Ryan White HIV/AIDS Program Assistance and HIV Treatment Outcomes

Abstract

Background: The Ryan White HIV/AIDS Program (RWHAP) provides persons infected with human immunodeficiency virus (HIV) with services not covered by other healthcare payer types. Limited data exist to inform policy decisions about the most appropriate role for RWHAP under the Patient Protection and Affordable Care Act (ACA).

Methods: We assessed associations between RWHAP assistance and antiretroviral therapy (ART) prescription and viral suppression. We used data from the Medical Monitoring Project, a surveillance system assessing characteristics of HIV-infected adults receiving medical care in the United States. Interview and medical record data were collected in 2009-2013 from 18 095 patients.

Results: Nearly 41% of patients had RWHAP assistance; 15% relied solely on RWHAP assistance for HIV care. Overall, 91% were prescribed ART, and 75% were virally suppressed. Uninsured patients receiving RWHAP assistance were significantly more likely to be prescribed ART (52% vs 94%; P < .01) and virally suppressed (39% vs 77%; P < .01) than uninsured patients without RWHAP assistance. Patients with private insurance and Medicaid were 6% and 7% less likely, respectively, to be prescribed ART than those with RWHAP only (P < .01). Those with private insurance and Medicaid were 5% and 12% less likely, respectively, to be virally suppressed (P ≤ .02) than those with RWHAP only. Patients whose private or Medicaid coverage was supplemented by RWHAP were more likely to be prescribed ART and virally suppressed than those without RWHAP supplementation (P ≤ .01).

Conclusions: Uninsured and underinsured HIV-infected persons receiving RWHAP assistance were more likely to be prescribed ART and virally suppressed than those with other types of healthcare coverage.

Keywords: HIV; Ryan White; antiretroviral therapy; health insurance; viral suppression.

Figure 1

Adjusted^a prevalence of (A) being prescribed antiretroviral therapy (ART) and (B) having human immunodeficiency virus (HIV) viral load <200 copies/mL, by private, Medicaid, or Medicare healthcare coverage and receipt of Ryan White HIV/AIDS Program (RWHAP) assistance among HIV-infected adults receiving medical care: Medical Monitoring Project, 2009–2013. Prevalence estimates are predicted probabilities from logistic regression model adjusted for (a) age, race, time since HIV diagnosis, and HIV disease stage and (b) age, race, nativity, poverty, education level, homelessness, and HIV disease stage. *P ≤ .01 for χ² test comparing healthcare coverage with and without RWHAP.