A mathematical model to estimate the state-specific impact of the Health Resources and Services Administration’s Ryan White HIV/AIDS Program

Klein, Pamela W.; Cohen, Stacy M.; Jacobson, Evin Uzun; Li, Zihao; Clark, Glenn; Fanning, Miranda; Sterling, Rene; Young, Steven R.; Sansom, Stephanie L.; Hauck, Heather

doi:10.1371/journal.pone.0234652

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…We applied the HIV Optimization and Prevention Economics (HOPE) model, a dynamic, compartmental model that simulates that portion of the US population aged 13 years and older that is sexually active or drug injecting. [11][12][13][14][15][16] Our analytic time horizon was 2021-2030. The population is stratified into 273 subpopulations by sex, age, race/ethnicity, transmission category, risk level, and circumcision status.…”

Section: Hope Modelmentioning

confidence: 99%

Optimizing HIV Prevention Efforts to Achieve EHE Incidence Targets

Jacobson

Hicks

Carrico

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: A goal of the US Department of Health and Human Services' Ending the HIV Epidemic (EHE) in the United States initiative is to reduce the annual number of incident HIV infections in the United States by 75% within 5 years and by 90% within 10 years. We developed a resource allocation analysis to understand how these goals might be met. Methods:We estimated the current annual societal funding [$2.8 billion (B)/yr] for 14 interventions to prevent HIV and facilitate treatment of infected persons. These interventions included HIV testing for different transmission groups, HIV care continuum interventions, pre-exposure prophylaxis, and syringe services programs. We developed scenarios optimizing or reallocating this funding to minimize new infections, and we analyzed the impact of additional EHE funding over the period 2021-2030.Results: With constant current annual societal funding of $2.8 B/yr for 10 years starting in 2021, we estimated the annual incidence of 36,000 new cases in 2030. When we added annual EHE funding of $500 million (M)/yr for 2021-2022, $1.5 B/yr for 2023-2025, and $2.5 B/yr for 2026-2030, the annual incidence of infections decreased to 7600 cases (no optimization), 2900 cases (optimization beginning in 2026), and 2200 cases (optimization beginning in 2023) in 2030.Conclusions: Even without optimization, significant increases in resources could lead to an 80% decrease in the annual HIV incidence in 10 years. However, to reach both EHE targets, optimization of prevention funding early in the EHE period is necessary. Implementing these efficient allocations would require flexibility of funding across agencies, which might be difficult to achieve.

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Section: Hope Modelmentioning

confidence: 99%

Optimizing HIV Prevention Efforts to Achieve EHE Incidence Targets

Jacobson

Hicks

Carrico

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…ADAPs pay for insurance and medical care for 20% of people living with HIV in the United States, and people on the program have high rates of viral suppression, the central measure of successful HIV treatment [ 2 , 3 ]. Despite the benefits of the program, many PLWH struggle to complete the procedures required to maintain enrollment in the program and subsequently become disenrolled [ 4 , 5 ]. However, the effect of ADAP disenrollment, particularly temporary disruptions in coverage, on HIV clinical outcomes is unclear.…”

Section: Introductionmentioning

confidence: 99%

AIDS Drug Assistance Program disenrollment is associated with loss of viral suppression beyond differences in homelessness, mental health, and substance use disorders: An evaluation in Washington state 2017–2019

et al. 2023

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AIDS Drug Assistance Programs (ADAPs) are state-administered programs that pay for medical care for people living with HIV in the US. Maintaining enrollment in the programs is challenging, and a large proportion of clients in Washington state (WA) fail to recertify and are disenrolled. In this study we sought to quantify the impact of disenrollment from ADAPs on viral suppression. We conducted a retrospective cohort study of the 5238 clients in WA ADAP from 2017 to 2019 and estimated the risk difference (RD) of viral suppression before and after disenrollment. We performed a quantitative bias analysis (QBA) to assess the effect of unmeasured confounders, as the factors that contribute to disenrollment and medication discontinuation may overlap. Of the 1336 ADAP clients who disenrolled ≥1 time, 83% were virally suppressed before disenrollment versus 69% after (RD 12%, 95%CI 9–15%). The RD was highest among clients with dual Medicaid-Medicare insurance (RD 22%, 95%CI 9–35%) and lowest among privately insured individuals (RD 8%, 95%CI 5–12%). The results of the QBA suggest that unmeasured confounders do not negate the overall RD. The ADAP recertification procedures negatively impact the care of clients who struggle to stay in the program; alternative procedures may reduce this impact.

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“…5,6 The Ryan White HIV/AIDS Program's (RWHAP) AIDS Drug Assistance Program (ADAP) is intended to remove financial barriers to treatment and is tremendously successful in improving access to HIV care. 7,8 Two previous studies demonstrated that ADAP was associated with higher rates of viral suppression and retention in care among women, 9,10 even among patients with other health insurance. 11 Conversely, interruptions in ADAP coverage may diminish access to treatment, and ADAP policies that affect continuity of coverage have potential to pose system-level barriers to viral suppression.…”

Section: Introductionmentioning

confidence: 99%

Characterization of the Population Affected by the 6-Month Recertification Criterion of the Ryan White HIV/AIDS Program's AIDS Drug Assistance Program in Washington State, 2017–2019

Erly

Khosropour

Hajat

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction: AIDS Drug Assistance Programs (ADAPs) provide financial support for medical care for people living with HIV (PLWH) in the United States. Federal policy requires that clients recertify for the program every 6 months, which has been described as a barrier to care access. Our objective was to describe the prevalence of and factors associated with ADAP disenrollment in Washington State.Methods: Between 2017 and 2019, we categorized ADAP clients by the success of their recertification applications as follows: (1) continuously enrolled, (2) ruled ineligible, or (3) disenrolled if they failed to recertify. We compared individuals who were disenrolled with those who were continuously enrolled by demographic and socioeconomic characteristics and engagement with case management using data from the Washington State HIV Surveillance and Ryan White data systems.Results: From 2017 to 2019, 5480 clients were enrolled in ADAP, of whom 1423 (26%) were disenrolled and 984 (18%) were ruled ineligible at least once. Compared with those who were continuously enrolled, disenrolled PLWH were more likely to be Black [unadjusted prevalence ratio (PR) vs White 1.31, 95% confidence interval (CI): 1.17 to 1.46], uninsured (PR vs private insurance 1.24, 95% CI: 1.10 to 1.40), and younger (PR 25-34 vs 35-44 years 1.23, 95% CI: 1.08 to 1.41). The median time to return after disenrollment was 12 months (95% CI: 8 to 19 months).Conclusions: Disenrollment after failure to recertify was the most common reason why PLWH lost ADAP coverage in Washington State. ADAP recertification procedures disproportionately affect Black, young, and uninsured PLWH and may contribute to disparities in HIV outcomes.

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A mathematical model to estimate the state-specific impact of the Health Resources and Services Administration’s Ryan White HIV/AIDS Program

Cited by 3 publications

References 11 publications

Optimizing HIV Prevention Efforts to Achieve EHE Incidence Targets

Optimizing HIV Prevention Efforts to Achieve EHE Incidence Targets

AIDS Drug Assistance Program disenrollment is associated with loss of viral suppression beyond differences in homelessness, mental health, and substance use disorders: An evaluation in Washington state 2017–2019

Characterization of the Population Affected by the 6-Month Recertification Criterion of the Ryan White HIV/AIDS Program's AIDS Drug Assistance Program in Washington State, 2017–2019

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