Enrollment in AIDS Drug Assistance Programs Linked With Viral Suppression, Study Finds

Enrollment in AIDS Drug Assistance Programs (ADAPs)—funded Qualified Health Plans (QHPs) is associated with viral suppression (VS) across states and demographic groups, according to a recent study in Clinical Infectious Diseases.

The research involved a multistate cohort of ADAP clients who were eligible for ADAP-funded QHPs. The study used a log-binomial model to estimate the association of demographics and healthcare delivery factors with QHP enrollment prevalence and 1-year risk of VS. An additional calculation was for the number needed to treat/enroll (NNT) for 1 additional person to achieve VS.

“Before the Patient Protection and Affordable Care Act (ACA), low-income people living with HIV (PLWH) who were uninsured or underinsured could receive antiretroviral therapy and other specified medications through state-run AIDS Drug Assistance Programs (ADAPs),” the authors explained. “In individual states, shifting from direct ADAP medication provision (direct ADAP) to ADAP-funded QHPs has been associated with improved VS rates for ADAP clients or low-income PLWH. This study aims to assess whether this association is consistent in multiple states (Nebraska, South Carolina, Virginia) for 2015, the second year of the ACA implementation.”

According to the results, 52% of the 7776 individuals in the cohort were enrolled in QHPs. Enrollment in a QHP in 2015 was associated with QHP coverage and engagement in care in 2014. Furthermore, PLWH who were engaged in care and had QHPs had a higher VS rate than those who received medications from direct ADAPs.

The results also revealed that QHPs’ NNT for an additional person to achieve VS is 20 and that starting undetectable and enrolling in QHPs in 2015 was associated with VS.

"If all eligible people living with HIV who are receiving support from a state AIDS Drug Assistance Program were enrolled in Qualified Health Plans, an additional 2.4% of AIDS Drug Assistance Program clients could achieve viral suppression. This could also avert 103 HIV infections and avoid more than $41 million dollars in healthcare costs," Kathleen A. McManus, MD, of the University of Virginia School of Medicine and UVA Health, stated. "As the United States focuses on ending HIV as an epidemic, we need to ensure that our health policies and laws support the goal of getting to zero new HIV diagnoses."

The researchers suggested that future studies should examine whether health system—level interventions can reduce disparities for PLWH.

Reference

McManus K, Christensen B, Nagraj VP, et al. Evidence from a multistate cohort: enrollment in Affordable Care Act Qualified Health Plans’ association with viral suppression [published online November 18, 2019]. Clin Infect Dis. doi: 10.1093/cid/ciz1123.