title: Affordable Care Act Qualified Health Plan Coverage: Association With Improved HIV Viral Suppression for AIDS Drug Assistance Program Clients in a Medicaid Nonexpansion State.
abstract: With the Patient Protection and Affordable Care Act, many state AIDS Drug Assistance Programs (ADAPs) shifted their healthcare delivery model from direct medication provision to purchasing qualified health plans (QHPs). The objective of this study was to characterize the demographic and healthcare delivery factors associated with Virginia ADAP clients' QHP enrollment and to assess the relationship between QHP coverage and human immunodeficiency virus (HIV) viral suppression.
  
  
  
  The cohort included persons living with HIV who were enrolled in the Virginia ADAP (n = 3933). Data were collected from 1 January 2013 through 31 December 2014. Multivariable binary logistic regression was conducted to assess for associations with QHP enrollment and between QHP coverage and viral load (VL) suppression.
  
  
  
  In the cohort, 47.1% enrolled in QHPs, and enrollment varied significantly based on demographic and healthcare delivery factors. In multivariable binary logistic regression, controlling for time, age, sex, race/ethnicity, and region, factors significantly associated with achieving HIV viral suppression included QHP coverage (adjusted odds ratio, 1.346; 95% confidence interval, 1.041-1.740; P = .02), an initially undetectable VL (2.809; 2.174-3.636; P < .001), HIV rather than AIDS disease status (1.377; 1.049-1.808; P = .02), and HIV clinic (P < .001).
  
  
  
  QHP coverage was associated with viral suppression, an essential outcome for individuals and for public health. Promoting QHP coverage in clinics that provide care to persons living with HIV may offer a new opportunity to increase rates of viral suppression.
authors.affiliation: Division of Infectious Diseases and International Health.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: McManus
authors.affiliation: Department of Virginia Department of Health, Richmond.
authors.forename: Anne
authors.initials: A
authors.lastname: Rhodes
authors.affiliation: Department of Virginia Department of Health, Richmond.
authors.forename: Steven
authors.initials: S
authors.lastname: Bailey
authors.affiliation: Department of Virginia Department of Health, Richmond.
authors.forename: Lauren
authors.initials: L
authors.lastname: Yerkes
authors.affiliation: Department of Public Health Sciences.
authors.forename: Carolyn L
authors.initials: CL
authors.lastname: Engelhard
authors.affiliation: Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
authors.forename: Karen S
authors.initials: KS
authors.lastname: Ingersoll
authors.affiliation: Department of Public Health Sciences.
authors.forename: George J
authors.initials: GJ
authors.lastname: Stukenborg
authors.affiliation: Division of Infectious Diseases and International Health.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Dillingham
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000821:virology; D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003695:Delivery of Health Care; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D014481:United States; D019562:Viral Load / Q000187:drug effects; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: AIDS Drug Assistance Program; HIV; HIV outcomes; Patient Protection and Affordable Care Act; healthcare delivery