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. 2024 Jun 1;38(7):1025-1032.
doi: 10.1097/QAD.0000000000003836. Epub 2024 Jan 11.

The health equity implications of the Health Resources and Services Administration's Ryan White HIV/AIDS Program

Ravi Goyal  1 , John Hotchkiss  2 , Boyd Gilman  2 , Pamela W Klein  3 , Robert J Mills  3 , Jennifer Starling  2 , Natasha K Martin  1 , Thomas Patton  1 , Stacy M Cohen  3 , Laura Cheever  3
Affiliations

The health equity implications of the Health Resources and Services Administration's Ryan White HIV/AIDS Program

Ravi Goyal et al. AIDS. .

Abstract

Objective: Investigate the role of the Ryan White HIV/AIDS Program (RWHAP) - which funds services for vulnerable and historically disadvantaged populations with HIV - in reducing health inequities among people with HIV over a 10-year horizon.

Design: We use an agent-based microsimulation model to incorporate the complexity of the program and long-time horizon.

Methods: We use a composite measure (the Theil index) to evaluate the health equity implications of the RWHAP for each of four subgroups (based on race and ethnicity, age, gender, and HIV transmission category) and two outcomes (probability of being in care and treatment and probability of being virally suppressed). We compare results with the RWHAP fully funded versus a counterfactual scenario, in which the medical and support services funded by the RWHAP are not available.

Results: The model indicates the RWHAP will improve health equity across all demographic subgroups and outcomes over a 10-year horizon. In Year 10, the Theil index for race and ethnicity is 99% lower for both outcomes under the RWHAP compared to the non-RWHAP scenario; 71-93% lower across HIV transmission categories; 31-44% lower for age; and 73-75% lower for gender.

Conclusion: Given the large number of people served by the RWHAP and our findings on its impact on equity, the RWHAP represents an important vehicle for achieving the health equity goals of the National HIV/AIDS Strategy (2022-2025) and the Ending the HIV Epidemic Initiative goal of reducing new infections by 90% by 2030.

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Conflict of interest statement

DECLARATION OF INTERESTS

PWK, RJM, SMC, and LC were employees of HRSA at the time of analysis. NKM receives unrestricted research grants from Gilead and AbbVie unrelated to this work.

Figures

Figure 1.
Figure 1.. Disease model structure for the model population including various stages of care.
Purple arrows indicate transitions affected by receipt of needed ancillary services, including MCM, mental health and substance abuse services, and other non-OAHS medical care and support services. People can transition from any care stage (Stages 2–6) to death (Stage 7). MCM = medical case management; OAHS = outpatient ambulatory health service.
Figure 2.
Figure 2.. Theil index for percentage of people with HIV (a) in care and treatment and (b) virally suppressed at Year 10: With versus without the RWHAP.
The bars represent the medians across all simulations and the brackets around the medians represent the 95% prediction intervals. An asterisk (*) indicates the 95% prediction intervals of the Theil index associated with the RWHAP and non-RWHAP scenarios do not overlap for the demographic characteristic.
See this image and copyright information in PMC

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