Division of Infectious Diseases and International Health, Charlottesville.
Center for Health Policy, University of Virginia, Charlottesville.
Clin Infect Dis. 2018 Oct 15;67(9):1403-1410. doi: 10.1093/cid/ciy296.
The Affordable Care Act (ACA) affects United States' healthcare by offering Medicaid expansion and tax subsidies to persons with low incomes, and its interaction with the current human immunodeficiency virus (HIV) healthcare delivery system is complex. The objective was to explore HIV medical providers' knowledge and attitudes about the ACA.
HIV medical providers were emailed a weblink to a survey. Descriptive statistics, Mann-Whitney U tests, and binary logistic regression were performed.
Of the 253 survey participants, the majority (61%) answered all 4 knowledge questions correctly. About 70% knew whether or not their state had decided to expand Medicaid. About 1 in 10 did not know if the ACA eliminated the Ryan White Program. When rating whether the ACA would improve their patients' HIV outcomes from 1-5 with 5 as "strongly agree," the providers' mean responses varied by state Medicaid status: 3.78 (standard deviation [SD], 0.83) for Medicaid expansion compared with 3.37 (SD, 1.00) for Medicaid nonexpansion (P = .002). Adjusting for medical provider type, years of HIV practice, and sources of ACA information, correct ACA knowledge was associated with providing care in a Medicaid nonexpansion state (adjusted odds ratio [aOR], 2.07; 95% confidence interval [CI], 1.11-3.88), obtaining knowledge from case managers (aOR, 1.89; 95% CI, 1.03-3.48), and obtaining knowledge from newspapers/magazines (aOR, 1.94; 95% CI, .99-3.81).
Medical providers in Medicaid expansion states were more optimistic about the ACA's likelihood to improve their patients' HIV outcomes. There are gaps in HIV medical providers' understanding of the ACA. Education could enhance systems-based practice.
平价医疗法案（ACA）通过向低收入人群提供医疗补助扩大和税收补贴，对美国的医疗保健产生了影响，其与当前艾滋病毒（HIV）医疗服务提供系统的相互作用非常复杂。目的是探讨 HIV 医疗服务提供者对 ACA 的了解和态度。
向 HIV 医疗服务提供者发送电子邮件，提供调查的网络链接。进行描述性统计、Mann-Whitney U 检验和二项逻辑回归。
在 253 名调查参与者中，大多数（61%）正确回答了所有 4 个知识问题。大约 70%的人知道他们所在的州是否决定扩大医疗补助。大约 10%的人不知道 ACA 是否取消了 Ryan White 计划。在从 1-5 对 ACA 是否会改善他们患者的 HIV 结果进行评分时，其中 5 表示“强烈同意”，提供者的平均反应因州医疗补助状况而异：扩大医疗补助的为 3.78（标准差 [SD]，0.83），而没有扩大医疗补助的为 3.37（SD，1.00）（P =.002）。调整医疗服务提供者类型、HIV 实践年限和 ACA 信息来源后，正确的 ACA 知识与在没有医疗补助的州提供护理相关（调整后的优势比 [aOR]，2.07；95%置信区间 [CI]，1.11-3.88），从个案经理处获得知识（aOR，1.89；95% CI，1.03-3.48），从报纸/杂志获得知识（aOR，1.94；95% CI，.99-3.81）。
在医疗补助扩大的州，医疗服务提供者对 ACA 改善患者 HIV 结果的可能性更为乐观。HIV 医疗服务提供者对 ACA 的理解存在差距。教育可以增强基于系统的实践。
