Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA, United States.
Killelea Consulting, Arlington, VA, United States.
Front Public Health. 2023 Jul 31;11:1172009. doi: 10.3389/fpubh.2023.1172009. eCollection 2023.
We characterized the challenges and innovations of states' Ryan White HIV/AIDS Program (RWHAP) Part B programs, including AIDS Drug Assistance Programs (ADAPs), during the COVID-19 pandemic. In the United States, these are important safety net programs for HIV healthcare, providing essential medical and support services, and medications, to people with HIV with low incomes who are uninsured/underinsured.
Data were collected via the 2021-2022 NASTAD National RWHAP Part B and ADAP Monitoring Project Report, a cross-sectional survey of state, district, and territorial programs through a mixed method study design. For quantitative data, we used descriptive statistics. Qualitative responses were coded and analyzed using content analysis.
Forty-seven RWHAP Part B and ADAPs responded (92% response rate). The majority of respondents reported that maintaining client eligibility (78%) and working remotely (70%) were the most challenging aspects of the pandemic, particularly in regards to implementing new telehealth and e-certification platforms. In response to COVID-19, programs introduced enrollment "grace periods" (19%), bolstered client outreach (11%), allowed more than a 30 day supply of medications (79%), and supported medication home delivery for clients (80%).
Despite the challenges of the COVID-19 pandemic, RWHAP Part B and ADAPs implemented several operational innovations in order to continue providing essential medicines and services. Other public health programs may adopt similar innovations, including digital innovations, for greater public health benefit. Future studies should assess the retention of policy innovations over time, their impact on the individual client level satisfaction or health outcomes, and what factors may improve the acceptability of telehealth and e-certification platforms.
我们描述了美国各州“瑞安·怀特艾滋病防治计划（RWHAP）B 部分项目（包括艾滋病药物援助项目（ADAP））在 COVID-19 大流行期间所面临的挑战和创新。在美国，这些项目是为艾滋病毒感染者提供医疗保健的重要安全网项目，为收入较低、未参保/参保不足的艾滋病毒感染者提供必要的医疗和支持服务以及药物。
通过 2021-2022 年 NASTAD 国家 RWHAP B 部分和 ADAP 监测项目报告收集数据，该报告采用混合方法研究设计，对州、地区和属地项目进行了横断面调查。对于定量数据，我们使用描述性统计。定性回复通过内容分析进行编码和分析。
47 个 RWHAP B 部分和 ADAP 项目做出回应（回应率为 92%）。大多数受访者表示，维持客户资格（78%）和远程工作（70%）是疫情期间最具挑战性的方面，特别是在实施新的远程医疗和电子认证平台方面。为应对 COVID-19，项目引入了登记“宽限期”（19%），加强了客户外联（11%），允许提供超过 30 天的药物供应（79%），并为客户提供药物上门配送（80%）。
尽管面临 COVID-19 大流行的挑战，但 RWHAP B 部分和 ADAP 实施了一些运营创新，以继续提供必要的药物和服务。其他公共卫生项目可能会采用类似的创新，包括数字创新，以获得更大的公共卫生效益。未来的研究应评估政策创新随时间的保留情况、它们对个人客户满意度或健康结果的影响，以及哪些因素可能提高远程医疗和电子认证平台的可接受性。
