Model Approach to AIDS Care

Sacramento is setting an example for the state with its coordinated and cooperative response to the AIDS pandemic.

Through the combined efforts of all public and private health-care providers, the community is creating a unique AIDS service center that will be a one-stop out-patient clinic, including all relevant programs, while also offering support to the 26 less-populated counties of Northern California, where AIDS also is spreading.

A fortuitous coincidence facilitated the creation of what is being called the Center for AIDS Research, Education and Service--CARES. The three principal hospitals, UC-Davis Medical Center, Mercy General and Sutter General, had agreed last year to collaborate on cooperative AIDS treatment plans, including alternatives to in-hospital care for persons with AIDS and the human immunodeficiency virus (HIV) that causes AIDS. At the same time, the Sierra Foundation board had just decided to make AIDS a priority commitment of its grants for the next three years. With hospital and foundation funding, the program was launched.

CARES will open its doors in early May in a downtown building, small, but large enough to accommodate staff to provide out-patient medical care, as well as financial, psychological, spiritual, legal and other related services for those infected with HIV. Through the cooperation of the Sacramento AIDS Foundation, complete case management will be available to assure each person the best possible care at the lowest cost.

All of the 11 hospitals in the area will continue to share the cases requiring acute care. Both UC Davis and Sutter are establishing AIDS wards. If CARES is successful, however, the hospitals will avoid excessive demand on their facilities by providing, through case management and referral, alternatives to hospital care, such as in-home support. Unlike so many hospitals in Southern California, the major hospitals in Sacramento operate near capacity. There is no county facility, so the county funds care for indigents in all hospitals at basic cost.

Sacramento ranks 13th among the 58 counties of the state in the incidence of AIDS. Sponsors of CARES see it as serving all of Northern California apart from the San Frahcisco Bay area, much in the same way that UC Davis’ trauma center now serves the vast region stretching to the Oregon border. This will make available, even in the smallest community, appropriate, managed care for those with the HIV infection. In addition, the Sierra Foundation is pressing an education program targeted at the county’s 73,000 intravenous drug users, where there is evidence that the HIV infection rate already is 3%.

“The whole community is working on this together,” Ron McGregor, interim executive director of CARES, told us. Which is certainly the way it should be.