Steven Erly1,2, Christine M Khosropour1, Anjum Hajat1, Monisha Sharma3, Jen Reuer2, Martha Grimm2, Kelse Kwaiser2, Julia C Dombrowski1,4. 1. Department of Epidemiology, University of Washington, Seattle, WA. 2. Department of Health, Office of Infectious Disease, Washington State, Olympia, WA. 3. Department of Global Health, University of Washington, Seattle, WA; and. 4. Division of Allergy and Infectious Disease, University of Washington, Seattle, WA.
Abstract
INTRODUCTION: AIDS Drug Assistance Programs (ADAPs) provide financial support for medical care for people living with HIV (PLWH) in the United States. Federal policy requires that clients recertify for the program every 6 months, which has been described as a barrier to care access. Our objective was to describe the prevalence of and factors associated with ADAP disenrollment in Washington State. METHODS: Between 2017 and 2019, we categorized ADAP clients by the success of their recertification applications as follows: (1) continuously enrolled, (2) ruled ineligible, or (3) disenrolled if they failed to recertify. We compared individuals who were disenrolled with those who were continuously enrolled by demographic and socioeconomic characteristics and engagement with case management using data from the Washington State HIV Surveillance and Ryan White data systems. RESULTS: From 2017 to 2019, 5480 clients were enrolled in ADAP, of whom 1423 (26%) were disenrolled and 984 (18%) were ruled ineligible at least once. Compared with those who were continuously enrolled, disenrolled PLWH were more likely to be Black [unadjusted prevalence ratio (PR) vs White 1.31, 95% confidence interval (CI): 1.17 to 1.46], uninsured (PR vs private insurance 1.24, 95% CI: 1.10 to 1.40), and younger (PR 25-34 vs 35-44 years 1.23, 95% CI: 1.08 to 1.41). The median time to return after disenrollment was 12 months (95% CI: 8 to 19 months). CONCLUSIONS: Disenrollment after failure to recertify was the most common reason why PLWH lost ADAP coverage in Washington State. ADAP recertification procedures disproportionately affect Black, young, and uninsured PLWH and may contribute to disparities in HIV outcomes.
INTRODUCTION: AIDS Drug Assistance Programs (ADAPs) provide financial support for medical care for people living with HIV (PLWH) in the United States. Federal policy requires that clients recertify for the program every 6 months, which has been described as a barrier to care access. Our objective was to describe the prevalence of and factors associated with ADAP disenrollment in Washington State. METHODS: Between 2017 and 2019, we categorized ADAP clients by the success of their recertification applications as follows: (1) continuously enrolled, (2) ruled ineligible, or (3) disenrolled if they failed to recertify. We compared individuals who were disenrolled with those who were continuously enrolled by demographic and socioeconomic characteristics and engagement with case management using data from the Washington State HIV Surveillance and Ryan White data systems. RESULTS: From 2017 to 2019, 5480 clients were enrolled in ADAP, of whom 1423 (26%) were disenrolled and 984 (18%) were ruled ineligible at least once. Compared with those who were continuously enrolled, disenrolled PLWH were more likely to be Black [unadjusted prevalence ratio (PR) vs White 1.31, 95% confidence interval (CI): 1.17 to 1.46], uninsured (PR vs private insurance 1.24, 95% CI: 1.10 to 1.40), and younger (PR 25-34 vs 35-44 years 1.23, 95% CI: 1.08 to 1.41). The median time to return after disenrollment was 12 months (95% CI: 8 to 19 months). CONCLUSIONS: Disenrollment after failure to recertify was the most common reason why PLWH lost ADAP coverage in Washington State. ADAP recertification procedures disproportionately affect Black, young, and uninsured PLWH and may contribute to disparities in HIV outcomes.
Authors: Noah C Godwin; James H Willig; Christa R Nevin; Hui-Yi Lin; Jeroan Allison; Kathy Gaddis; Jennifer Peterson; Michael S Saag; Michael J Mugavero; James L Raper Journal: Health Serv Res Date: 2011-01-06 Impact factor: 3.402
Authors: Kristin M Olson; Noah C Godwin; Sara Anne Wilkins; Michael J Mugavero; Linda D Moneyham; Larry Z Slater; James L Raper Journal: J Assoc Nurses AIDS Care Date: 2014-02-04 Impact factor: 1.354
Authors: David A Wohl; Rita K Kuwahara; Kamran Javadi; Christine Kirby; David L Rosen; Sonia Napravnik; Claire Farel Journal: AIDS Patient Care STDS Date: 2017-10-17 Impact factor: 5.078
Authors: Jens D Lundgren; Abdel G Babiker; Fred Gordin; Sean Emery; Birgit Grund; Shweta Sharma; Anchalee Avihingsanon; David A Cooper; Gerd Fätkenheuer; Josep M Llibre; Jean-Michel Molina; Paula Munderi; Mauro Schechter; Robin Wood; Karin L Klingman; Simon Collins; H Clifford Lane; Andrew N Phillips; James D Neaton Journal: N Engl J Med Date: 2015-07-20 Impact factor: 91.245
Authors: Emma Sophia Kay; Andrew Edmonds; Christina Ludema; Adaora Adimora; Maria L Alcaide; Aruna Chandran; Mardge H Cohen; Mallory O Johnson; Seble Kassaye; Mirjam-Colette Kempf; Caitlin A Moran; Oluwakemi Sosanya; Tracey E Wilson Journal: AIDS Care Date: 2020-11-25
Authors: Baligh R Yehia; Leslie Stewart; Florence Momplaisir; Aaloke Mody; Carol W Holtzman; Lisa M Jacobs; Janet Hines; Karam Mounzer; Karen Glanz; Joshua P Metlay; Judy A Shea Journal: BMC Infect Dis Date: 2015-06-28 Impact factor: 3.090
Authors: Pamela W Klein; Stacy M Cohen; Evin Uzun Jacobson; Zihao Li; Glenn Clark; Miranda Fanning; Rene Sterling; Steven R Young; Stephanie Sansom; Heather Hauck Journal: PLoS One Date: 2020-06-22 Impact factor: 3.240