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HIV viral suppression under Ryan White care comparable to Medicaid, private insurance

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January 9, 2019

Compared with relying on the Ryan White HIV/AIDS Program for health services, transitioning to Medicaid or private health insurance was not associated with a change in patients’ HIV viral suppression, researchers found.

“We expected that HIV patients' viral suppression might benefit from having health insurance coverage that covered non-HIV-related services,” Julia Raifman, ScD, assistant professor of health law, policy and management at the Boston University School of Public Health, told Infectious Disease News. “The finding that patients were able to maintain consistent viral suppression just as well when their HIV care was covered by the Ryan White HIV/AIDS Program speaks to the importance of the Ryan White HIV/AIDS Program.”

Raifman and colleagues used data from the HIV Research Network cohort for adults aged 18 to 65 years who received care from 2012 to 2015, excluding any who had Medicare at any point, to compare viral suppression changes among patients who transitioned from being covered by Ryan White services to Medicaid or private health insurance. The primary outcome was consistent viral suppression in 2015.

In all, 73.7% of the 1,942 patients included in the study remained uncovered and supported by the Ryan White program, whereas 18.6% transitioned to Medicaid and 7.6% transitioned to private insurance. According to Raifman and colleagues, the prevalence of consistent viral suppression in 2015 did not differ significantly among the patients who transitioned to Medicaid (adjusted prevalence ratio [PR] = 0.95; 95% CI, 0.87-1.04) or private insurance (aPR = 1.04; 95% CI, 0.95-1.13) compared with those who remained supported by the Ryan White program.

“These findings are important because they speak to the ability of the Ryan White HIV/AIDS Program to support patients in achieving consistent viral suppression, which improves patient health and greatly reduces risk of onward transmission of HIV,” Raifman said. “That the Ryan White HIV/AIDS Program helps patients maintain consistent viral suppression suggests it is important to continue funding the Ryan White HIV/AIDS Program.” – by Caitlyn Stulpin

Disclosures: Raifman reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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Robert D. Harrington, MD
Perspective

This interesting study reports that HIV-infected individuals who were engaged in care, had no health coverage other than Ryan White HIV/AIDS Program (RWHAP) support and who were virally suppressed remained so whether they stayed on the RWHAP or transitioned to Medicaid or private health insurance. This finding is reassuring because patients who do transition from the RWHAP to Medicaid or private insurance often face new obstacles to care such as prescription copays, referral requirements, drug prior-authorization requirements and formulary restrictions that can impact access to ART and HIV care. In many cases, depending on state of residence, low-income patients who have transitioned to Medicaid or private insurance can still benefit from the RWHAP in the form of copayments and assistance with insurance premiums, thereby providing a safety net for the high costs associated with good HIV care. Therefore, the importance of the RWHAP for those who use it as their primary health insurer and those who rely on it to supplement the benefits of Medicaid or private health insurance cannot be overstated. Until we have high-quality, reasonable-cost universal health care for all, the RWHAP will remain indispensable.

Robert D. Harrington, MD

Professor of medicine, University of Washington
Interim chief of medicine and section chief, infectious diseases
Harborview Medical Center

Disclosure: Harrington reports no relevant financial disclosures.