AIDS Drug Assistance Programs (ADAPs) are a critical arm of the Ryan White HIV/AIDS Program (RWHAP) that enable uninsured/underinsured people with HIV (PWH) with low incomes access to HIV-related medications. While ADAPs continue to expand options for health insurance coverage and have documented effectiveness towards promoting viral suppression, no studies have analyzed longitudinal trends in client utilization. The objective of this study was to evaluate trends in ADAP utilization among key demographic subpopulations using national, regional, and state-level longitudinal data.
State-level data regarding ADAP client utilization were collected via the National Alliance of State and Territorial AIDS Directors (NASTAD) National RWHAP Part B and ADAP Monitoring Project reports for years 2008-2018. Estimated HIV prevalence data were collected from the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) AtlasPlus (2008-2018). Descriptive statistics were applied to estimate the overall proportion of PWH served by ADAP including demographic subpopulations (age, race/ethnicity, and sex). Linear mixed models were built to assess the proportion of clients served over time by the fixed effects of year and a binary, indicator term (i.e. <2015) to adjust for the increase in ADAP utilization following the elimination of programmatic waitlists in 2015 and the random effect of states.
Of the estimated 1,020,450 PWH nationally in 2018, 234,798 (23%) were served by ADAP. This was a significant increase compared to 2008 in which 14% of the estimated 768,038 PWH were served. The proportion of PWH served by ADAP increased significantly over time (% change per year: 0.4%, 95% CI 0.2 – 0.6) with a large increase in 2015 (% change from 2014: 9.3%, 95% CI 7.7 – 10.9). PWH aged 13 – 24 experienced the largest increase in proportion served (18%) when compared to those aged 25 – 44 and 45 or older (11% and 7%, respectively). Overall, ADAP utilization increased among each racial subpopulation. However, the uptick in White PWH was significantly higher (23%) when compared to Black or Hispanic PWH (11% and 9%, respectively), both at the national and regional level.
While ADAPs continue to expand coverage and provide support for uninsured/underinsured clients, there are disparities in client utilization among racial subpopulations on both a national and regional scale. Further study is warranted to assess the factors that contribute to this health inequity.