The Ryan White HIV/AIDS Program and Clinical Outcomes: A Retrospective Chart Review

Background/Purpose: For over 25 years, the federal Ryan White HIV/AIDS Program (RWHAP) has provided medical and social services care to low-income people living with HIV (PLWH) as a payer of last resort. In fact, RWHAP is the sole provider of medical care for over a quarter of RWHAP clients, many of whom live in states that have elected to not expand Medicaid under the Affordable Care Act (ACA).

In order to assess the impact that RWHAP assistance has on HIV-related health outcomes, we conducted a retrospective cohort study of all PLWH who received primary medical care at a Southeastern university-affiliated HIV/AIDS clinic within a two-year period. While extant literature suggests that PLWH who receive medical care that is either partially or fully funded through RWHAP have better health outcomes than PLWH who have private or public insurance only, none have examined patient outcomes since the ACA’s full implementation.

Methods: Data and Samples: We reviewed de-identified patient records for 2276 adult PLWH who received primary medical care at the study site between 5/1/13 and 4/30/15.

Measures: Viral suppression was our dichotomous outcome measure in this study. Our primary independent variable of interest was RWHAP assistance, and other independent variables were insurance type (uninsured, public, or private), gender, age, income, and race.

Results:

Descriptive analyses showed that most participants were African American (68.7%), male (74.1%), and had RWHAP assistance (88.8%). Although insurance type was fairly evenly distributed, most were insured (74.4%) with either private (38.5%) or public (35.9%) insurance. The mean age was about 45 years old. The mean monthly income was $901.36. Most participants (83.3%) had a suppressed viral load.

Bivariate analyses indicated that uninsured PLWH and lower income PLWH were less likely to have RWHAP assistance than PLWH with public or private health insurance or PLWH with higher incomes. Our multivariate analysis revealed that even after controlling for insurance type, age, gender, income, and race, PLWH with RWHAP assistance were 1.69 times more likely than PLWH without RWHAP assistance to achieve viral suppression (p=.001).

Conclusion and Implications: Our multivariate findings support the results of past studies, which suggest that PLWH who receive RWHAP assistance have better health outcomes than PLWH who do not. Our bivariate results, which indicated that RWHAP assistance was negatively associated with higher income and receipt of health insurance, were unexpected since RWHAP is a payer of last resort for low-income PLWH. However, a possible explanation for this seemingly counterintuitive result is that PLWH who were most in need of RWHAP services also may have experienced multiple barriers to care. This highlights the need for HIV physicians and social workers to ensure that all RWHAP-eligible patients are aware of the program and are able to access its services. At the macro level, our study contributes to the growing body of literature that supports continued congressional funding of RWHAP.