TY - JOUR
T1 - Health insurance and AIDS Drug Assistance Program (ADAP) increases retention in care among women living with HIV in the United States
AU - Kay, Emma Sophia
AU - Edmonds, Andrew
AU - Ludema, Christina
AU - Adimora, Adaora
AU - Alcaide, Maria L.
AU - Chandran, Aruna
AU - Cohen, Mardge H.
AU - Johnson, Mallory O.
AU - Kassaye, Seble
AU - Kempf, Mirjam Colette
AU - Moran, Caitlin A.
AU - Sosanya, Oluwakemi
AU - Wilson, Tracey E.
N1 - Funding Information:
All US states (and Washington, D.C.) and territories receive AIDS Drug Assistance Program (ADAP) funding, which is funded through Part B of the RWHAP (Health Resources and Services Administration HIV/AIDS Bureau, ). States use earmarked ADAP funds as the “payer of last resort” to purchase HIV antiretroviral therapy [ART] for low income, uninsured, or underinsured PLWH. Approximately one-quarter of the 1.1 million PLWH in the US rely on ADAP to help them pay for ART (NASTAD, ). States are allowed to set their own income eligibility requirements for receiving ADAP, which ranges from 200% (Texas, Idaho, Puerto Rico) to 550% (South Carolina) of the FPL (KFF, ). Drug formularies for ART vary by state, and there are no federal requirements to cover non-HIV drugs for ADAP recipients with co-morbid conditions (McManus et al., ). States may also set insurance-based eligibility requirements. The only federal ADAP requirements are formal documentation of HIV infection and state residency (KFF, ).
Funding Information:
This work was supported by National Institutes of Health: [grant number U01-HL146192-01,U01-HL146193-01,U01-HL146194-01,U01-HL146201-01,U01-HL146202-01,U01-HL146203-01,U01-HL146204-01,U01-HL146205-01,U01-HL146208-01,U01-HL146240-01,U01-HL146241-01,U01-HL146242-01,U01-HL146245-01,U01-HL146333-01]. Data in this manuscript were collected by the MACS/WIHS Combined Cohort Study (MWCCS). The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). MWCCS (Principal Investigators): Atlanta CRS (Ighovwerha Ofotokun, Anandi Sheth, and Gina Wingood), U01-HL146241-01; Baltimore CRS (Todd Brown and Joseph Margolick), U01-HL146201-01; Bronx CRS (Kathryn Anastos and Anjali Sharma), U01-HL146204-01; Brooklyn CRS (Deborah Gustafson and Tracey Wilson), U01-HL146202-01; Data Analysis and Coordination Center (Gypsyamber D?Souza, Stephen Gange and Elizabeth Golub), U01-HL146193-01; Chicago-Cook County CRS (Mardge Cohen and Audrey French), U01-HL146245-01; Chicago-Northwestern CRS (Steven Wolinsky), U01-HL146240-01; Connie Wofsy Women?s HIV Study, Northern California CRS (Bradley Aouizerat and Phyllis Tien), U01-HL146242-01; Los Angeles CRS (Roger Detels and Otoniel Martinez-Maza), U01-HL146333-01; Metropolitan Washington CRS (Seble Kassaye and Daniel Merenstein), U01-HL146205-01; Miami CRS (Maria Alcaide, Margaret Fischl, and Deborah Jones), U01-HL146203-01; Pittsburgh CRS (Jeremy Martinson and Charles Rinaldo), U01-HL146208-01; UAB-MS CRS (Mirjam-Colette Kempf and Deborah Konkle-Parker), U01-HL146192-01; UNC CRS (Adaora Adimora), U01-HL146194-01. The MWCCS is funded primarily by the National Heart, Lung, and Blood Institute (NHLBI), with additional co-funding from the Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Human Genome Research Institute (NHGRI), National Institute On Aging (NIA), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Neurological Disorders And Stroke (NINDS), National Institute Of Mental Health (NIMH), National Institute On Drug Abuse (NIDA), National Institute Of Nursing Research (NINR), National Cancer Institute (NCI), National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Deafness and Other Communication Disorders (NIDCD), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). MWCCS data collection is also supported by UL1-TR000004 (UCSF CTSA), P30-AI-050409 (Atlanta CFAR), P30-AI-050410 (UNC CFAR), and P30-AI-027767 (UAB CFAR).
Funding Information:
Data in this manuscript were collected by the MACS/WIHS Combined Cohort Study (MWCCS). The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). MWCCS (Principal Investigators): Atlanta CRS (Ighovwerha Ofotokun, Anandi Sheth, and Gina Wingood), U01-HL146241-01; Baltimore CRS (Todd Brown and Joseph Margolick), U01-HL146201-01; Bronx CRS (Kathryn Anastos and Anjali Sharma), U01-HL146204-01; Brooklyn CRS (Deborah Gustafson and Tracey Wilson), U01-HL146202-01; Data Analysis and Coordination Center (Gypsyamber D’Souza, Stephen Gange and Elizabeth Golub), U01-HL146193-01; Chicago-Cook County CRS (Mardge Cohen and Audrey French), U01-HL146245-01; Chicago-Northwestern CRS (Steven Wolinsky), U01-HL146240-01; Connie Wofsy Women’s HIV Study, Northern California CRS (Bradley Aouizerat and Phyllis Tien), U01-HL146242-01; Los Angeles CRS (Roger Detels and Otoniel Martinez-Maza), U01-HL146333-01; Metropolitan Washington CRS (Seble Kassaye and Daniel Merenstein), U01-HL146205-01; Miami CRS (Maria Alcaide, Margaret Fischl, and Deborah Jones), U01-HL146203-01; Pittsburgh CRS (Jeremy Martinson and Charles Rinaldo), U01-HL146208-01; UAB-MS CRS (Mirjam-Colette Kempf and Deborah Konkle-Parker), U01-HL146192-01; UNC CRS (Adaora Adimora), U01-HL146194-01. The MWCCS is funded primarily by the National Heart, Lung, and Blood Institute (NHLBI), with additional co-funding from the Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Human Genome Research Institute (NHGRI), National Institute On Aging (NIA), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Neurological Disorders And Stroke (NINDS), National Institute Of Mental Health (NIMH), National Institute On Drug Abuse (NIDA), National Institute Of Nursing Research (NINR), National Cancer Institute (NCI), National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Deafness and Other Communication Disorders (NIDCD), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). MWCCS data collection is also supported by UL1-TR000004 (UCSF CTSA), P30-AI-050409 (Atlanta CFAR), P30-AI-050410 (UNC CFAR), and P30-AI-027767 (UAB CFAR).
Publisher Copyright:
© 2020 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2021
Y1 - 2021
N2 - Our objective was to examine the association between healthcare payer type and missed HIV care visits among 1,366 US women living with HIV (WLWH) enrolled in the prospective Women’s Interagency HIV Study (WIHS). We collected secondary patient-level data (October 1, 2017-September 30, 2018) from WLWH at nine WIHS sites. We used bivariate and multivariable binary logistic regression to examine the relationship between healthcare payer type (cross-classification of patients’ ADAP and health insurance enrollment) and missed visits-based retention in care, defined as no-show appointments for which patients did not reschedule. Our sample included all WLWH who self-reported having received HIV care at least once during the two consecutive biannual WIHS visits a year prior to October 1, 2017-September 30, 2018. In the bivariate model, compared to uninsured WLWH without ADAP, WLWH with private insurance + ADAP were more likely to be retained in care, as were WLWH with Medicaid only and private insurance only. In the adjusted model, WLWH with private insurance only were more likely to be retained in care compared to uninsured WLWH without ADAP. Private health insurance and ADAP are associated with increased odds of retention in care among WLWH.
AB - Our objective was to examine the association between healthcare payer type and missed HIV care visits among 1,366 US women living with HIV (WLWH) enrolled in the prospective Women’s Interagency HIV Study (WIHS). We collected secondary patient-level data (October 1, 2017-September 30, 2018) from WLWH at nine WIHS sites. We used bivariate and multivariable binary logistic regression to examine the relationship between healthcare payer type (cross-classification of patients’ ADAP and health insurance enrollment) and missed visits-based retention in care, defined as no-show appointments for which patients did not reschedule. Our sample included all WLWH who self-reported having received HIV care at least once during the two consecutive biannual WIHS visits a year prior to October 1, 2017-September 30, 2018. In the bivariate model, compared to uninsured WLWH without ADAP, WLWH with private insurance + ADAP were more likely to be retained in care, as were WLWH with Medicaid only and private insurance only. In the adjusted model, WLWH with private insurance only were more likely to be retained in care compared to uninsured WLWH without ADAP. Private health insurance and ADAP are associated with increased odds of retention in care among WLWH.
KW - AIDS Drug Assistance Program
KW - Women living with HIV
KW - Women’s Interagency HIV study
KW - retention in care
UR - http://www.scopus.com/inward/record.url?scp=85096548410&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85096548410&partnerID=8YFLogxK
U2 - 10.1080/09540121.2020.1849529
DO - 10.1080/09540121.2020.1849529
M3 - Article
C2 - 33233937
AN - SCOPUS:85096548410
VL - 33
SP - 1044
EP - 1051
JO - AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
JF - AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
SN - 0954-0121
IS - 8
ER -