HIV & VCT Campaign: Role of Medical Schemes

8m lives 3.4m members (employed and pensioners) Closed (employer based schemes) and open schemes Medical schemes pick up its liability –PMB

HIV prevalence % 2007 CMS Report: Registration when in advanced phase of disease True prevalence: –+300%

HIV & PMB: largely curative focus VCT Co-trimoxazole as preventative therapy Screening and preventative therapy for TB Diagnosis and treatment of sexually transmitted infections Pain management in palliative care Treatment of opportunistic infections Prevention of mother-to-child transmission of HIV Post-exposure prophylaxis following occupational exposure or sexual assault ARVs

Campaign benefits that are not included in PMB HGT testing Hb testing BP Condoms Some not really screening tests! Engage with CMS

VCT & PMB No guide to minimum benefits –At least one a year –Preferably two a year –Price proposal? NDoH/Clicks initiative: R80 –Supported by the BHF Longer term VCT service for all providers

Codes for VCT Diagnosis code (ICD10) –Z11.4 Special screening examination for Human Immunodeficiency Virus (HIV) –Data collection: Concern about quality of diagnosis coding Procedure code –Non existent (industry using dummy or consult codes) –NDoH to introduce code/s (including cost of materials) VCT including 2 nd test and materials –Monetary value for the service

Prevention Gap in SA High STI & High HIV –Chlamydia screening (17-24y): 0% (HQA 2009 Report) –70-75% of infected women asymptomatic –Less in men For prevention of STI/HIV spread (7% pick up in US) USPSTF recommendation Price of POC kit –Retail list price: (R8.50 to R26 + Vat) + markup –Tariff 3906 cannot be used (Lab) Nappi – – – –453634

Recruitment Medical schemes to actively recruit beneficiaries to present themselves for VCT/STI screening –Message on statements –Advertising –Member communiqués –Provider communiqués –Press –…

Healthcare Quality *MAG conference