(Reuters Health) - A 25-year-old program named for Ryan White, who was expelled from school at age 13 because he had HIV, now provides essential services to nearly three-quarters of HIV-positive patients in the U.S., a new analysis shows.
Compared to other outpatient HIV treatment facilities, those funded by the federal Ryan White HIV/AIDS Program (RWHAP) offer more case management, mental health and substance abuse support services, and those services make a difference in patient outcomes, according to researchers from Centers for Disease Control and Prevention (CDC).
Facilities that applied for and received funding through the RWHAP have served more vulnerable populations, including the poor or recently homeless or incarcerated, said lead author Dr. John Weiser of the CDC’s Division of HIV/AIDS Prevention in Atlanta, Georgia.
“As expected, patients receiving care at RWHAP-funded facilities, because they were more likely to experience life challenges, were less likely overall to achieve viral suppression than those receiving care at non-RWHAP-funded facilities,” Weiser told Reuters Health by email.
“However, after taking those differences into consideration, poor patients were more likely to achieve viral suppression if they received care at RWHAP-funded facilities,” he said.
Achieving viral suppression by taking HIV medication means that levels of the virus in the body are so low that people have a nearly average life expectancy and are less likely to transmit the disease, according to the CDC.
In 1990, the RWHAP was established to fund states, metropolitan areas and clinics to increase access to high-quality HIV care and treatment for low-income, uninsured and underinsured individuals and families.
Currently reaching 500,000 people with HIV – more than half of those in the U.S. living with the disease – the RWHAP is a “payer of last resort” for core medical services like medication that a facility could otherwise not afford, and also for support services like food, housing and transportation or counseling services.
As the Affordable Care Act and Medicaid expansion increase access to HIV treatment for many Americans, the supportive services that the RWHAP funds are still often not covered by Medicaid and commercial insurance, Weiser said. So facilities without RWHAP funding would need to find another way to pay for them, he noted.
For the new study, published in JAMA Internal Medicine, Weiser’s team looked at data from 2009 and 2011 covering a sample of 8,038 HIV-infected adults receiving medical care at 989 outpatient health care facilities across the U.S.
They found that 34 percent of facilities received RWHAP funding and 72.8 percent of patients were treated at one of these facilities.
Patients getting care at RWHAP-funded facilities were more likely to be young, female and black or Hispanic, to have less than a high school education, be at or below the poverty level and to lack health insurance.
Nonetheless, almost 75 percent of patients at RWHAP funded facilities achieved viral suppression, only slightly less than the 79 percent at other facilities.
“If we’re going to have an increase in the number of cases, we’re going to have to increase the proportion of people who are virally suppressed,” said commentary author Stephen F. Morin of the University of California, San Francisco, who worked on the authorization of the Ryan White program as part of congresswoman Nancy Pelosi’s staff in the 1980s.
Ryan White-funded programs are “stretched to the limit” in states that did not expand Medicaid, like Alabama, Morin told Reuters Health.
Many states are having trouble financing important case management services, he said.
Ryan White died in 1990 at age 18, just months before Congress passed the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act.
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