Ryan White-Funded HIV Programs Offer More Complete Services

Marcia Frellick

September 02, 2015

Low-income patients with HIV who received care at a facility funded by the Ryan White HIV/AIDS Program (RWHAP) were more likely to achieve viral suppression than those at non-RWHAP-funded facilities, according to a new study.

RWHAP-funded facilities were also more likely than others to provide services such as case management and mental health and addiction services.

John Weiser, MD, MPH, from the Division of HIV/AIDS Prevention of the Centers for Disease Control and Prevention in Atlanta, Georgia, and colleagues report their findings online August 31 in JAMA Internal Medicine.

The unadjusted rates of viral suppression favored the non-RWHAP-funded clinics, at 79.0%, compared with 74.4% of patients at RWHAP-funded facilities. However, after adjusting for patient characteristics, the likelihood of viral suppression among poor patients was higher at RWHAP-funded (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.02 - 1.16) clinics. The rates of antiretroviral therapy were similar among the two types of clinics (HR, 1.01; 95% CI, 0.99 - 1.03),

Evidence of RWHAP’s Success

RWHAP was established in 1990 to help low-income, uninsured, and underinsured people living with HIV and their families receive quality HIV treatment. It reaches more than 500,000 people each year and accounts for 16% of federal spending on HIV care and treatment, the authors note.

The Affordable Care Act has expanded healthcare coverage for HIV-infected people, as HIV as a preexisting condition can no longer be excluded from coverage. However, expanded coverage might not cover support services such as transportation, counseling, and help with copays that help people remain in care and adherent to antiretroviral therapy.

"Therefore, it is likely that the RWHAP will continue to play a key role in providing these crucial services," the authors write.

The researchers used 2009 and 2011 data from the Medical Monitoring Project, a national sample of 8038 HIV-infected adults receiving medical care at 989 outpatient facilities.

The RWHAP-funded facilities were more likely than non-RWHAP facilities to provide case management (76.1% [95% CI, 69.9% - 82.2%] vs 15.4% [10.4% - 20.4%]), mental health services (64.0% [95% CI, 57.0% - 71.0%] vs 18.0% [95% CI, 14.0% - 21.9%]), and substance abuse services (33.6% [95% CI, 27.0% - 40.2%] vs 12.0% [8.0% - 16.0%]) and other support services.

The RWHAP design of multidisciplinary care has been described as a model for the team approach of the patient-centered medical home, which has been shown to improve how primary care is organized and delivered, according to the authors.

In the study, 34.4% of facilities received RWHAP funding and 72.8% of patients received care at RWHAP-funded facilities.

"Without facilities supported by the RWHAP, these patients may have had reduced access to services elsewhere," the authors conclude.

In an invited commentary, Stephen Morin, PhD, from the University of California, San Francisco, emphasizes the benefits of viral suppression, in that patients who are suppressed are much less likely to transmit HIV.

Finding those with the virus and achieving suppression is good for both individuals' health and public health and could result in significant cost savings, he writes.

Dr Morin notes that 29 states have expanded Medicaid, and that has freed up some Ryan White funds for support services. However, 21 states, which include some of the poorest states in the South, have not expanded Medicaid and continue to rely heavily on Ryan White–funded facilities.

"Congress is to be commended for establishing the Ryan White Program and for investing in a flexible HIV response," he writes. "However, this work is not finished. 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," he writes.

Funding for the Medical Monitoring Project is provided by the Centers for Disease Control and Prevention. Dr Morin worked on the authorization of the Ryan White program and providing oversight and funding for the program as a member of Congresswoman Nancy Pelosi's staff between 1987 and 1998. The other authors have disclosed no relevant financial relationships.

JAMA Intern Med. Published online August 31, 2015. Article abstract, Commentary extract


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