The Ryan White HIV/AIDS Program After the Patient Protection and Affordable Care Act Full Implementation: a Critical Review of Predictions, Evidence, and Future Directions

Overview

Journal Top Antivir Med

Specialties Infectious Diseases
Microbiology

Date 2019 Oct 22

PMID 31634860

Citations 6

Authors

Tamar Ginossar

John Oetzel

Lindsay Van Meter

Andrew A Gans

Joel E Gallant

Affiliations

Soon will be listed here.

Abstract

The Ryan White HIV/AIDS Program (RWHAP) has been effective in serving people living with HIV (PLWH). Our goal was to examine the impact of the implementation of the Affordable Care Act (ACA) on the program's role in HIV care and its clients. We utilized critical review to synthesize the literature on the anticipated effects of the ACA, and assess the evidence regarding the early effects of the ACA on the program and on PLWH who receive RWHAP services. To date, research on the impact of ACA on RWHAP has been fragmented. Despite the expected benefits of the ACA to PLWH, access and linkage to care, reducing inequity in HIV risk and access to care, and coping with comorbidities remain pressing challenges. There are additional gaps following ACA implementation related to immigrant care. RWHAP's proven success in addressing these challenges, and the political threats to ACA, highlight the need for maintaining the program to meet HIV care needs. More evidence on the role and impact of RWHAP in this new era is needed to guide policy and practice of care for PLWH. Additional research is needed to explore RWHAP care and its clients' health outcomes following ACA implementation, with a focus on at-risk groups such as immigrants, transgender women, homeless individuals, and PLWH struggling with mental health problems.

Citing Articles

Mixed Methods Evaluation of a Youth-Friendly Clinic for Young People Living with HIV Transitioning from Pediatric Care.

Chew H, Bonnet K, Schlundt D, Hill N, Pierce L, Ahonkhai A Trop Med Infect Dis. 2024; 9(9).

PMID: 39330887 PMC: 11435583. DOI: 10.3390/tropicalmed9090198.

Understanding why racial/ethnic inequities along the HIV care continuum persist in the United States: a qualitative exploration of systemic barriers from the perspectives of African American/Black and Latino persons living with HIV.

Filippone P, Serrano S, Campos S, Freeman R, Cluesman S, Israel K Int J Equity Health. 2023; 22(1):168.

PMID: 37649049 PMC: 10466874. DOI: 10.1186/s12939-023-01992-6.

Considerations for partnering with Ryan White Case Managers to create equitable opportunities for people with HIV to participate in research.

Lockhart E, Turner D, Galea J, Marhefka S PLoS One. 2022; 17(10):e0276057.

PMID: 36260624 PMC: 9581377. DOI: 10.1371/journal.pone.0276057.

Impact of Insurance Status on Outcomes in Individuals with AIDS-Defining Cancers.

Jiang J, Reid E AIDS Res Hum Retroviruses. 2021; 37(11):884-892.

PMID: 34583514 PMC: 8817691. DOI: 10.1089/AID.2021.0102.

The influence of healthcare financing on cardiovascular disease prevention in people living with HIV.

Webel A, Schexnayder J, Rentrope C, Bosworth H, Hileman C, Okeke N BMC Public Health. 2020; 20(1):1768.

PMID: 33228623 PMC: 7685650. DOI: 10.1186/s12889-020-09896-8.

References

Zamani-Hank Y . The Affordable Care Act and the Burden of High Cost Sharing and Utilization Management Restrictions on Access to HIV Medications for People Living with HIV/AIDS. Popul Health Manag. 2015; 19(4):272-8. DOI: 10.1089/pop.2015.0076. View

Berry S, Fleishman J, Yehia B, Cheever L, Hauck H, Korthuis P . Healthcare Coverage for HIV Provider Visits Before and After Implementation of the Affordable Care Act. Clin Infect Dis. 2016; 63(3):387-95. PMC: 4946016. DOI: 10.1093/cid/ciw278. View

Durenberger D . Health Care Reform and the American Congress. Milbank Q. 2015; 93(4):663-6. PMC: 4678930. DOI: 10.1111/1468-0009.12155. View

Doshi R, Milberg J, Jumento T, Matthews T, Dempsey A, Cheever L . For Many Served By The Ryan White HIV/AIDS Program, Disparities In Viral Suppression Decreased, 2010-14. Health Aff (Millwood). 2017; 36(1):116-123. DOI: 10.1377/hlthaff.2016.0655. View

Hirschhorn L, Landers S, McInnes D, Malitz F, Ding L, Joyce R . Reported care quality in federal Ryan White HIV/AIDS Program supported networks of HIV/AIDS care. AIDS Care. 2009; 21(6):799-807. DOI: 10.1080/09540120802511992. View

Price C, Eibner C . For states that opt out of Medicaid expansion: 3.6 million fewer insured and $8.4 billion less in federal payments. Health Aff (Millwood). 2013; 32(6):1030-6. DOI: 10.1377/hlthaff.2012.1019. View

Huff A, Chumbler N, Cherry C, Hill M, Veguilla V . An in-depth mixed-methods approach to Ryan White HIV/AIDS care program comprehensive needs assessment from the Northeast Georgia Public Health District: the significance of patient privacy, psychological health, and social stigma to care. Eval Program Plann. 2015; 49:137-48. DOI: 10.1016/j.evalprogplan.2015.01.003. View

Abraham J . How might the Affordable Care Act's coverage expansion provisions influence demand for medical care?. Milbank Q. 2014; 92(1):63-87. PMC: 3955378. DOI: 10.1111/1468-0009.12041. View

Cahill S, Mayer K, Boswell S . The Ryan White HIV/AIDS Program in the Age of Health Care Reform. Am J Public Health. 2015; 105(6):1078-85. PMC: 4431102. DOI: 10.2105/AJPH.2014.302442. View

10.

Beer L, Mattson C, Bradley H, Skarbinski J . Understanding Cross-Sectional Racial, Ethnic, and Gender Disparities in Antiretroviral Use and Viral Suppression Among HIV Patients in the United States. Medicine (Baltimore). 2016; 95(13):e3171. PMC: 4998540. DOI: 10.1097/MD.0000000000003171. View

11.

Lipira L, Williams E, Hutcheson R, Katz A . Evaluating the Impact of the Affordable Care Act on HIV Care, Outcomes, Prevention, and Disparities: A Critical Research Agenda. J Health Care Poor Underserved. 2017; 28(4):1254-1275. DOI: 10.1353/hpu.2017.0112. View

12.

Sood N, Juday T, Vanderpuye-Orgle J, Rosenblatt L, Romley J, Peneva D . HIV care providers emphasize the importance of the Ryan White Program for access to and quality of care. Health Aff (Millwood). 2014; 33(3):394-400. DOI: 10.1377/hlthaff.2013.1297. View

13.

Bradley H, Hall H, Wolitski R, Van Handel M, Stone A, LaFlam M . Vital Signs: HIV diagnosis, care, and treatment among persons living with HIV--United States, 2011. MMWR Morb Mortal Wkly Rep. 2014; 63(47):1113-7. PMC: 5779517. View

14.

Altice F, Kamarulzaman A, Soriano V, Schechter M, Friedland G . Treatment of medical, psychiatric, and substance-use comorbidities in people infected with HIV who use drugs. Lancet. 2010; 376(9738):367-87. PMC: 4855280. DOI: 10.1016/S0140-6736(10)60829-X. View

15.

Beane S, Culyba R, DeMayo M, Armstrong W . Exploring the medical home in Ryan White HIV care settings: a pilot study. J Assoc Nurses AIDS Care. 2014; 25(3):191-202. PMC: 4104981. DOI: 10.1016/j.jana.2013.10.007. View

16.

Goldman D, Juday T, Seekins D, Linthicum M, Romley J . Early HIV treatment in the United States prevented nearly 13,500 infections per year during 1996-2009. Health Aff (Millwood). 2014; 33(3):362-9. PMC: 4124881. DOI: 10.1377/hlthaff.2013.0830. View

17.

McManus K, Engelhard C, Dillingham R . Current challenges to the United states' AIDS drug assistance program and possible implications of the affordable care act. AIDS Res Treat. 2013; 2013:350169. PMC: 3614023. DOI: 10.1155/2013/350169. View

18.

Abara W, Heiman H . The Affordable Care Act and low-income people living with HIV: looking forward in 2014 and beyond. J Assoc Nurses AIDS Care. 2014; 25(6):476-82. PMC: 4472370. DOI: 10.1016/j.jana.2014.05.002. View

19.

Pappas G, Yujiang J, Seiler N, Malcarney M, Horton K, Shaikh I . Perspectives on the role of patient-centered medical homes in HIV Care. Am J Public Health. 2014; 104(7):e49-53. PMC: 4056203. DOI: 10.2105/AJPH.2014.302022. View

20.

Bradley H, Viall A, Wortley P, Dempsey A, Hauck H, Skarbinski J . Ryan White HIV/AIDS Program Assistance and HIV Treatment Outcomes. Clin Infect Dis. 2015; 62(1):90-98. PMC: 5087096. DOI: 10.1093/cid/civ708. View