492. Year 2 of the AIDS Drug Assistance Program transition to Affordable Care Act Qualified Health Plans in a Medicaid Nonexpansion State: ACA still showing positive effects on HIV viral suppression
Session: Poster Abstract Session: HIV Policy and Healthcare Utilization
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • IDWeek_Y2ACAOutcomes.pdf (184.3 kB)
  • Background: With the Affordable Care Act, many state AIDS Drug Assistance Programs (ADAPs) are shifting their healthcare delivery model from direct medication provision to purchasing qualified health plans (QHPs). The objective was to characterize the demographic and healthcare delivery factors associated with Virginia ADAP clients’ year 2 QHP enrollment and to assess the relationship between QHP coverage and HIV viral suppression.

    Methods: Cohort A included Virginia ADAP clients who were eligible for ADAP-funded QHPs. Cohort B contains Cohort A subjects with a viral load (VL) in 2014 and in the second half of 2015. Cohort C were Cohort B subjects with detectable VLs in 2014. Cohort B2 were Cohort B subjects with 2015 QHP coverage. Data were collected from January 1, 2014- December 31, 2015. Multivariable binary logistic regression was conducted to assess the magnitude and significance of demographic and healthcare delivery factor effects on QHP enrollment and VL suppression.

    Results: For year 2, 63% of Cohort A (n = 4,631) enrolled in QHPs. 2015 QHP enrollment was significantly associated with differences in 2014 QHP coverage (adjusted odds ratio 111.79; 95% confidence interval, 84.33-148.20; p<.001), age (p<.001), race/ethnicity (p=.026), financial status (p<.001), and region (p<.001). In Cohort B (n = 2501), achieving VL suppression was significantly associated with differences in 2015 QHP coverage (1.27; 1.01-1.60; p=.043), an initially undetectable VL (2.69; 2.13-3.39; p<.001), gender (p=.025), age (p=.011), HIV rather than AIDS diagnosis (1.41; 1.12-1.78; p=.004), financial status (p=.004), and region (p<.001). In Cohort C (n = 607), achieving VL suppression was significantly associated with HIV disease status (1.99; 1.35-2.93; p=.001) and region (p<.001). In Cohort B2 (n=1674), not achieving VL suppression was significantly associated with differences in an initially detectable VL (2.66; 1.98-3.56; p<.001), AIDS diagnosis (1.40; 1.05-1.87; p=.034), and region (p<.001).

    Conclusion: QHP enrollment increased compared to year 1, but still varied significantly based on demographic and healthcare delivery factors. QHP coverage was again associated with viral suppression, an essential outcome for individuals and for public health.

    Kathleen Mcmanus, MD, MSCR1, Anne Rhodes, PhD2, Lauren Yerkes, MPH3, Carolyn Engelhard, MPA4, Karen Ingersoll, PhD5, George Stukenborg, PhD4 and Rebecca Dillingham, MD, MPH6, (1)Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, (2)Division of Disease Prevention, Virginia Department of Health, Richmond, VA, (3)Virginia Department of Health, Richmond, VA, (4)Department of Public Health Sciences, University of Virginia, Charlottesville, VA, (5)Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, (6)Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA

    Disclosures:

    K. Mcmanus, None

    A. Rhodes, None

    L. Yerkes, None

    C. Engelhard, None

    K. Ingersoll, None

    G. Stukenborg, None

    R. Dillingham, None

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