Virginia Department of Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
Virginia Commonwealth University School of Medicine, Richmond, Virginia
Clin Infect Dis. 2017 Aug 15;65(4):619-625. doi: 10.1093/cid/cix380.
Knowledge gaps remain about how the Ryan White human immunodeficiency virus (HIV)/AIDS Program (RW) contributes to health outcomes. We examined the association between different RW service classes and retention in care (RiC) or viral suppression (VS).
We identified Virginians engaged in any HIV care between 1 January and 31 December 2014. RW beneficiaries were classified by receipt of ≥1 service from 3 classes: Core medical, Support, and insurance and/or direct medication assistance through the AIDS Drug Assistance Program (ADAP). Receipt of all RW classes was defined as comprehensive assistance. We used multivariable logistic regression to compare the odds of RiC and of VS by comprehensive assistance and by RW classes alone and in combination.
Among 13104 individuals, 58% received any RW service and 17% comprehensive assistance. Comprehensive assistance is significantly associated with RiC (adjusted odds ratio [aOR], 8.8 [95% confidence interval {CI}, 7.2-10.8]) and viral suppression (aOR, 3.3 [95% CI, 2.9-3.8]). Receiving any 2 RW classes or Core alone is significantly associated with RiC and VS, with the strength of association decreasing as the number of classes decreases. Recipients of Support alone are significantly less likely to have VS (aOR, 0.75 [95% CI, .59-.96]). For ADAP recipients also receiving Core and/or Support, insurance assistance is significantly associated with VS compared to receiving direct medication only (aOR, 1.6 [95% CI, 1.3-1.9]); this relationship is not significant for those who receive ADAP alone.
Receiving more classes of RW-funded services is associated with improved HIV outcomes. For some populations with insurance, RW-funded services may still be required for optimal health outcomes.
关于 Ryan White 人类免疫缺陷病毒（HIV）/艾滋病计划（RW）如何促进健康结果，知识差距仍然存在。我们研究了不同 RW 服务类别与保持护理（RiC）或病毒抑制（VS）之间的关联。
我们确定了 2014 年 1 月 1 日至 12 月 31 日期间参与任何 HIV 护理的弗吉尼亚州居民。RW 受益人根据以下 3 个类别获得的服务≥1 项进行分类：核心医疗、支持和保险以及通过艾滋病药物援助计划（ADAP）获得的直接药物援助。接受所有 RW 类别被定义为全面援助。我们使用多变量逻辑回归比较了综合援助和 RW 类别单独和组合时 RiC 和 VS 的可能性。
在 13104 名个体中，58%接受了任何 RW 服务，17%接受了全面援助。综合援助与 RiC 显著相关（调整后的优势比 [aOR]，8.8 [95%置信区间 {CI}，7.2-10.8]）和病毒抑制（aOR，3.3 [95% CI，2.9-3.8]）。接受任何 2 个 RW 类别或仅核心与 RiC 和 VS 显著相关，随着类别的减少，关联的强度也随之降低。仅接受支持的接受者不太可能具有 VS（aOR，0.75 [95% CI，0.59-0.96]）。对于还接受核心和/或支持的同时接受 ADAP 的接受者，与仅接受直接药物相比，保险援助与 VS 显著相关（aOR，1.6 [95% CI，1.3-1.9]）；对于单独接受 ADAP 的人来说，这种关系并不显著。
接受更多类别的 RW 资助服务与改善 HIV 结果相关。对于某些有保险的人群，RW 资助的服务可能仍然是获得最佳健康结果所必需的。
