Cargando…

AIDS Drug Assistance Program disenrollment is associated with loss of viral suppression beyond differences in homelessness, mental health, and substance use disorders: An evaluation in Washington state 2017–2019

AIDS Drug Assistance Programs (ADAPs) are state-administered programs that pay for medical care for people living with HIV in the US. Maintaining enrollment in the programs is challenging, and a large proportion of clients in Washington state (WA) fail to recertify and are disenrolled. In this study...

Descripción completa

Detalles Bibliográficos
Autores principales: Erly, Steven J., Khosropour, Christine M., Hajat, Anjum, Sharma, Monisha, Reuer, Jennifer R., Dombrowski, Julia C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10159195/
https://www.ncbi.nlm.nih.gov/pubmed/37141285
http://dx.doi.org/10.1371/journal.pone.0285326
_version_ 1785037083741519872
author Erly, Steven J.
Khosropour, Christine M.
Hajat, Anjum
Sharma, Monisha
Reuer, Jennifer R.
Dombrowski, Julia C.
author_facet Erly, Steven J.
Khosropour, Christine M.
Hajat, Anjum
Sharma, Monisha
Reuer, Jennifer R.
Dombrowski, Julia C.
author_sort Erly, Steven J.
collection PubMed
description AIDS Drug Assistance Programs (ADAPs) are state-administered programs that pay for medical care for people living with HIV in the US. Maintaining enrollment in the programs is challenging, and a large proportion of clients in Washington state (WA) fail to recertify and are disenrolled. In this study we sought to quantify the impact of disenrollment from ADAPs on viral suppression. We conducted a retrospective cohort study of the 5238 clients in WA ADAP from 2017 to 2019 and estimated the risk difference (RD) of viral suppression before and after disenrollment. We performed a quantitative bias analysis (QBA) to assess the effect of unmeasured confounders, as the factors that contribute to disenrollment and medication discontinuation may overlap. Of the 1336 ADAP clients who disenrolled ≥1 time, 83% were virally suppressed before disenrollment versus 69% after (RD 12%, 95%CI 9–15%). The RD was highest among clients with dual Medicaid-Medicare insurance (RD 22%, 95%CI 9–35%) and lowest among privately insured individuals (RD 8%, 95%CI 5–12%). The results of the QBA suggest that unmeasured confounders do not negate the overall RD. The ADAP recertification procedures negatively impact the care of clients who struggle to stay in the program; alternative procedures may reduce this impact.
format Online
Article
Text
id pubmed-10159195
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-101591952023-05-05 AIDS Drug Assistance Program disenrollment is associated with loss of viral suppression beyond differences in homelessness, mental health, and substance use disorders: An evaluation in Washington state 2017–2019 Erly, Steven J. Khosropour, Christine M. Hajat, Anjum Sharma, Monisha Reuer, Jennifer R. Dombrowski, Julia C. PLoS One Research Article AIDS Drug Assistance Programs (ADAPs) are state-administered programs that pay for medical care for people living with HIV in the US. Maintaining enrollment in the programs is challenging, and a large proportion of clients in Washington state (WA) fail to recertify and are disenrolled. In this study we sought to quantify the impact of disenrollment from ADAPs on viral suppression. We conducted a retrospective cohort study of the 5238 clients in WA ADAP from 2017 to 2019 and estimated the risk difference (RD) of viral suppression before and after disenrollment. We performed a quantitative bias analysis (QBA) to assess the effect of unmeasured confounders, as the factors that contribute to disenrollment and medication discontinuation may overlap. Of the 1336 ADAP clients who disenrolled ≥1 time, 83% were virally suppressed before disenrollment versus 69% after (RD 12%, 95%CI 9–15%). The RD was highest among clients with dual Medicaid-Medicare insurance (RD 22%, 95%CI 9–35%) and lowest among privately insured individuals (RD 8%, 95%CI 5–12%). The results of the QBA suggest that unmeasured confounders do not negate the overall RD. The ADAP recertification procedures negatively impact the care of clients who struggle to stay in the program; alternative procedures may reduce this impact. Public Library of Science 2023-05-04 /pmc/articles/PMC10159195/ /pubmed/37141285 http://dx.doi.org/10.1371/journal.pone.0285326 Text en © 2023 Erly et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Erly, Steven J.
Khosropour, Christine M.
Hajat, Anjum
Sharma, Monisha
Reuer, Jennifer R.
Dombrowski, Julia C.
AIDS Drug Assistance Program disenrollment is associated with loss of viral suppression beyond differences in homelessness, mental health, and substance use disorders: An evaluation in Washington state 2017–2019
title AIDS Drug Assistance Program disenrollment is associated with loss of viral suppression beyond differences in homelessness, mental health, and substance use disorders: An evaluation in Washington state 2017–2019
title_full AIDS Drug Assistance Program disenrollment is associated with loss of viral suppression beyond differences in homelessness, mental health, and substance use disorders: An evaluation in Washington state 2017–2019
title_fullStr AIDS Drug Assistance Program disenrollment is associated with loss of viral suppression beyond differences in homelessness, mental health, and substance use disorders: An evaluation in Washington state 2017–2019
title_full_unstemmed AIDS Drug Assistance Program disenrollment is associated with loss of viral suppression beyond differences in homelessness, mental health, and substance use disorders: An evaluation in Washington state 2017–2019
title_short AIDS Drug Assistance Program disenrollment is associated with loss of viral suppression beyond differences in homelessness, mental health, and substance use disorders: An evaluation in Washington state 2017–2019
title_sort aids drug assistance program disenrollment is associated with loss of viral suppression beyond differences in homelessness, mental health, and substance use disorders: an evaluation in washington state 2017–2019
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10159195/
https://www.ncbi.nlm.nih.gov/pubmed/37141285
http://dx.doi.org/10.1371/journal.pone.0285326
work_keys_str_mv AT erlystevenj aidsdrugassistanceprogramdisenrollmentisassociatedwithlossofviralsuppressionbeyonddifferencesinhomelessnessmentalhealthandsubstanceusedisordersanevaluationinwashingtonstate20172019
AT khosropourchristinem aidsdrugassistanceprogramdisenrollmentisassociatedwithlossofviralsuppressionbeyonddifferencesinhomelessnessmentalhealthandsubstanceusedisordersanevaluationinwashingtonstate20172019
AT hajatanjum aidsdrugassistanceprogramdisenrollmentisassociatedwithlossofviralsuppressionbeyonddifferencesinhomelessnessmentalhealthandsubstanceusedisordersanevaluationinwashingtonstate20172019
AT sharmamonisha aidsdrugassistanceprogramdisenrollmentisassociatedwithlossofviralsuppressionbeyonddifferencesinhomelessnessmentalhealthandsubstanceusedisordersanevaluationinwashingtonstate20172019
AT reuerjenniferr aidsdrugassistanceprogramdisenrollmentisassociatedwithlossofviralsuppressionbeyonddifferencesinhomelessnessmentalhealthandsubstanceusedisordersanevaluationinwashingtonstate20172019
AT dombrowskijuliac aidsdrugassistanceprogramdisenrollmentisassociatedwithlossofviralsuppressionbeyonddifferencesinhomelessnessmentalhealthandsubstanceusedisordersanevaluationinwashingtonstate20172019