Oral Abstract Submission
Rebecca Dillingham, MD, MPH
University of Virginia
Disclosure: Gilead: Research Grant or Support
NIH: Grant/Research Support
Virginia Department of Health: Grant/Research Support
Warm Health Technology: Consultant
In individual states, the Patient Protection and Affordable Care Act has been associated with improved viral suppression (VS) rates for AIDS Drug Assistance Program (ADAP) clients or low-income people living with HIV (PLWH). This study aims to assess whether this association is consistent in multiple states (Nebraska, South Carolina, Virginia).
Methods : The multistate cohort included ADAP clients who were eligible for ADAP-funded Qualified Health Plans (QHPs). Data were collected from 2014 through 2015. A log-binomial model was used to estimate the association of demographics (age, race/ethnicity, sex, AIDS, rurality, HIV risk factor, previous VS) and healthcare delivery factors (income, previous ADAP plan, previous HIV care engagement) with QHP enrollment prevalence and one-year risk of VS.
Results : For the cohort (n=7800; 5% NE, 36% SC, 59% VA), 52% enrolled in ADAP-funded QHPs with enrollment ranging from 35% to 63% by state. Enrollment in ADAP-funded QHPs in 2015 was higher for those who had ADAP-funded QHPs in 2014 (adjusted prevalence ratio [aPR] 3.28; 95% confidence interval [CI] 3.21-3.35) and those who were engaged in care in 2014 (aPR 1.16; 95% CI 1.05-1.27), and it was lower for those with a rural residence (aPR 0.91; 95% CI 0.81-1.00). Of those who were consistently engaged in care (n=4597), as defined by one viral load in 2014 and one viral load in 2015 separated by at least 180 days, those who received medications from Direct ADAP had a VS rate of 80.2% and those with ADAP-funded QHPs had a VS rate of 86.0%. The number needed to enroll in ADAP-funded QHPs for an additional PLWH to achieve VS is 18. Those who achieved VS in 2014 (adjusted risk ratio [aRR] 1.39, 95% CI 1.30-1.48) and those who enrolled in QHPs in 2015 (aRR 1.06, 95% CI 0.99-1.13) were more likely to achieve/maintain VS.
Additional efforts should be made to reach rural PLWH for QHP enrollment. State ADAPs, especially those in the South and those in states without Medicaid expansion, should consider investing in purchasing QHPs for PLWH because increased enrollment could improve VS rates. This evidence-based intervention could be a part of “Ending the HIV Epidemic.” Once ADAP clients are enrolled in ADAP-funded QHPs, they stay enrolled, and QHP enrollment is associated with VS across states and demographic groups<./p>