Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2017 04 25() doi 10.1093/cid/cix380
Knowledge gaps remain about how the Ryan White HIV/AIDS Program (RW) contributes to health outcomes. We examined the association between different RW service classes and retention in care (RiC) or viral suppression (VS).
We identified Virginians engaged in any HIV care, January 1-December 31, 2014. RW beneficiaries were classified by receipt of ≥1 service from three classes: Core medical, Support and insurance and/or direct medication assistance through the AIDS Drug Assistance Program (ADAP). Receipt of all RW classes was defined as comprehensive assistance. We used multivariable logistic regression to compare the odds of RiC and of VS by comprehensive assistance and by RW classes alone and in combination.
Among 13,104 individuals, 58% received any RW service and 17% comprehensive assistance. Comprehensive assistance is significantly associated with RiC (adjusted odds ratio, 95% confidence interval: 8.8, 7.2-10.8) and VS (3.3, 2.9-3.8). Receiving any two RW classes or Core alone is significantly associated with RiC and VS, with the strength of association decreasing as the number of classes decreases. Recipients of Support alone are significantly less likely to have VS (0.75, 0.59-0.96). For ADAP recipients also receiving Core and/or Support, insurance assistance is significantly associated with VS compared to receiving direct medication only (1.6, 1.3-1.9); this relationship is not significant for those who receive ADAP alone.
Receiving more classes of RW-funded services is associated with improved HIV outcomes. For some populations with insurance, RW-funded services may still be required for optimal health outcomes.