Impact of Health Insurance, ADAP, and Income on HIV Viral Suppression Among US Women in the Women's Interagency HIV Study, 2006-2009

• Type of Material: Article
• Authors: Christina Ludema, University of North Carolina; Stephen R. Cole, University of North Carolina; Joseph J. Eron, University of North Carolina; Andrew Edmonds, University of North Carolina; G. Mark Holmes, University of North Carolina; Kathryn Anastos, Albert Einstein College of Medicine; Jennifer Cocohoba, University of California San Francisco; Mardge Cohen, Rush University; Hannah Cooper, Emory University; Elizabeth T. Golub, Johns Hopkins University; Seble Kassaye, Georgetown University; Deborah Konkle-Parker, University of Mississippi; Lisa Metsch, Columbia University; Joel Milam, University of Southern California; Tracey E. Wilson, State University of New York; Adaora A. Adimora, University of North Carolina
• Language: English
• Date: 2016-11-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © Copyright 2016 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1097/QAI.0000000000001078
• Title of Journal or Parent Work: Journal of Acquired Immune Deficiency Syndromes
• ISSN: 1525-4135
• Volume: 73
• Issue: 3
• Start Page: 307
• End Page: 312
• Grant/Funding Information: Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Deafness and other Communication Disorders (NIDCD), and the NIH Office of Research on Women’s Health.; The WIHS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID),with additional co-funding from the Eunice Kennedy ShriverNational Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute on Mental Health (NIMH).; WIHS data collection is also supported by UL1-TR000004 (UCSF CTSA) and UL1-TR000454 (Atlanta CTSA).; WIHS (Principal Investigators): UAB-MS WIHS (Michael Saag, Mirjam-Colette Kempf, and Deborah Konkle-Parker), U01-AI-103401; Atlanta WIHS (Ighovwerha Ofotokun and Gina Wingood), U01-AI-103408; Bronx WIHS (Kathryn Anastos), U01-AI-035004; Brooklyn WIHS (Howard Minkoff and Deborah Gustafson), U01-AI-031834; Chicago WIHS (Mardge Cohen), U01-AI-034993; Metropolitan Washington WIHS (Mary Young), U01-AI-034994; Miami WIHS (Margaret Fischl and Lisa Metsch), U01-AI-103397; UNC WIHS (Adaora Adimora), U01-AI-103390; Connie Wofsy Women’s HIV Study, Northern California (Ruth Greenblatt, Bradley Aouizerat, and Phyllis Tien), U01-AI-034989; WIHS Data Management and Analysis Center (Stephen Gange and Elizabeth Golub), U01-AI-042590; Southern California WIHS (Alexandra Levine and Marek Nowicki), U01-HD-032632 (WIHS I – WIHS IV).; Supported in part by the National Institutes of Health (NIH U01 AI103390, and K24 HD059358).
• Keywords: income; women; COVERAGE; INFECTION; ADHERENCE; health insurance; Science & Technology; Immunology; MARGINAL STRUCTURAL MODELS; CARE; ANTIRETROVIRAL THERAPY; DISEASE; socioeconomic factors; HIV; Infectious Diseases; Life Sciences & Biomedicine
• Research Categories: Biology, Virology; Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Background: Implementation of the Affordable Care Act m otivates assessment of health insurance and supplementary programs, such as the AIDS Drug Assistance Program (ADAP) on health outcomes of HIV-infected people in the United States. We assessed the effects of health insurance, ADAP, and income on HIV viral load suppression. Methods: We used existing cohort data from the HIV-infected participants of the Women's Interagency HIV Study. Cox proportional hazards models were used to estimate the time from 2006 to unsuppressed HIV viral load ( > 200 copies/mL) among those with Medicaid, private, Medicare, or other public insurance, and no insurance, stratified by the use of ADAP. Results: In 2006, 65% of women had Medicaid, 18% had private insurance, 3% had Medicare or other public insurance, and 14% reported no health insurance. ADAP coverage was reported by 284 women (20%); 56% of uninsured participants reported ADAP coverage. After accounting for study site, age, race, lowest observed CD4, and previous health insurance, the hazard ratio (HR) for unsuppressed viral load among those privately insured without ADAP, compared with those on Medicaid without ADAP (referent group), was 0.61 (95% CI: 0.48 to 0.77). Among the uninsured, those with ADAP had a lower relative hazard of unsuppressed viral load compared with the referent group (HR, 95% CI: 0.49, 0.28 to 0.85) than those without ADAP (HR, 95% CI: 1.00, 0.63 to 1.57). Conclusions: Although women with private insurance are most likely to be virally suppressed, ADAP also contributes to viral load suppression. Continued support of this program may be especially critical for states that have not expanded Medicaid.