that way, it usually is very meaningful to them and can be freeing, because they don’t have the burden of remembering pills every day. We are excited for this program, because everyone deserves access to this kind of therapy, regardless of where they live. People who live in rural areas may find some relief, may have a better quality of life, because they can receive this treatment without traveling hours to get it.”
She also applauded Nebraska Medicine for its part in the effort.
“The concept seems simple,” she said. “But there are many issues, nationwide, not just in Nebraska, related to cost, access, insurance coverage, and patient retention involved in providing this type of treatment right now. It can be complicated to get patients connected to it and implement it well. We are so thankful for our partnership with Nebraska Medicine and the people and the many departments that have supported this effort and made it sustainable for patients. Hopefully, we’ll learn a lot from this process that will make it more easily transferable to other locations.”