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Ryan White facilities more likely to provide case management, support to HIV patients
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Recent data suggest health care facilities that receive funding from the Ryan White HIV/AIDS Program were more likely to provide case management, mental health, substance abuse and other support services to patients with HIV.
“Because many HIV-infected persons lack resources that support health, provision of support services may improve their health outcomes,” Jacek Skarbinski, MD, of the CDC’s Division of Global HIV/AIDS and Tuberculosis, and colleagues wrote. “Although the [Ryan White HIV/AIDS Program (RWHAP) has extensive data on clients and funded facilities, little is known about how patient characteristics, service needs, access to services and clinical outcomes compare across RWHAP-funded and non-RWHAP-funded facilities.
Jacek Skarbinski
To determine these differences, researchers examined data from the 2009 and 2011 cycles of the Medical Monitoring Project, an ongoing national survey of adults with HIV receiving medical care in the United States. Clinical, socioeconomic, substance use and treatment data for 8,038 eligible patients with HIV were collected from June 2009 through May 2012 via interviews and medical records. Information such as ownership, funding sources and provided medical care also was compiled for 989 health care facilities and analyzed against patient data for potential relationships.
The researchers found that 34.4% of the examined facilities received RWHAP support, but 72.8% of the patients received care at these funded facilities. Demographically, patients who attended RWHAP-funded facilities were more often female, aged 18 to 39 years, black or Hispanic, and recently incarcerated or homeless. Moreover, these patients were more likely to have less than a high school education, income at or below the poverty level and no health care coverage.
Although prescription of ART was similar (adjusted prevalence ratio = 1.01; 95% CI, 0.99-1.03), patients treated at RWHAP-funded facilities were more likely to receive case management or other support such as mental health services, substance abuse services and risk counseling.
Patients at or below the poverty level were more likely to achieve viral suppression if they attended these facilities (APR = 1.09; 95% CI, 1.02-1.16); however, nonfunded facilities had a higher overall rate of viral suppression (74.4%; 95% CI, 72%-76.8% vs. 79%; 95% CI, 75.9%-82.2%).
“These facilities serve patients with multiple social determinants of poor health who heavily use on-site services known to be associated with improved outcomes,” Skarbinski and colleagues wrote. “Without health care facilities supported by the RWHAP, these patients may have reduced access to support services elsewhere.”
In a related editorial, Stephen F. Morin, PhD, of the Center for AIDS Prevention Studies at the University of California, San Francisco, said the outcomes and service programs identified by Skarbinski and colleagues demonstrate the flexibility of the RWHAP since its establishment in 1990. In addition, he also wrote that this quality will be of great use as the Affordable Care Act (ACA) restructures future care.
“As some HIV primary care is being shifted to ACA coverage, the need for more intensive medical case management and other support services not covered by ACA or Medicaid plans is now being recognized as essential to getting the maximum proportion of HIV patients virally suppressed,” Morin wrote. “Over the next 10 years, the Ryan White Program will be a key component of meeting ambitious national goals for both HIV treatment and prevention.” – by Dave Muoio
Disclosure: Morin reports working on the authorization of the RWHAP and providing oversight and funding for the program as a member of congresswoman Nancy Pelosi’s staff. All other researchers report no relevant financial disclosures.
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