Affordable Care Act Qualified Health Plan Coverage: Association With Improved HIV Viral Suppression for AIDS Drug Assistance Program Clients in a Medicaid Nonexpansion State
Affordable Care Act Qualified Health Plan Coverage: Association With Improved HIV Viral Suppression for AIDS Drug Assistance Program Clients in a Medicaid Nonexpansion State
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DOI：
10.1093/cid/ciw277
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发表时间：
2016-08-01
影响因子：
11.8
通讯作者：
Dillingham, Rebecca
中科院分区：
文献类型：
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作者：
McManus, Kathleen A.;Rhodes, Anne;Dillingham, Rebecca
背景。通过《患者保护和平价医疗法案》，许多州的艾滋病药物援助计划 (ADAP) 将其医疗保健提供模式从直接提供药物转变为购买合格的健康计划 (QHP)。本研究的目的是描述与弗吉尼亚 ADAP 客户 QHP 注册相关的人口和医疗保健提供因素，并评估 QHP 覆盖率与人类免疫缺陷病毒 (HIV) 病毒抑制之间的关系。方法。该队列包括参加弗吉尼亚 ADAP 的艾滋病毒感染者 (n = 3933)。数据收集时间为2013年1月1日至2014年12月31日。进行多变量二元逻辑回归来评估与QHP入组以及QHP覆盖率和病毒载量（VL）抑制之间的关联。结果。在该队列中，47.1% 的人参加了 QHP，并且根据人口和医疗保健提供因素，入学情况存在显着差异。在多变量二元 Logistic 回归中，控制时间、年龄、性别、种族/民族和地区，与实现 HIV 病毒抑制显着相关的因素包括 QHP 覆盖率（调整后的比值比，1.346；95% 置信区间，1.041-1.740；P=.02）、最初不可检测的 VL（2.809；2.174-3.636；P）
Background. With the Patient Protection and Affordable Care Act, many state AIDS Drug Assistance Programs (ADAPs) shifted their healthcare delivery model from direct medication provision to purchasing qualified health plans (QHPs). The objective of this study was to characterize the demographic and healthcare delivery factors associated with Virginia ADAP clients' QHP enrollment and to assess the relationship between QHP coverage and human immunodeficiency virus (HIV) viral suppression.Methods. The cohort included persons living with HIV who were enrolled in the Virginia ADAP (n = 3933). Data were collected from 1 January 2013 through 31 December 2014. Multivariable binary logistic regression was conducted to assess for associations with QHP enrollment and between QHP coverage and viral load (VL) suppression.Results. In the cohort, 47.1% enrolled in QHPs, and enrollment varied significantly based on demographic and healthcare delivery factors. In multivariable binary logistic regression, controlling for time, age, sex, race/ethnicity, and region, factors significantly associated with achieving HIV viral suppression included QHP coverage (adjusted odds ratio, 1.346; 95% confidence interval, 1.041-1.740; P=.02), an initially undetectable VL (2.809; 2.174-3.636; P