As the Ryan White HIV/AIDS Program (RWHAP) commemorates its 25th this summer, two new articles published this week highlight the critical role the Program has in providing care and treatment services to low income people living with HIV in the United States.
According to a new article in the Journal of the American Medical Association, “Service Delivery and Patient Outcomes in Ryan White HIV/AIDS Program-funded and Non-funded Healthcare Facilities in the United States”, over two-thirds of HIV-infected persons in the United States receive care at RWHAP-funded facilities. Many have multiple health and behavioral health challenges and heavily utilize medical care and essential support services at RWHAP-funded facilities. Results in the article demonstrate that receiving care and support services at RWHAP funded facilities are associated with improved outcomes.
The article on service delivery and patient outcomes explored the differences in patient characteristics, service needs, service access, and clinical outcomes between facilities receiving RWHAP funding versus facilities not receiving RWHAP funding. To examine the differences between these facilities, data from the 2009 and 2011 cycles of the Medical Monitoring Project, a national probability sample of HIV-infected adults in care, were used to make comparisons. Overall, 34.4 percent of facilities received RWHAP funding and 72.8 percent of HIV patients received care at RWHAP-funded facilities. Compared to patients at non-RWHAP-funded facilities, those attending RWHAP-funded facilities were younger and less educated and larger proportions had incomes below the federal poverty level, were female, black or Hispanic and without health care coverage. Larger proportions of RWHAP-funded facilities provided case management and other support services, substance abuse treatment, and mental health services, and patients attending RWHAP-funded facilities were more likely to receive these services.
The article concludes that low income patients were more likely to achieve viral suppression if they received care at a RWHAP-funded facility. In addition, without health care facilities supported by RWHAP, these patients may have reduced access to services elsewhere.
A second article, “Impact of Ryan White HIV/AIDS Program Assistance on HIV Treatment Outcomes” featured in Clinical Infectious Diseases this week assessed the association between Ryan White HIV/AIDS Program assistance, alone or in combination with private or public health care coverage, and HIV treatment outcomes among HIV-infected adults in medical care. It illustrated that uninsured and underinsured HIV-infected persons receiving Ryan White HIV/AIDS Program services had better health outcomes than those with private or public health care coverage (e.g. Medicaid or health insurance).
The study utilized data collected using face-to-face patient interviews and medical record abstractions in 2009-2013 from the Medical Monitoring Project (MMP). MMP is a surveillance system designed to produce nationally representative, cross-sectional estimates of behavioral and clinical characteristics of HIV-infected adults receiving medical care in the United States.
Among all patients in the study, 40.7 percent had any RWHAP service and 15.3 percent relied solely on RWHAP services for HIV care. Nearly 57 percent of patients had private or public health care coverage only, including private insurance (17.0 percent), Medicaid (15.9 percent), Medicare (3.4 percent), or both (9.4 percent); 2.7 percent were uninsured with no RWHAP assistance. Overall, 91.1 percent of patients were on antiretroviral treatment (ART), and 74.7 percent were virally suppressed. Compared to uninsured patients not receiving RWHAP assistance, uninsured patients receiving RWHAP assistance were significantly more likely to be on ART and to be virally suppressed. After adjusting for patient characteristics, those with private insurance, Medicaid, or Medicare were 6 percent, 7 percent, and 4 percent less likely, respectively, to be on ART than those with RWHAP only (P<0.01). Patients with private insurance or Medicaid were 5 percent and 12 percent, less likely, respectively, to be virally suppressed (P<0.05) than those with RWHAP only. Patients whose private or Medicaid coverage for services was augmented by RWHAP services were more likely to be on ART and to be virally suppressed than those without RWHAP services (P<0.01).