02 Sep Poor Patients Receiving Care Through Ryan White Programs Achieve Better HIV Control
Medical Research: What is the background for this study? What are the main findings?
Dr. Weiser: Ryan White was an Indiana teenager diagnosed with AIDS in the late 1980s. As a result of fear and stigma, he was barred from school and went on to become a national advocate for HIV education and acceptance. This year marks the 25th anniversary of his death and passage of the Ryan White CARE Act creating The Ryan White HIV/AIDS Program (RWHAP) which provides funding for healthcare facilities to deliver needed medical care and support services for hundreds of thousands of poor, uninsured, and underinsured Americans. While increased access to Medicaid and private insurance under the Affordable Care Act will provide coverage for medical care, it might not provide coverage for support services so it is likely that the RWHAP will continue to play a key role in providing these crucial services.
Overall, 34.4 percent of facilities received Ryan White HIV/AIDS Program funding and 72.8 percent of patients received care at RWHAP-funded facilities. Many of the patients at Ryan White HIV/AIDS Program -funded facilities had multiple social determinants of poor health, with patients at RWHAP-funded facilities more likely to be ages 18 to 29; female; black or Hispanic; have less than a high school education; income at or below the poverty level; and lack health care coverage.
Despite the greater likelihood of poverty, unstable housing and lack of health care coverage, nearly 75 percent of patients receiving care at RWHAP-funded facilities achieved viral suppression. The percentage of ART (antiretroviral therapy) prescribing was similar for patients at RWHAP-funded compared with non-funded facilities. Patients at RWHAP-funded facilities were less likely to be virally suppressed. However, individuals at or below the poverty level and those ages 30 to 39 who received care at a RWHAP-funded facility compared with those who received care at a non-RWHAP-funded facility were more likely to achieve viral suppression.
Medical Research: What should clinicians and patients take away from your report?
Dr. Weiser: Our findings supports the premise that RWHAP-funded facilities, which provide substantial support services for marginalized persons (e.g., those living at or below the poverty level), provide better care for poor persons compared with non-Ryan White HIV/AIDS Program -funded facilities.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Weiser: Among HIV-infected persons in the United States, 70% are not virally suppressed. Of those, two thirds are not in care. (Vital Signs, 2014) Further research is needed to explore the association between supportive services funded by the Ryan White HIV/AIDS Program and linkage to and retention in care.
Weiser J, Beer L, Frazier EL, et al. Service Delivery and Patient Outcomes in Ryan White HIV/AIDS Program–Funded and –Nonfunded Health Care Facilities in the United States. JAMA Intern Med. Published online August 31, 2015. doi:10.1001/jamainternmed.2015.4095.
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Dr. John Weiser MD MPH (2015). Poor Patients Receiving Care Through Ryan White Programs Achieve Better HIV Control