Responding to Racial and Ethnic Disparities in Use of HIV Drugs: Analysis of State Policies

Morin, Stephen F.; Sengupta, Sohini; Cozen, Myrna; Richards, T. Anne; Shriver, Michael D.; Palacio, Herminia; Kahn, James G.

doi:10.1093/phr/117.3.263

Cited by 17 publications

(12 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While this study identified social barriers (e.g., distrust of government and traditional medicine, lack of informa-tion, HIV-related stigma) associated with different ethnic groups as possible explanations for this trend, policy and structural issues of state-administered ADAP programs seemed to be most salient, given that "[a]ccess to HIV pharmaceuticals depends greatly on the state in which an individual lives" [7]. Rather than re-tailoring each state's individual ADAP policy towards disadvantaged groups, a nationally standardized policy and eligibility criterion would systematically address the issue across all states.…”

Section: Adap and Minority Groupsmentioning

confidence: 92%

“…Whether scarce resources should be allocated on the basis of race must be assessed. In a comparison study between the four states with the largest HIV/AIDS population (New York, California, Florida, and Texas), "African Americans represented a higher proportion of people living with AIDS than their proportion in the overall population [7]. The same study also indicated that African Americans were "less likely to receive protease-inhibitors than non-Latino whites" [7].…”

Section: Adap and Minority Groupsmentioning

confidence: 99%

“…This national ADAP standard would eliminate barriers of access for low income individuals. These barriers have a disproportionate effect on members of racial/ethnic minority groups [7]. However, the creation of a new national ADAP policy might also result in a greater fiscal strain on poorer states [8].…”

Section: Adap and Minority Groupsmentioning

confidence: 99%

See 2 more Smart Citations

An Evaluation Synthesis of US AIDS Drug Assistance Program Policy

Horneffer¹,

Yang²

2013

WJA

View full text Add to dashboard Cite

US Congress passed the CARE Act in 1990 in response to a dramatically growing need for resources to combat the AIDS epidemic. One of the programs contained in the Act was the AIDS Drug Assistance Program (ADAP), a federally-funded but state-maintained and managed program primarily concerned with providing medication for low-income HIV/AIDS patients. While ADAP programs across the country reached one-third of all patients in 2007, these programs are now in budgetary danger due to the economic recession, state budgetary constraints, the rising cost of healthcare generally, and longer life expectancies associated with current highly active antiretroviral therapy (HAART). This paper first evaluates the current state of ADAP, its strengths and weaknesses, and examines its sustainability in the short term if short-term measures are taken. Concluding that such measures would not lead to long-term sustainability, this paper then argues for a long-term solution to ADAP’s current problems, namely a national, centralized ADAP standard for budgetary and administrative matters. Such a program would increase the long-term sustainability and effectiveness of current ADAP programs by employing more efficient, standard policies and allowing larger, wholesale purchases of costly HAART medications. Moreover, a national policy would address the disparity that currently exists in ADAP programs today with regard to both minorities and those on the waiting lists for treatment. The institution of a national ADAP program would certainly face many political hurdles. Consequently, this paper also looks to a recent political dispute, the enactment of the Affordable Care Act (ACA), for guidance. Using the passage of the ACA as an example could light the path for passage of a national ADAP standard. Ultimately, this would lead to a more effective and sustainable program for HIV/AIDS patients in the United States.

show abstract

Section: Adap and Minority Groupsmentioning

confidence: 92%

Section: Adap and Minority Groupsmentioning

confidence: 99%

See 1 more Smart Citation

An Evaluation Synthesis of US AIDS Drug Assistance Program Policy

Horneffer¹,

Yang²

2013

WJA

View full text Add to dashboard Cite

show abstract

“…A number of previous researchers have used Medicaid claims data to construct samples of HIV/AIDS patients (Eichner and Kahn, 2001;Kahn et al, 2002;Morin et al, 2002). Following this research, we use ICD-9 diagnosis codes on the Medicaid inpatient and outpatient claims to determine whether individuals are diagnosed with this illness.…”

Section: B Defining the Hiv/aids Samplementioning

confidence: 99%

Estimating the Impact of Medical Innovation: A Case Study of HIV Antiretroviral Treatments

Duggan¹,

Evans²

2008

Forum for Health Economics &Amp; Policy

View full text Add to dashboard Cite

As health care consumes a growing share of GDP, the demand for better evidence regarding the effects of health care treatments and how these vary across individuals is increasing. Estimating this with observational data is difficult given the endogeneity of treatment decisions. But because the random assignment clinical trials (RACTs) used in the FDA approval process only estimate average health effects and do not consider spending, there is no good alternative. In this study we use administrative data from California's Medicaid program to estimate the impact of HIV antiretroviral treatments (ARVs). We use data on health care utilization to proxy for health status and exploit the rapid takeup of ARVs following their FDA approval. Our estimate of a 68 percent average mortality rate reduction is in line with the results from RACTs. We also find that the ARVs lowered short-term health care spending by reducing expenditures on other categories of medical care. Combining these two effects we estimate the cost per life year saved at $19,000. Our results suggest an alternative method for estimating the real-world effects of new treatments that is especially well-suited to those treatments that diffuse rapidly following their approval.

show abstract

“…However, there has been a recent trend toward an increase in the proportion of new AIDS cases among Hispanics in California and Texas, two border states, a trend not observed in New York or Florida. 9 This shows that more work needs to be done to compare the care received by Hispanic and non-Hispanic HIV-positive patients. The aim of this study was to describe and explore what factors are associated with the distribution of HIV stage, presence of OIs, and standard of care offered at the time of enrollment into the Special Projects of National Significance (SPNS) among PLWH/A receiving care along the U.S.-Mexico border.…”

mentioning

confidence: 99%

Estimation of the Prevalence of AIDS, Opportunistic Infections, and Standard of Care among Patients with HIV/AIDS Receiving Care Along the U.S.-Mexico Border through the Special Projects of National Significance: A Cross-Sectional Study

Carabin

Keesee

Machado

et al. 2008

AIDS Patient Care and STDs

View full text Add to dashboard Cite

There is high demand for care among the Hispanic population in states along the U.S.-Mexico border. The objective is to describe the standard of care received by people living with HIV/AIDS (PLWH/A) at enrollment into one of five Special Projects of National Significance (SPNS) Sites located along the U.S.-Mexico border. This cross-sectional study describes the presence of opportunistic infections (OIs), AIDS status and two types of standard of care received by 707 PLWH/A participating in SPNS. Patients receiving care through SPNS in one of the five sites between June 1, 2002 and December 31, 2003 were invited to participate to the medical chart review component of the study. The association between sociodemographic variables and the prevalence of OIs and AIDS at enrollment was estimated using multivariate hierarchical logistic models. More than one quarter of the 707 participants had at least one OI recorded and 58% of new and 60% of existing patients had AIDS at enrollment in SPNS. The association between being Hispanic and having higher prevalence of OI and AIDS at entry varied by SPNS site. Standard of care was well followed overall. This is the first study describing HIV stage and OI prevalences and standard of care in PLWH/A in all U.S.-Mexico bordering states. Being of Hispanic ethnicity may not fully explain discrepancy in access to care along the border.

show abstract

Responding to Racial and Ethnic Disparities in Use of HIV Drugs: Analysis of State Policies

Abstract: State policies play a significant role in determining access to HIV drugs, and state policies can be used to reduce racial/ethnic disparities in pharmaceutical access. Overall, eliminating racial/ethnic disparities in access to HIV pharmaceuticals appears to be an achievable goal.

Cited by 17 publications

References 6 publications

An Evaluation Synthesis of US AIDS Drug Assistance Program Policy

An Evaluation Synthesis of US AIDS Drug Assistance Program Policy

Estimating the Impact of Medical Innovation: A Case Study of HIV Antiretroviral Treatments

Estimation of the Prevalence of AIDS, Opportunistic Infections, and Standard of Care among Patients with HIV/AIDS Receiving Care Along the U.S.-Mexico Border through the Special Projects of National Significance: A Cross-Sectional Study

Contact Info

Product

Resources

About