Evidence From a Multistate Cohort: Enrollment in Affordable Care Act Qualified Health Plans' Association With Viral Suppression

Kathleen A McManus; Bianca Christensen; V Peter Nagraj; Renae Furl; Lauren Yerkes; Susan Swindells; Sharon Weissman; Anne Rhodes; Paul Targonski; Elizabeth Rogawski McQuade; Rebecca Dillingham

doi:10.1093/cid/ciz1123

Evidence From a Multistate Cohort: Enrollment in Affordable Care Act Qualified Health Plans' Association With Viral Suppression

Clin Infect Dis. 2020 Dec 17;71(10):2572-2580. doi: 10.1093/cid/ciz1123.

Authors

Kathleen A McManus^{1

2}, Bianca Christensen³, V Peter Nagraj⁴, Renae Furl⁵, Lauren Yerkes⁶, Susan Swindells⁵, Sharon Weissman⁷, Anne Rhodes⁶, Paul Targonski^{8

9}, Elizabeth Rogawski McQuade^{1

8}, Rebecca Dillingham¹

Affiliations

¹ Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA.
² Center for Health Policy, University of Virginia, Charlottesville, Virginia, USA.
³ University of Nebraska College of Medicine, Omaha, Nebraska, USA.
⁴ School of Medicine Research Computing, University of Virginia, Charlottesville, Virginia, USA.
⁵ Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA.
⁶ Virginia Department of Health, Richmond, Virginia, USA.
⁷ Division of Infectious Diseases, University of South Carolina, Columbia, South Carolina, USA.
⁸ Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA.
⁹ Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.

Abstract

Background: Healthcare delivery changes associated with viral suppression (VS) could contribute to the United States' "Ending the HIV Epidemic" (EtHE) initiative. This study aims to determine whether Qualified Health Plans (QHPs) purchased by AIDS Drug Assistance Programs (ADAPs) are associated with VS for low-income people living with HIV (PLWH) across 3 states.

Methods: A multistate cohort of ADAP clients eligible for ADAP-funded QHPs were studied (2014-2015). A log-binomial model was used to estimate the association of demographics and healthcare delivery factors with QHP enrollment prevalence and 1-year risk of VS. A number needed to treat/enroll (NNT) for 1 additional person to achieve viral suppression was calculated.

Results: Of the cohort (n = 7776), 52% enrolled in QHPs. QHP enrollment in 2015 was associated with QHP coverage in 2014 (adjusted PR [aPR], 3.28; 95% confidence intervals [CIs], 3.06-3.53) and engagement in care in 2014 (aPR, 1.16; 1.04-1.28). PLWH who were engaged in care (n = 4597) and had QHPs had a higher VS rate than those who received medications from Direct ADAP (86.0% vs 80.2%). QHPs' NNT for an additional person to achieve VS is 20 (14.1-34.5). Starting undetectable (adjusted risk ratio [aRR], 1.39; 1.28-1.52) and enrolling in QHPs in 2015 (aRR, 1.06; 0.99-1.14) was associated with VS.

Conclusions: Once enrolled in ADAP-funded QHPs, ADAP clients stay enrolled. Enrollment is associated with VS across states/demographic groups. ADAPs, especially in the South and in Medicaid nonexpansion states, should consider investing in QHPs because increased enrollment could improve VS rates. This evidence-based intervention could be part of EtHE.

Keywords: AIDS Drug Assistance Program; HIV; Patient Protection and Affordable Care Act; health; healthcare reform; insurance.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Anti-HIV Agents* / therapeutic use
HIV Infections* / drug therapy
HIV Infections* / epidemiology
Humans
Medicaid
Patient Protection and Affordable Care Act
Poverty
United States / epidemiology

Substances

Anti-HIV Agents

Grants and funding

K08 AI136644/AI/NIAID NIH HHS/United States