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Randomized Controlled Trial
. 2013 Nov 18;8(11):e78952.
doi: 10.1371/journal.pone.0078952. eCollection 2013.

Association between U.S. state AIDS Drug Assistance Program (ADAP) features and HIV antiretroviral therapy initiation, 2001-2009

David B Hanna  1 , Kate Buchacz, Kelly A Gebo, Nancy A Hessol, Michael A Horberg, Lisa P Jacobson, Gregory D Kirk, Mari M Kitahata, P Todd Korthuis, Richard D Moore, Sonia Napravnik, Pragna Patel, Michael J Silverberg, Timothy R Sterling, James H Willig, Ann Collier, Hasina Samji, Jennifer E Thorne, Keri N Althoff, Jeffrey N Martin, Benigno Rodriguez, Elizabeth A Stuart, Stephen J Gange; North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of the International Epidemiologic Databases to Evaluate AIDS (IeDEA)
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Randomized Controlled Trial

Association between U.S. state AIDS Drug Assistance Program (ADAP) features and HIV antiretroviral therapy initiation, 2001-2009

David B Hanna et al. PLoS One. .

Abstract

Background: U.S. state AIDS Drug Assistance Programs (ADAPs) are federally funded to provide antiretroviral therapy (ART) as the payer of last resort to eligible persons with HIV infection. States differ regarding their financial contributions to and ways of implementing these programs, and it remains unclear how this interstate variability affects HIV treatment outcomes.

Methods: We analyzed data from HIV-infected individuals who were clinically-eligible for ART between 2001 and 2009 (i.e., a first reported CD4+ <350 cells/uL or AIDS-defining illness) from 14 U.S. cohorts of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). Using propensity score matching and Cox regression, we assessed ART initiation (within 6 months following eligibility) and virologic suppression (within 1 year) based on differences in two state ADAP features: the amount of state funding in annual ADAP budgets and the implementation of waiting lists. We performed an a priori subgroup analysis in persons with a history of injection drug use (IDU).

Results: Among 8,874 persons, 56% initiated ART within six months following eligibility. Persons living in states with no additional state contribution to the ADAP budget initiated ART on a less timely basis (hazard ratio [HR] 0.73, 95% CI 0.60-0.88). Living in a state with an ADAP waiting list was not associated with less timely initiation (HR 1.12, 95% CI 0.87-1.45). Neither additional state contributions nor waiting lists were significantly associated with virologic suppression. Persons with an IDU history initiated ART on a less timely basis (HR 0.67, 95% CI 0.47-0.95).

Conclusions: We found that living in states that did not contribute additionally to the ADAP budget was associated with delayed ART initiation when treatment was clinically indicated. Given the changing healthcare environment, continued assessment of the role of ADAPs and their features that facilitate prompt treatment is needed.

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Conflict of interest statement

Competing Interests: M.J.S. reports research grants from Merck and Pfizer. All other authors declare that no competing interests exist. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Flow charts showing selection into each of the two analyses.
Gray indicates the population of interest for the propensity score-matched analyses.
Figure 2
Figure 2. Map of U.S. states represented in study.
See this image and copyright information in PMC

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