Ryan White Program Effective for HIV Care
The Ryan White HIV/AIDS Program helps more than 500,000 low-income people living with HIV to access HIV-related health care. With the implementation of the Affordable Care Act in 2014, however, many of the uninsured people who relied on the program were able to access coverage through Medicaid expansion, a Health Insurance Marketplace, or an employer.
But patients who remained uninsured and continued to rely on the Ryan White HIV/AIDS Program were just as likely to achieve consistent viral suppression as patients who transitioned to Medicaid or private insurance, according to a new study led by a School of Public Health researcher.
The study was published in Clinical Infectious Diseases.
“Patients were able to maintain consistent viral suppression just as well when they had no support for HIV care except through the Ryan White Program,” says lead author Julia Raifman, assistant professor of health law, policy & management. “Continued support for the Ryan White Program is critical for maintaining the health of people living with HIV and for preventing new HIV infections in the United States.”
The Ryan White Program provides full support for HIV-related services for uninsured patients, and assists insured patients with co-pays and cost-sharing. HIV viral suppression, achieved through uninterrupted use of an HIV medication regimen, is associated not only with improved health, but also greatly reduces the likelihood of transmitting the virus.
Raifman and her colleagues used viral load and insurance data on 1,942 patients at four HIV care sites in different regions of the US from 2012 through 2015. All of the patients were uninsured and relied on the Ryan White Program for HIV care in 2013.
The researchers divided the patients into three categories: the 73.7 percent who remained uninsured, the 18.6 percent who transitioned to Medicaid (including more than half of the patients living in Medicaid-expansion states) in 2014, and the 7.6 percent who transitioned to private insurance in 2014.
They found that rates of viral suppression were fairly consistent for each of these three groups in 2013 and in 2015. In the group that remained uninsured, the rate of consistent viral suppression was 74.4 percent in 2013 and 74.9 percent in 2015. For the group that would transition to Medicaid, the rate of consistent viral suppression was 64.4 percent in 2013 and 66.6 percent in 2015. In the group that would transition to private insurance, the rate of consistent viral suppression was 83.1 percent in 2013 and 79.1 percent in 2015.
“One possible reason for the lack of an association between healthcare coverage transition and viral suppression is that different types of insurance coverage may not have differentially facilitated or impeded consistent medication access and adherence,” the authors wrote. “A second possibility is that any new barriers associated with Medicaid or private insurance may have been overcome through ongoing Ryan White HIV/AIDS Program assistance such as covering co-pays.”
The authors note that more than 75 percent of people who received some form of Ryan White support in 2017 had healthcare coverage.
The study was co-authored by Keri Althoff, Kelly Gebo, Richard Moore, and Stephen Berry of Johns Hopkins University; Peter Rebeiro of Vanderbilt University; Christopher Mathews of the University of California, San Diego; Laura Cheever and Heather Hauck of the HIV/AIDS Bureau; and Judith Aberg of Mount Sinai Icahn School of Medicine.