Changes to HIV treatment access for people ineligible for Medicare

Since November 2011, National Association of People with HIV Australia (NAPWHA) and the Kirby Institute, with the assistance of all Australian HIV pharmaceutical companies, set up a free access trial for people with HIV deemed by the federal government to be ineligible for Medicare. NAPWHA’s work advocates for people with HIV ineligible for Medicare, who often delay starting treatment, and who are forced to purchase ARVs online and may not access their ideal regimen. Our work involves influencing key federal government agencies towards improving health equity and treatment access for people with HIV ineligible for Medicare. A consultation between NAPWHA and the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) In 2007, HIV S100 prescribers nationwide and members of the Australian Health Protection Committee’s Blood Borne Viruses and Sexually Transmissible Infection Standing Committee (BBVSS) estimated the number of Medicare ineligible people living with HIV (PLHIV) in Australia at between 250 and 300 [1].

The Australian HIV Observational Database Study (ATRAS) commenced In November 2011 and ran until 2015.  Via a compassionate access scheme, ATRAS provided antiretroviral (ARV) treatment for up to four years to 180 HIV-positive patients who were temporary residents in Australia and ineligible for Medicare [2].

The AHOD Temporary Residents’ Access Study (ATRAS) started out of necessity to help a vulnerable group of 180 HIV-positive people by providing free antiretroviral (ARV) treatment to people who were not yet permanent residents – commonly those on student or bridging visas. ATRAS was the first study in Australia to systematically collect visa and HIV-related information on the sub-group of HIV-positive people who are Medicare ineligible [3].

[1] ATRAS rept 1 p.4-5
[2] ATRAS rept 1 p.4
[3] Ibid. p.2

In 2019, NAPWHA and the Kirby Institute UNSW, Sydney published an analysis of new data with recommendations for systemic improvements to treatment access  for people living with HIV in Australia who are ineligible for Medicare. The 2019 report concludes that the current system does not work for patients, clinicians, industry partners or State/Territory Governments and it needs a complete overhaul. Medicare ineligible people with HIV need to access treatment and care the same way as other people with HIV in Australia, without additional barriers.

A solution is therefore required that allows clinicians to prescribe from the entire suite of ARV available on the PBS without the  additional burden of direct negotiation with pharmaceutical companies. This solution would facilitate community-based organisations to promote the availability of HIV treatment and care to Medicare ineligible PLHIV.

An unmonitored cohort of HIV positive individuals who are experiencing significant barriers to appropriate care and treatment presents considerable public health implications. Improved, regular and standardised data collection from the State and Territory jurisdictions and pharmaceutical companies is urgently required to better understand this group and their doctors’ prescribing patterns.

• Newly available HIV resources supporting health providers and patients to navigate the Australian health and immigration system published on 1 December 2018 via Australasian Society for HIv, Viral Hepatitis and Sexual Health (ASHM)
• Australia will never be HIV-free if access to prevention requires a Medicare card by Nicholas Medland published on 23 January 2019 via The Conversation
• People who are ineligible for Medicare to gain access to HIV treatment and care posted on 30 November 2020
• People who are ineligible for Medicare to gain access to HIV treatment and care (update) posted on 30 November 2021