Impact of Health Insurance, ADAP, and Income on HIV Viral Suppression among US Women in the Women's Interagency HIV Study, 2006-2009

Christina Ludema, Stephen R. Cole, Joseph J. Eron, Andrew Edmonds, G. Mark Holmes, Kathryn Anastos, Jennifer Cocohoba, Mardge Cohen, Hannah L F Cooper, Elizabeth Golub, Seble Kassaye, Deborah Konkle-Parker, Lisa Metsch, Joel Milam, Tracey E. Wilson, Adaora A. Adimora

Research output: Contribution to journalArticle

Abstract

Background: Implementation of the Affordable Care Act motivates assessment of health insurance and supplementary programs, such as the AIDS Drug Assistance Program (ADAP) on health outcomes of HIV-infected people in the United States. We assessed the effects of health insurance, ADAP, and income on HIV viral load suppression. Methods: We used existing cohort data from the HIV-infected participants of the Women's Interagency HIV Study. Cox proportional hazards models were used to estimate the time from 2006 to unsuppressed HIV viral load (>200 copies/mL) among those with Medicaid, private, Medicare, or other public insurance, and no insurance, stratified by the use of ADAP. Results: In 2006, 65% of women had Medicaid, 18% had private insurance, 3% had Medicare or other public insurance, and 14% reported no health insurance. ADAP coverage was reported by 284 women (20%); 56% of uninsured participants reported ADAP coverage. After accounting for study site, age, race, lowest observed CD4, and previous health insurance, the hazard ratio (HR) for unsuppressed viral load among those privately insured without ADAP, compared with those on Medicaid without ADAP (referent group), was 0.61 (95% CI: 0.48 to 0.77). Among the uninsured, those with ADAP had a lower relative hazard of unsuppressed viral load compared with the referent group (HR, 95% CI: 0.49, 0.28 to 0.85) than those without ADAP (HR, 95% CI: 1.00, 0.63 to 1.57). Conclusions: Although women with private insurance are most likely to be virally suppressed, ADAP also contributes to viral load suppression. Continued support of this program may be especially critical for states that have not expanded Medicaid.

Original languageEnglish (US)
Pages (from-to)307-312
Number of pages6
JournalJournal of Acquired Immune Deficiency Syndromes
Volume73
Issue number3
DOIs
StatePublished - Nov 1 2016

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Anti-HIV Agents
Health Insurance
HIV
Insurance
Viral Load
Medicaid
Medicare
Patient Protection and Affordable Care Act
Proportional Hazards Models

Keywords

  • health insurance
  • HIV
  • income
  • socioeconomic factors
  • women

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Impact of Health Insurance, ADAP, and Income on HIV Viral Suppression among US Women in the Women's Interagency HIV Study, 2006-2009. / Ludema, Christina; Cole, Stephen R.; Eron, Joseph J.; Edmonds, Andrew; Holmes, G. Mark; Anastos, Kathryn; Cocohoba, Jennifer; Cohen, Mardge; Cooper, Hannah L F; Golub, Elizabeth; Kassaye, Seble; Konkle-Parker, Deborah; Metsch, Lisa; Milam, Joel; Wilson, Tracey E.; Adimora, Adaora A.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 73, No. 3, 01.11.2016, p. 307-312.

Research output: Contribution to journalArticle

Ludema, C, Cole, SR, Eron, JJ, Edmonds, A, Holmes, GM, Anastos, K, Cocohoba, J, Cohen, M, Cooper, HLF, Golub, E, Kassaye, S, Konkle-Parker, D, Metsch, L, Milam, J, Wilson, TE & Adimora, AA 2016, 'Impact of Health Insurance, ADAP, and Income on HIV Viral Suppression among US Women in the Women's Interagency HIV Study, 2006-2009', Journal of Acquired Immune Deficiency Syndromes, vol. 73, no. 3, pp. 307-312. https://doi.org/10.1097/QAI.0000000000001078
Ludema, Christina ; Cole, Stephen R. ; Eron, Joseph J. ; Edmonds, Andrew ; Holmes, G. Mark ; Anastos, Kathryn ; Cocohoba, Jennifer ; Cohen, Mardge ; Cooper, Hannah L F ; Golub, Elizabeth ; Kassaye, Seble ; Konkle-Parker, Deborah ; Metsch, Lisa ; Milam, Joel ; Wilson, Tracey E. ; Adimora, Adaora A. / Impact of Health Insurance, ADAP, and Income on HIV Viral Suppression among US Women in the Women's Interagency HIV Study, 2006-2009. In: Journal of Acquired Immune Deficiency Syndromes. 2016 ; Vol. 73, No. 3. pp. 307-312.
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AU - Cole, Stephen R.

AU - Eron, Joseph J.

AU - Edmonds, Andrew

AU - Holmes, G. Mark

AU - Anastos, Kathryn

AU - Cocohoba, Jennifer

AU - Cohen, Mardge

AU - Cooper, Hannah L F

AU - Golub, Elizabeth

AU - Kassaye, Seble

AU - Konkle-Parker, Deborah

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AU - Wilson, Tracey E.

AU - Adimora, Adaora A.

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N2 - Background: Implementation of the Affordable Care Act motivates assessment of health insurance and supplementary programs, such as the AIDS Drug Assistance Program (ADAP) on health outcomes of HIV-infected people in the United States. We assessed the effects of health insurance, ADAP, and income on HIV viral load suppression. Methods: We used existing cohort data from the HIV-infected participants of the Women's Interagency HIV Study. Cox proportional hazards models were used to estimate the time from 2006 to unsuppressed HIV viral load (>200 copies/mL) among those with Medicaid, private, Medicare, or other public insurance, and no insurance, stratified by the use of ADAP. Results: In 2006, 65% of women had Medicaid, 18% had private insurance, 3% had Medicare or other public insurance, and 14% reported no health insurance. ADAP coverage was reported by 284 women (20%); 56% of uninsured participants reported ADAP coverage. After accounting for study site, age, race, lowest observed CD4, and previous health insurance, the hazard ratio (HR) for unsuppressed viral load among those privately insured without ADAP, compared with those on Medicaid without ADAP (referent group), was 0.61 (95% CI: 0.48 to 0.77). Among the uninsured, those with ADAP had a lower relative hazard of unsuppressed viral load compared with the referent group (HR, 95% CI: 0.49, 0.28 to 0.85) than those without ADAP (HR, 95% CI: 1.00, 0.63 to 1.57). Conclusions: Although women with private insurance are most likely to be virally suppressed, ADAP also contributes to viral load suppression. Continued support of this program may be especially critical for states that have not expanded Medicaid.

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