The California Department of Health Services' Office of AIDS program to provide drug resistance testing to patients without private or public health insurance (those who would be eligible for ADAP, regardless of enrollment in ADAP) was initiated on November 1, 2000. This voucher program, in combination with a similar program designed to offer HIV RNA testing, is called the "HIV Diagnostic Assay Program." The mission of the resistance testing program includes three components: 1) to provide access to resistance testing when clinically indicated for those who do not have other reimbursement options; 2) to provide access for clinicians to expert consultation to assist with decisions in ordering resistance tests, and their interpretation within the context of the patient's medical history; and 3) to develop a clinical and laboratory database to be used for program evaluation and future studies.

In order to provide clinician consultation services, the Pacific AIDS Education Training Center (PAETC) has expanded it's National HIV Telephone Consultation Service (Warmline) at 800-933-3413. Warmline callers can receive specific in-depth consultation from the Warmline's Resistance Testing Consultation Service. This service is available to any clinician in California during the current pilot phase, but does not require participation in the California State resistance testing program. Standard educational and consultative resistance-related services are available to California and non-California clinicians though the Warmline. The National HIV Telephone Consultation Service estimates that 60% of all calls are currently about antiretroviral use and/or resistance testing and results. For information about the Warmline, go to: http://www.ucsf.edu/hivcntr/services.html#warmline

HIV resistance testing consultation and support for California clinicians are available through the Warmline (1-800-933-3413) under a pilot project funded by the State Office of AIDS. Warmline clinicians may refer complicated resistance testing cases for review by the HIV Resistance Testing Panel, a service provided by the Warmline and the UCSF Positive Health Program at San Francisco General Hospital. The panel has uploaded 8 detailed case reports at the Web address listed below for public review and education. Each report includes 1) listing of panel members, 2) comprehensive description of antiretroviral use, CD4+ T-Cell counts, HIV-1 RNA levels and adherence, 3) resistance test findings (genotypic and/or phenotypic), 4) comprehensive considerations regarding interpretations and implications for treatment, 5) discussions of the pros and cons of several recommended antiretroviral regimens, and 6) dosing, monitoring and follow-up recommendations. This service may be accessed directly through HIVResistanceWeb by going to the Test Information page, where resources are also available to assist with interpretation of a specific genotype sequence or ask non-patient specific resistance-related questions.

For information about the Resistance Testing Consultation Service, go to: http://www.ucsf.edu/hivcntr/resources/resistancecases/index.html#rpt

It was predicted that 5,000 resistance tests would be ordered per year through this program, and expected that it would take about 3 to 4 years for the program to penetrate the provider community and reach its maximum utilization. Eight-hundred and seventy-eight tests were done since the program began in November, 2000, including 77% genotypes and 23% phenotypes. Six of the nine laboratories contracted with the State Office of AIDS to participate in this program are currently being utilized. Additional laboratories will be invited to apply for participation in the fiscal year 2002-2003 contract cycle. The State Office of AIDS (and the HIV Resistance Test Advisory Group that helped to formulate this program) is interested in learning about any barriers in accessing this program, and ensuring that all who are eligible for resistance testing are receiving these tests.

Should the pilot consultation project developed through the Warmline prove successful, as it appears to be, additional funding will be sought to expand this service to non-California clinicians. If this is a service you would be interested in seeing expanded beyond California, contact Ronald Goldschmidt, MD at rongold@itsa.ucsf.edu. The resistance testing voucher program is currently underutilized. The State Office of AIDS and the HIV Resistance Test Advisory Group are evaluating potential barriers to utilization. For more information about this program, please contact: Toni Post, Program Coordinator at (916) 322-5561.