325. Effects of Recent Virginia AIDS Drug Assistance Program Policy Changes on Diabetes and Hyperlipidemia Control in People Living with HIV (PLWH)
Session: Poster Abstract Session: HIV Co-morbidities
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
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  • Background: AIDS Drug Assistance Program (ADAP) is the "payer of last resort" for PLWH who earn limited income to obtain antiretroviral therapy, medications for opportunistic infections, and medications for co-morbidities such as hypertension, diabetes, and hyperlipidemia. Each state ADAP determines its own formulary. In the past few years, the states faced flat funding and increasing demand, which led to formulary cuts and enrollment wait lists. In November 2010, Virginia ADAP eliminated all medications except for ART and medications used to treat or prevent opportunistic infections. This cut eliminated all diabetes and hyperlipidemia medications.

    Methods: Data was collected on two groups of PLWH who were prescribed medications for diabetes or hyperlipidemia, one received medications from ADAP and the other did not. Data was collected for 13 months before and after the policy change. Diabetes, hyperlipidemia, and HIV control were compared using standard laboratory measures. Visit adherence and missed visits were also analyzed.

    Results: During the pre-policy period, non-ADAP patients had better diabetes control than ADAP patients with glycosylated hemoglobin values of 7.65% (0.97) and 6.79% (0.99) respectively (p =0.042). More ADAP patients than non-ADAP patients (79% vs. 52%) had good visit adherence, or visits in greater than or equal to 75% of eligible 90-day quarters (p = 0.006). Otherwise, the no significant differences between groups were identified.

    Conclusion: There has been little research on how ADAP cost containment measures affect PLWH who rely on ADAP. ADAP patients had slightly worse diabetes control compared to the non-ADAP group before the policy change. It is possible that this is due to the ADAP population's poor access to non-HIV primary care, including care for diabetes. It is reassuring that, even during a time of flux in ADAP resources, the ADAP patients remained engaged in HIV care, which is an important predictor of good clinical outcomes in PLWH. Moreover, their HIV and co-morbidity outcomes were not negatively impacted by the policy change. The Ryan White-supported clinics provide excellent HIV care to qualifying PLWH, and post ACA, they should be leveraged to provide additional primary care for co-morbidities.

    Kathleen Mcmanus, M.D. MSc, Internal Medicine, University of Virginia, Charlottesville, VA and Rebecca Dillingham, MD/MPH, Infectious Diseases and International Health, University of Virginia, Charlottesville, VA

    Disclosures:

    K. Mcmanus, None

    R. Dillingham, None

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