493. United States HIV Healthcare Providers’ Knowledge and Attitudes about the Patient Protection and Affordable Care Act
Session: Poster Abstract Session: HIV Policy and Healthcare Utilization
Thursday, October 27, 2016
Room: Poster Hall
  • IDWeek_NationalACASurvey.pdf (705.6 kB)
  • Background: The Affordable Care Act (ACA) affects United States’ healthcare by offering Medicaid expansion and tax subsidies to persons with low incomes. The interaction of the ACA and current HIV healthcare delivery (federally funded Ryan White clinics and AIDS Drug Assistance Programs) is complex. The objective was to explore HIV providers’ knowledge and attitudes about the ACA.

    Methods: HIV providers were e-mailed a weblink to a survey. The survey assessed sources of ACA information, and knowledge and attitudes about the ACA.

    Results: The 253 survey respondents were from 35 of the 50 United States and the District of Columbia. Providers reported that their main source of knowledge was websites (32%), newspapers or magazines (23%), and case managers (12%). The majority of respondents (61%) answered all 4 knowledge questions correctly. 71% knew whether or not their state had decided to expand Medicaid. 17% did not know about ACA tax subsidies, and more than 10% did not know that the ACA does not eliminate the Ryan White Program. On a scale rating the ACA’s impact from 1-5 with 5 as the best, the mean response for improving their patients’ HIV outcomes varied significantly by a provider’s state Medicaid status: 3.78 (standard deviation, 0.83) for Medicaid expansion compared with 3.37 (1.00) for Medicaid non-expansion (p =.002). Correct ACA knowledge was significantly associated with differences in provider type (p=.011), providing care in Medicaid nonexpansion state (adjusted odds ratio, 2.57; 95% confidence interval, 1.30-5.10; p=.007), obtaining knowledge from case managers (2.88; 1.35-6.13; p=.006), the radio (2.31; 1.02-5.23; p=.044), newspapers/magazines (2.20; 1.00-4.81, p=.049), and websites (2.12; 1.00-4.50; p=.050), and having a positive attitude towards the ACA’s effects on the United States’ health outcomes (2.81; 1.58-5.02; p<.001).

    Conclusion: Providers in Medicaid expansion states were more optimistic about the ACA improving their patients’ HIV outcomes. There remain knowledge gaps in HIV providers’ understanding of the ACA and its relation to US HIV care. Education should be disseminated through currently used resources (websites, newspapers/magazines, and case managers) to improve knowledge of this important health system shift and to enhance systems-based practice.

    Kathleen Mcmanus, MD, MSCR, Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, Kelsey Mcmanus, BA, Royal College of Surgeons in Ireland, Dublin, Ireland and Rebecca Dillingham, MD, MPH, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA


    K. Mcmanus, None

    K. Mcmanus, None

    R. Dillingham, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.