scholarly journals Affordable Care Act Qualified Health Plan Coverage: Association With Improved HIV Viral Suppression for AIDS Drug Assistance Program Clients in a Medicaid Nonexpansion State

2016 ◽  
Vol 63 (3) ◽  
pp. 396-403 ◽  
Author(s):  
Kathleen A. McManus ◽  
Anne Rhodes ◽  
Steven Bailey ◽  
Lauren Yerkes ◽  
Carolyn L. Engelhard ◽  
...  
Keyword(s):  
Health Plan ◽  
Affordable Care Act ◽  
Viral Suppression ◽  
Assistance Program ◽  
Aids Drug Assistance Program ◽  
Hiv Viral Suppression

scholarly journals Affordable Care Act Qualified Health Plan Enrollment for AIDS Drug Assistance Program Clients: Virginia's Experience and Best Practices

2016 ◽  
Vol 32 (9) ◽  
pp. 885-891 ◽  
Author(s):  
Kathleen A. McManus ◽  
Robert C. Rodney ◽  
Anne Rhodes ◽  
Steven Bailey ◽  
Rebecca Dillingham
Keyword(s):  
Best Practices ◽  
Health Plan ◽  
Affordable Care Act ◽  
Assistance Program ◽  
Aids Drug Assistance Program

scholarly journals Year 2 of Affordable Care Act Qualified Health Plans (QHPs) in a Medicaid Nonexpansion State: QHPs Associated With Viral Suppression for Virginia AIDS Drug Assistance Program Clients

2018 ◽  
Vol 5 (12) ◽  
Author(s):  
Kathleen A McManus ◽  
Anne Rhodes ◽  
Lauren Yerkes ◽  
Carolyn L Engelhard ◽  
Karen S Ingersoll ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Delivery ◽  
Affordable Care Act ◽  
Viral Suppression ◽  
Care Delivery ◽  
Binary Logistic Regression ◽  
Health Plans ◽  
Assistance Program ◽  
Financial Status ◽  
Aids Drug Assistance Program

Abstract Background For year 1 of the Affordable Care Act (ACA), Virginia AIDS Drug Assistance Program (ADAP) clients with Qualified Health Plans (QHPs) achieved a higher rate of viral suppression. This study characterizes the demographic and health care delivery factors associated with QHP enrollment in year 2 and assesses the relationship between 2015 QHP coverage and HIV viral suppression. Methods The cohort included Virginia ADAP clients who were eligible for ADAP-funded QHPs. Data were collected from 2014 to 2015. Multivariable binary logistic regression was conducted to assess the association of demographic and health care delivery factors with QHP enrollment and viral suppression. Results In year 2, 63% of the cohort (n = 4631) enrolled in QHPs; 2015 ADAP-funded QHP enrollment was associated with 2014 ADAP-funded QHP (adjusted odds ratio [aOR], 111.11; 95% confidence interval [CI], 90.91–166.67), 2014 engagement in care (aOR, 2.16; 95% CI, 1.65–2.82), age (P < .001), race/ethnicity (P = .03), financial status (P < .001), and region (P < .001). For clients engaged in care (n = 2501), viral suppression was higher (83.3%) for those with ADAP-funded QHP coverage than for those who received medications from ADAP (79.9%). In multivariable binary logistic regression, achieving viral suppression was associated with 2015 QHP coverage (aOR, 1.27; 95% CI, 1.01–1.60), an initially undetectable viral load (aOR, 2.69; 95% CI, 2.13–3.39), gender (P = .03), age (P = .01), no AIDS diagnosis (aOR, 1.41; 95% CI, 1.12–1.78), financial status (P = .004), and region (P < .001). Conclusions Virginia ADAP client 2015 QHP enrollment increased compared with year 1 and varied based on demographic and health care delivery factors. QHP coverage was again associated with viral suppression, an essential outcome for individuals and for public health.

scholarly journals 883. Evidence from a Multistate Cohort: Enrollment in Affordable Care Act Qualified Health Plans Results in Viral Suppression

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S19-S20
Author(s):  
Kathleen A McManus ◽  
Bianca B Christensen ◽  
V P Nagraj ◽  
Elizabeth T Rogawski McQuade ◽  
Renae Furl ◽  
...  
Keyword(s):  
South Carolina ◽  
Viral Load ◽  
Affordable Care Act ◽  
Low Income ◽  
Viral Suppression ◽  
Healthcare Delivery ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Health Plans ◽  
Assistance Program

Abstract Background 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 1-year risk of VS. Results For the cohort (n = 7,800; 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 = 4,597), 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. Conclusion 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. Disclosures All Authors: No reported Disclosures.

scholarly journals 2014 Affordable Care Act Enrollment of AIDS Drug Assistance Program Clients and Associated HIV Outcomes

2015 ◽  
Vol 2 (suppl_1) ◽  
Author(s):  
Kathleen Mcmanus ◽  
Anne Rhodes ◽  
Lauren Yerkes ◽  
Steven Bailey ◽  
Rebecca Dillingham
Keyword(s):  
Affordable Care Act ◽  
Assistance Program ◽  
Aids Drug Assistance Program

scholarly journals The Effect of Partnership Presence and Support on HIV Viral Suppression Among Serodiscordant Partnered and Single Heterosexual HIV-Positive Individuals in Brazil

2021 ◽  
Author(s):  
Zoë Baker ◽  
Pamina Gorbach ◽  
Marineide Gonçalves de Melo ◽  
Ivana Varela ◽  
Eduardo Sprinz ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Hiv Positive ◽  
Hiv Viral Suppression

scholarly journals 1311. Ryan White HIV Care Continuum Model Doubled the Rate of Community HIV Viral Suppression for Newly Diagnosed Patients: A 10-Year Review

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S473-S473
Author(s):  
Christina Rizk ◽  
Alice Zhao ◽  
Janet Miceli ◽  
Portia Shea ◽  
Merceditas Villanueva ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Linkage To Care ◽  
Hiv Care ◽  
Hiv Care Continuum ◽  
Newly Diagnosed ◽  
New Haven ◽  
Care Continuum ◽  
Art Initiation ◽  
Ryan White ◽  
Hiv Viral Suppression

Abstract Background It is estimated that 1,295 per 100,000 are people living with HIV (PLWH) in New Haven, which is the second highest rate of HIV prevalence in Connecticut. Since 2009, New Haven has established the Ryan White (RW) HIV Care Continuum. The main goals of HIV care are early linkage to care, ART initiation, and HIV viral suppression. This study is designed to understand the trends and outcomes in newly diagnosed PLWH in New Haven County. Methods This study is a retrospective medical record review of all newly diagnosed RW eligible PLWH from January 1, 2009 to December 31, 2018. The data were collected in REDCap database and included demographics, HIV risk factor, presence of mental health and/or substance abuse disorder, date of diagnosis, date of initial visit, and ART initiation. Health outcomes such as AIDS at diagnosis and rate of viral suppression were evaluated. The data were then analyzed to show the trends over 10 years. Results From January 1, 2009 to December 31, 2018 there were 420 newly diagnosed RW PLWH. Sixty-seven percent of those were male, 56% were non-white, 47% self-identified as Men who have Sex with Men (MSM), and 41% were heterosexual. Twenty-nine percent had AIDS-defining condition at the time of the diagnosis. Thirty-four percent of the 420 patients had a mental health and/or substance use disorder; 53% of those were MSM and 51% were non-white. Over the 10-year period, it was noted that the duration between date of HIV diagnosis and linkage to care as well as ART initiation decreased. This decline was associated with a substantial increase in viral suppression. The average time between the dates of HIV diagnosis and initial visit decreased from 269 days in 2009 to 13 days in 2018. Moreover, the average time between the dates of diagnosis and ART initiation dropped from 308 days in 2009 to 15 days in 2018. The 1-year HIV viral suppression rate subsequently doubled from 44% in 2009 to 87% in 2018 (P < 0.01). Conclusion The Ryan White HIV Care Continuum Model with emphasis on early linkage to care and ART initiation can have a significant impact on HIV viral suppression at a community level for newly diagnosed patients. Another important observation in this study was the alarming high rate of AIDS at diagnosis, which highlights the need for universal HIV testing, and early diagnosis. Disclosures All authors: No reported disclosures.

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