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Low-income HIV patients in ACA health plans show more viral suppression
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SAN DIEGO — Data presented here at IDWeek 2015 suggest there are higher rates of viral suppression among AIDS Drug Assistance Program clients who enrolled in Affordable Care Act insurance plans.
“We were concerned with this natural policy change, and we wanted to ensure that our patients were going to achieve at least the same, if not better, HIV outcomes,” Kathleen McManus, MD, of the University of Virginia, said during a press conference. “We collaborated with the Virginia Department of Health to look at this within our state … which did not expand Medicaid.”
Kathleen McManus
McManus and colleagues examined a cohort of 3,933 adult AIDS Drug Assistance Program (ADAP) patients in Virginia who were eligible for Affordable Care Act (ACA) insurance plan enrollment. Patient data were collected from January 2013 through December 2014. Factors associated with ACA enrollment and viral suppression were identified using multivariable binary logistic regression.
The researchers found that 47.1% of eligible ADAP patients enrolled in an ACA plan. Enrollment was lower among those who were male, black, aged 25 years to 44 years, or diagnosed with AIDS as opposed to HIV. Enrollment rates ranged from 14% to 70% at individual clinics, and patients who were eligible for federal tax credits or whose previous ADAP enrollment would expire were prioritized by the health care system, and therefore were more likely to initiate ACA enrollment.
Viral suppression was achieved by 85.5% of those enrolled in an ACA plan, as opposed to 78.7% suppression among the unenrolled. Regression analysis found this difference to be significant, and that ACA enrollment was significantly associated with an increased chance of viral suppression among this population (OR = 1.45). Greater rates of viral suppression also were identified among patients with previously undetected viral loads.
According to McManus, these encouraging outcomes are an example of cost-effective HIV care in the wake of recent policy changes.
“The government, and therefore taxpayers, are some of the biggest payers for HIV medicine and HIV care in the U.S.,” McManus said. “Any time that we can use those dollars to achieve good HIV outcomes, that’s good for everybody. Every time someone who has HIV becomes virologically suppressed, we’re reducing the possibility that they’re going to transmit to more people.”
Carlos del Rio
“I think many of us have really wondered what the impact of ACA was going to be in the care of patients with HIV,” Carlos del Rio, MD, professor of medicine at Emory University School of Medicine and chair-elect of the HIV Medicine Association, said during the press conference. “It’s really telling us what happened in a state that … did not expand Medicaid, but was able to use their ADAP dollars in a very different way to provide access to patients.” – by Dave Muoio
Reference:
McManus K, et al. Abstract 728. Presented at: IDWeek; Oct. 7-11, 2015; San Diego.
Disclosures: McManus, del Rio and the other researchers report no relevant financial disclosures.
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Adaora Adimora, MD, MPH
The results of this study suggest that purchase of insurance through whatever means, including through use of ADAP funds, benefits patients. It supports the obvious need for insurance to provide access to care for all patients.Click Here to Manage Email Alerts