Month: May 2026

Advancing the Future of HIV Care in Our Community

Public Health Notes

By Kenton K. Murthy, DO, MS, MPH, AAHIVS
TCPH Assistant Director & Deputy Local Health Authority

This article was originally published in the May/June 2026 issue of  Tarrant County Physician.

The Preventive Medicine Clinic (PMC), the oldest Ryan White HIV clinic in Tarrant County, has served the community continuously since its founding in 1991. In 2026, Tarrant County Public Health marks a significant milestone—35 years of delivering comprehensive HIV care, prevention, and patient support through this foundational program. In recognition of this milestone, PMC is undergoing a strategic transformation aimed at expanding access, enhancing quality, and delivering care in a more cost-effective and sustainable manner.

This evolution calls for a new identity—one that reflects not only where we have been, but where we are going. Today, we introduce Thrive Health. People living with HIV are no longer simply surviving; with the right care and treatment, they are thriving, and our new identity is meant to reflect this new era of care.

But we are not simply a rebrand; we are also entering a new phase focused on integration, innovation, and system-wide collaboration to address a persistent challenge: HIV incidence remains steady, and in some populations, is increasing. This moment calls not only for recognition of past success but for decisive action moving forward.

The Ryan White System of Care in Tarrant County
The modern HIV care system in the United States is built in large part on the foundation of the Ryan White HIV/AIDS Program, administered by Health Resources and Services Administration, an agency of the US Department of Health and Human Services. First established in 1990, the program was named after Ryan White, a young hemophilia patient who became a national advocate for HIV awareness after facing significant stigma and discrimination.

This program was designed to address a critical gap by ensuring access to HIV care for individuals who were uninsured or underinsured during a time when treatment options were limited and outcomes were poor. Over time, it evolved into a comprehensive system of care that supports medical treatment, medications, and essential support services.

Today, the Ryan White HIV/AIDS Program represents a multi-billion-dollar federal investment, with annual national funding of approximately $2.6 billion, supporting care for more than half of all people living with HIV in the United States. It has been widely recognized for achieving some of the highest viral suppression rates of any federally funded healthcare program.

In Tarrant County, Ryan White funding supports a coordinated network of clinics, including Thrive Health and other regional partners, delivering comprehensive care that includes HIV primary medical services; antiretroviral therapy management; rapid-start treatment for newly diagnosed patients; PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) services; case management; mental health and substance use care; oral health; pharmacy support; laboratory monitoring; and assistance addressing housing and transportation. Through this integrated model, HIV has been transformed into a manageable chronic condition, with significant improvements in life expectancy and reductions in transmission.

Local Epidemiology: A Growing HIV Burden in Tarrant County
Unfortunately, in Tarrant County, as in other parts of the United States, the burden of HIV continues to grow. In 2022, it was estimated that approximately 6,715 individuals were living with HIV in Tarrant County. By 2026, that number has risen to an estimated range of 7,500 to 8,000 individuals.
This increase is multifactorial and reflects a number of factors:

Ongoing HIV transmission

  • Improved survival due to effective antiretroviral therapy
  • Population growth within Tarrant County
  • The downstream effects of the COVID-19 pandemic, which disrupted routine healthcare delivery, reduced access to HIV testing and prevention services, and contributed to delays in diagnosis and linkage to care

Collectively, these factors highlight the persistent gaps in prevention and access that must continue to be addressed by healthcare and public health experts.

Why Continued HIV Screening Matters
Despite advances in treatment, HIV remains a significant public health concern. Routine screening is critical because early diagnosis allows for immediate initiation of therapy, leading to improved individual outcomes and reduced transmission through viral suppression. At the same time, a substantial number of individuals remain undiagnosed or are diagnosed late in the course of disease.

Tarrant County Public Health’s Disease Surveillance, Outreach, and Prevention (DSOP) team plays a central role in HIV and STD control efforts. Their work includes conducting field-based testing and outreach in high-risk populations, performing partner services and contact tracing, and leading comprehensive contact investigations for newly diagnosed HIV and syphilis cases. In addition, DSOP facilitates linkage to care for newly diagnosed individuals and actively works to re-engage patients who have fallen out of care, while collaborating closely with clinicians and epidemiologists to monitor trends and improve outcomes.

In addition, for several years, a key success in Tarrant County has been the implementation of opt-out HIV screening at JPS Emergency Department. This innovative program has led to the identification of numerous new HIV cases and has improved linkage to care at Ryan White outpatient clinics.
Building on this success, Tarrant County Public Health, in collaboration with the Tarrant County HIV Administrative Agency and key physician leadership from JPS, is actively working with other local hospitals to expand opt-out HIV screening across emergency departments throughout the region, with the goal of standardizing testing practices and improving early detection across multiple healthcare systems. These initiatives, if successful, could improve early detection of HIV and treatment of people living with HIV, thus helping to stop the spread of this disease.

Thrive Health: A Transformational Model for Integrated, Cost-Effective, High-Value Care
The transition from PMC to Thrive Health represents a deliberate transformation aligned with Tarrant County Public Health’s broader effort to become a more efficient, high-performing public health system. The previous clinic identities no longer fully reflected the scope or impact of services being delivered, and the 35-year anniversary provides an appropriate moment to evolve into a more unified and forward-looking model.

This transformation is driven by a focus on improving operational efficiency, returning to a physician-centric model of care, and optimizing the use of existing staff to increase patient throughput and enhance care delivery. At its core, the redesign is aligned with the Triple Aim of Healthcare—improving quality, expanding access, and reducing costs.

From a quality perspective, Thrive Health is expanding preventive services, including increasing vaccination rates—particularly among HIV PrEP patients—and incorporating routine Pap smears for eligible women in the STD clinic who have not been screened within recommended intervals. From an access standpoint, the move toward a team-based care model is expected to increase patient volume and reduce barriers to care.

In parallel, several targeted care initiatives are being implemented. A Rapid Restart Program is being developed to identify patients who have been out of care for six months or longer, with coordinated efforts from front desk staff, patient navigators, and case managers to reconnect these individuals to care and to overcome barriers. For appropriate patients, providers will review prior records, order necessary labs, and facilitate expedited re-initiation of antiretroviral therapy, including the use of home-based care teams when appropriate.

Alongside expanded vaccination efforts, preventive care is being strengthened through the integration of cervical cancer screening. Thrive Health is initially focusing on high-risk populations such as patients on PrEP before scaling to broader clinic populations. Together, these initiatives represent a shift toward a more proactive, population health-driven model of care.

Launching the Tarrant County HIV Care Collaborative
While Thrive Health celebrates 35 years of service in Tarrant County, we recognize that this work cannot be done alone. Our success and longevity is built on strong partnerships with fellow Ryan White HIV providers, including JPS Healing Wings, CAN Community Health, and AIDS Healthcare Foundation.

To further strengthen these collaborations, Tarrant County Public Health is launching the Tarrant County Ryan White HIV Care Collaborative—a first-of-its-kind initiative bringing together Ryan White providers across the region. This collaborative will serve as a platform for regular discussions on local HIV trends, ongoing education in prevention and treatment, and enhanced coordination of care across systems. A central priority will be improving linkage-to-care efforts through closer integration with DSOP and epidemiology teams.

Together, this unified approach represents a critical step toward reducing HIV transmission and improving health outcomes across Tarrant County.

Looking Forward
Thrive Health’s legacy demonstrates that coordinated HIV care works. However, continued innovation, collaboration, and system redesign are essential to meet the evolving needs of our population.

The future of HIV care in Tarrant County will be found in collaborations that deliver high-value, patient-centered care that allow individuals to lead healthy, fulfilling lives. By working together, we can move closer to ending the HIV epidemic—one patient, one system, and one collaboration at a time—because when we work together, we thrive.

Beating the Stigma: The Challenges in Treating Substance Use Disorders

President’s Paragraph

By Cheryl Hurd, MD, TCMS President

This article was originally published in the May/June 2026 issue of  Tarrant County Physician.

By the time you all read this article, I hope you will have had a chance to listen to some of Tarrant County Medical Minute’s many interesting podcast episodes. I recently had the privilege of being invited as a guest on the podcast (you can find my episode here), which TCMS launched in 2025. It was fun, and I also found it to be an opportunity to continue to highlight mental health and advocacy. As I’ve mentioned before, mental health is marginalized and stigmatized but so essential to overall health. I appreciated the opportunity to talk about this on the podcast, fulfilling one of my promises to speak openly about mental health issues.

So, today we are going to talk about an even more stigmatized mental health issue—substance use disorders. They are far more common than many of us realize. According to the Substance Abuse and Mental Health Services Administration in their National Survey on Drug Use and Health in 2023–24, nearly 48 million Americans age 12 and older, or about one in six people, meet criteria for a substance use disorder in any given year.1

Texas mirrors this national statistic. Alcohol use disorder accounts for the largest proportion, followed by drug use disorders involving marijuana, stimulants, opioids and more. State‑level estimates from the National Survey on Drug Use and Health indicate that roughly one out of seven Texans meets criteria for a substance use disorder each year.2 While this is slightly lower than the national average, it still represents millions of people across our state whose health, relationships, and economic stability are affected. In a state as large and diverse as Texas, the collective impact of these conditions is substantial: it affects healthcare utilization, workforce participation, public safety, and even community well-being.

For physicians, this data shows what is already evident in clinical practice. Substance use disorders frequently coexist with chronic medical conditions, complicating diagnoses and treatments while increasing the risk of poor health outcomes. For legislators and policymakers, the numbers highlight the scope of the issue and the importance of continuous investment in prevention, early identification, evidence‑based treatment, and long‑term recovery support. And for the general public, the message is both sobering and illuminating: substance use disorders are common, treatable medical conditions, not moral failures or character flaws.

Substance use disorders do not exist in isolation. National data consistently demonstrates high rates of co‑occurring mental illness as well.1 This overlap reinforces the need for integrated approaches to care that address the whole person rather than fragmented systems that separate “mental health” from “substance use.” The stigma surrounding substance use disorders mirrors the stigma that has historically marginalized mental health conditions—just as depression and anxiety were once dismissed as weaknesses rather than illnesses, substance use disorders continue to be judged rather than treated.

Stigma remains one of the most powerful barriers to care. It delays seeking help, discourages honest conversations between patients and physicians, and shapes policies that emphasize punishment over treatment. When individuals fear judgment, they are less likely to disclose substance use concerns, less likely to engage in treatment, and less likely to experience recovery. This is true no matter what walk of life you stem from, no matter what profession you are in. Reducing stigma is thus a clinical, ethical, and public health imperative.

Texas‑specific health data further illustrates the downstream effects of untreated substance use disorders, including alcohol‑related hospitalizations, drug‑related overdoses, and preventable deaths.2 Even when prevalence rates are slightly lower than national averages, the absolute number of affected individuals places significant strain on healthcare systems and communities. These outcomes are not inevitable; evidence‑based prevention strategies, timely access to treatment, and sustained recovery supports have been shown to reduce morbidity, mortality, and costs.3 The key is that these initiatives have to be adequately funded and broadly accessible.

It is essential to treat substance use disorders as seriously and compassionately as other chronic illnesses. This includes speaking openly about prevalence, acknowledging the role of stigma, and advocating for systems of care that are based on scientific evidence rather than outdated assumptions. If one in six Americans—and one in seven Texans—are affected, then nearly every family, workplace, and community has a stake in how we respond. As physicians, policy advocates, and community leaders, we have both the opportunity and the responsibility to lead with data, compassion, and transparency. By reframing substance use disorders as the common, treatable health conditions they are, we can achieve these goals of reducing stigma, improving access to care, and improving the health and well-being of the populations we serve.

For physicians, the message should be clear: substance use disorders are common and addressing them as part of routine medical care should be best practice. Screening and brief, non-judgmental conversations about substance use should be normalized in our clinical settings. How we ask and how we respond do matter. Framing substance use disorders as treatable medical conditions like the evidence shows will increase patient disclosures, increase their engagement in treatment, and ultimately lead to their trust in us. We must lead the shift from judgment to treatment by insisting that substance use disorders are met with evidenced based care, equitable insurance coverage, and our compassion—not silence or shame.

“We, as a culture, have not fully acknowledged how much help is needed. The only real shame is on us for not being willing to speak openly. For continuing to deny that mental health is related to our overall health. We need to start talking, and we need to start now.”
– OPRAH WINFREY

References:

  1. Blaire Bryant, Naomi Freel, and Emily Steckler, “SAMHSA Releases New 2024 Data on Rates of Mental Illness and Substance Use Disorder in the US,” National Association of Counties, July 28, 2025, https://www.naco.org/news/samhsa-releases-new-2024-data-rates-mental-illness-and-substance-use-disorder-us.
  2. “Substance Use Disorder Statistics,” Drug Policy Facts, accessed May 4, 2026, https://www.drugpolicyfacts.org/node/4476.
  3. Johanna Bellon et al., “Association of Outpatient Behavioral Health Treatment With Medical and Pharmacy Costs in the First 27 Months Following a New Behavioral Health Diagnosis in the US,” JAMA Network Open 5, no. 12 (2022): e2244644, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799220.
  4. Substance Abuse and Mental Health Services Administration, “National Survey on Drug Use and Health (NSDUH): 2023 National Releases,” SAMHSA, accessed April 1, 2026, https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health/national-releases/2023.
  5. Substance Abuse and Mental Health Services Administration, “State Estimates of Mental Health and Substance Use,” accessed April 1, 2026, https://nsduhweb.rti.org/respweb/estimates.html.
  6. Li-Tzy Wu, He Zhu, and Udi E. Ghitza, “Multicomorbidity of Chronic Diseases and Substance Use Disorders and Their Association with Hospitalization: Results from Electronic Health Records Data,” Drug and Alcohol Dependence 192 (2018): 316–23, https://doi.org/10.1016/j.drugalcdep.2018.08.013.
  7. Lauren R. Ray et al., “Combined Pharmacotherapy and Cognitive Behavioral Therapy for Adults With Alcohol or Substance Use Disorders: A Systematic Review and Meta-analysis,” JAMA Network Open 3, no. 6 (2020): e208279, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767358.
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