1 School of Social Work, University of Michigan , Ann Arbor, Michigan.
2 Department of Social Work, University of Alabama at Birmingham , Birmingham, Alabama.
AIDS Patient Care STDS. 2018 Jul;32(7):265-271. doi: 10.1089/apc.2018.0032.
The Ryan White HIV/AIDS program (RWHAP) provides essential primary and supplementary health services to people living with HIV (PLWH). We examined the relationship between supplementary RWHAP services (Part B) and two outcomes: viral suppression (VS) and two separate measures of retention in care (RiC) based on kept- and missed-visits. We used purposive sampling to identify adult patients who received primary medical care at an academically-affiliated HIV/AIDS clinic in the southeastern United States (N = 1159) and who attended at least one scheduled HIV primary care appointment at the study site during 2015. Unadjusted and adjusted logistic regression models were fit, in which RWHAP supplementary services were the primary independent variables of interest. Age, race, gender, education level, and income were control variables. Among 1159 PLWH, 45.3% received RWHAP supplementary services in addition to public insurance, private insurance, or primary RWHAP. Among participants, 91.4% were virally suppressed, 87.4% were retained in care using the Institute of Medicine (IOM) kept-visits measure, and 60% were retained in care using the missed-visits measure. In multivariable models, patients with RWHAP supplementary services had significantly higher odds of (1) VS [adjusted odds ratio (AOR) = 1.91], (2) RiC using the IOM kept-visits measure (AOR = 2.56), and (3) RiC using the missed-visits measure (AOR = 1.58). Receipt of supplementary RWHAP services is associated with increased odds of VS and two measures of RiC when adjusting for key sociodemographic variables. Policymakers should consider the vital role of RWHAP as continued funding is uncertain.
瑞安·怀特艾滋病防治计划（RWHAP）为艾滋病毒感染者（PLWH）提供基本的初级和补充卫生服务。我们考察了补充性 RWHAP 服务（B 部分）与以下两个结果之间的关系：病毒抑制（VS）和两种分别基于失约和如约就诊的保留治疗率（RiC）测量值。我们采用目的性抽样方法，在美国东南部一家学术附属艾滋病诊所识别出接受初级医疗护理的成年患者（N=1159），并在研究期间至少有一次在研究地点预约了初级艾滋病毒护理就诊。我们拟合了未经调整和调整后的逻辑回归模型，其中 RWHAP 补充服务是主要关注的独立变量。年龄、种族、性别、教育程度和收入是控制变量。在 1159 名 PLWH 中，45.3%的人在接受公共保险、私人保险或主要 RWHAP 之外还接受了 RWHAP 补充服务。在参与者中，91.4%的人病毒得到抑制，87.4%的人根据医学研究所（IOM）的如约就诊测量标准保留治疗，60%的人根据失约就诊测量标准保留治疗。在多变量模型中，接受 RWHAP 补充服务的患者（1）VS 的可能性显著更高[调整后的优势比（AOR）=1.91]，（2）使用 IOM 如约就诊测量标准的 RiC（AOR=2.56），以及（3）使用失约就诊测量标准的 RiC（AOR=1.58）。在调整关键社会人口统计学变量后，接受补充性 RWHAP 服务与 VS 以及两种 RiC 测量值的可能性增加相关。政策制定者应考虑到 RWHAP 的重要作用，因为持续供资的情况并不确定。
