title: Underutilization of the AIDS Drug Assistance Program: associated factors and policy implications.
abstract: BACKGROUND
  The AIDS Drug Assistance Program (ADAP) provides antiretroviral medications to low-income individuals with HIV infection.
  
  
  METHODS
  A prospective cohort study of ADAP utilization, measured using medication possession ratio (MPR), was conducted during the 2008 calendar year at the University of Alabama at Birmingham 1917 HIV Clinic. Multivariable ordinal logistic regression evaluated factors associated with ADAP utilization.
  
  
  RESULTS
  Among 245 patients, MPR quartiles (Q) were the following: Q1<69 percent, Q2=69-83 percent, Q3=84-93 percent, Q4>93 percent. In ordinal logistic regression, younger age (OR=0.59 per 10 years; 95 percent CI=0.44-0.79), nonwhite males (2.18; 1.18-4.04), lower CD4 count (2.79 for <200 cells/mm(3) ; 1.44-5.43), and a history of alcohol abuse (2.11; 1.02-4.37) were associated with poor ADAP utilization.
  
  
  CONCLUSIONS
  One quarter of ADAP enrollees had MPR below 69 percent, a level well below that associated with optimal HIV treatment outcomes, indicating a need for programmatic interventions to improve ADAP utilization.
authors.affiliation: University of Alabama School of Medicine, 908 20th St. South, Birmingham, AL 35294, USA. noahg@uab.edu
authors.forename: Noah C
authors.initials: NC
authors.lastname: Godwin
authors.forename: James H
authors.initials: JH
authors.lastname: Willig
authors.forename: Christa R
authors.initials: CR
authors.lastname: Nevin
authors.forename: Hui-Yi
authors.initials: HY
authors.lastname: Lin
authors.forename: Jeroan
authors.initials: J
authors.lastname: Allison
authors.forename: Kathy
authors.initials: K
authors.lastname: Gaddis
authors.forename: Jennifer
authors.initials: J
authors.lastname: Peterson
authors.forename: Michael S
authors.initials: MS
authors.lastname: Saag
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
authors.forename: James L
authors.initials: JL
authors.lastname: Raper
mesh_terms: D000328:Adult; D000407:Alabama; D019380:Anti-HIV Agents / Q000191:economics*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006291:Health Policy; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008483:Medical Assistance / Q000706:statistics & numerical data*; D055118:Medication Adherence; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D019380:Anti-HIV Agents