Ryan White HIV/AIDS Program Assistance and HIV Treatment Outcomes.
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.
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
Heather
H
Bradley
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
Abigail H
AH
Viall
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
Pascale M
PM
Wortley
HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland.
Antigone
A
Dempsey
HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland.
Heather
H
Hauck
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
Jacek
J
Skarbinski
D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
HIV; Ryan White; antiretroviral therapy; health insurance; viral suppression