Waiting list guidelines for prioritizing clients

Three prioritization strategies

The AIDS Drug Assistances Protocol Fund Medical Advisory Committee's Recommendations for State ADAP Waiting List Guidelines, revised in September, 2004, suggest these prioritization strategies for clients who are on waiting lists to receive AIDS Drug Assistance Program (ADAP) drugs to treat their HIV disease:

Group I: States with only applicant CD4 data

— Prioritization Category A (first priority): pregnant women;

— Prioritization Category B (second priority): persons who are or were recently on ARV therapy (whose therapy has been interrupted by administrative obstacles in continuing access to ARV drugs in transferring to a state ADAP program);

— Prioritization Category C (third priority): persons (including post-partum women) with a CD4 count below 200;

— Prioritization Category D (fourth priority): persons (including post-partum women) with CD4 cells 200-349.

Group II: States with applicant CD4 and HIV RNA data

— Prioritization Category A (first priority): pregnant women

— Prioritization Category B (second priority): persons who are or were recently on ARV therapy (whose therapy has been interrupted by administrative obstacles in continuing access to ARV drugs in transferring to a state ADAP program);

— Prioritization Category C (third priority): persons (including post-partum women) with a CD4 count below 200;

— Prioritization Category D (fourth priority): persons (including post-partum women) with CD4 cells 200-349 and HIV RNA levels greater than 55,000;

— Prioritization Category E (fifth priority): persons (including post-partum women) with CD4 cells 200-349 and HIV RNA levels less than 55,000.

• Presumably, all of these post-partum women will have access to formula feeding, and therefore the risk of transmission to their infants is non-existent. The decision about post-partum ART should be guided by the choice of the individual woman and whether she meets the CD4 criteria.