Current challenges to the United states' AIDS drug assistance program and possible implications of the affordable care act.
Current challenges to the United states' AIDS drug assistance program and possible implications of the affordable care act.
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DOI：
10.1155/2013/350169
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发表时间：
2013
影响因子：
1.7
通讯作者：
Dillingham R
中科院分区：
文献类型：
--
作者：
McManus KA;Engelhard CL;Dillingham R
艾滋病药物援助计划是通过1990年瑞安·怀特综合艾滋病资源紧急法案颁布的，是为低收入、未参保或保险不足的艾滋病毒/艾滋病患者提供处方药的“最后支付者”。ADAP面临着来自联邦政府的资金减少。国家对ADAP的资助是可自由支配的，但一些州增加了捐款，以弥补资金缺口。随着艾滋病毒携带者寿命的延长，对ADAP支持的需求不断增加；抗逆转录病毒疗法(ART)指南已被修改，建议开始对所有人进行治疗；美国正在提高艾滋病毒检测目标；经济衰退仍在继续。在需求增加和资金有限的情况下，反兴奋剂机构正在采取成本控制措施。自2010年以来，紧急联邦基金一直在为ADAP纾困，但这些都是不可持续的。在未来几年，与艾滋病毒护理相关的提供者和政策制定者将需要引导《平价医疗法案》(ACA)的实施。从通过反兴奋剂计划向弱势群体提供可持续的抗逆转录病毒治疗的相关挑战中吸取的经验教训，应为即将作出的关于如何确保在实施抗逆转录病毒药物援助期间和之后提供抗逆转录病毒药物的决定提供参考。
AIDS Drug Assistance Programs, enacted through the Ryan White Comprehensive AIDS Resources Emergency Act of 1990, are the “payer of last resort” for prescription medications for lower income, uninsured, or underinsured people living with HIV/AIDS. ADAPs face declining funding from the federal government. State funding of ADAP is discretionary, but some states increased their contributions to meet the gap in funding. The demand for ADAP support is increasing as people living with HIV are living longer; the antiretroviral therapy (ART) guidelines have been changed to recommend initiation of treatment for all; the United States is increasing HIV testing goals; and the recession continues. In the setting of increased demand and limited funding, ADAPs are employing cost containment measures. Since 2010, emergency federal funds have bailed out ADAP, but these are not sustainable. In the coming years, providers and policy makers associated with HIV care will need to navigate the implementation of the Affordable Care Act (ACA). Lessons learned from the challenges associated with providing sustainable access to ART for vulnerable populations through ADAP should inform upcoming decisions about how to ensure delivery of ART during and after the implementation of the ACA.