Evidence From a Multistate Cohort: Enrollment in Affordable Care Act Qualified Health Plans' Association With Viral Suppression.
Evidence From a Multistate Cohort: Enrollment in Affordable Care Act Qualified Health Plans' Association With Viral Suppression.
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来自多层人群的证据：招生负担得起的护理法案合格的健康计划与病毒抑制的协会。
DOI：
10.1093/cid/ciz1123
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发表时间：
2020-12-17
期刊：
影响因子：
--
通讯作者：
Dillingham R
中科院分区：
文献类型：
--
作者：
McManus KA;Christensen B;Nagraj VP;Furl R;Yerkes L;Swindells S;Weissman S;Rhodes A;Targonski P;Rogawski McQuade E;Dillingham R
与病毒抑制(VS)相关的医疗保健提供变化可能有助于美国的“结束艾滋病毒流行”(ETH)倡议。这项研究旨在确定艾滋病药物援助计划(ADAP)购买的合格健康计划(QHP)是否与3个州的低收入艾滋病毒携带者(PLWH)的VS相关。对有资格获得ADAP资助的QHP的多州ADAP客户队列进行了研究(2014-2015)。使用对数二项模型来估计人口统计学和医疗保健提供因素与QHP登记流行率和VS一年风险的关系。计算了额外1人实现病毒抑制所需的治疗/登记(NNT)数量。在队列中(n=7776)，52%的人登记了QHP。2015年的QHP注册与2014年的QHP覆盖范围(调整后的PR[Apr]，3.28；95%可信区间[CI]，3.06-3.53)和2014年的护理参与度(Apr，1.16；1.04-1.28)相关。从事护理(n=4597)和有QHPS的PLWH患者的VS率高于接受直接ADAP药物治疗的患者(86.0%vs80.2%)。QHPS的NNT为20(14.1-34.5)。开始无法检测(调整后的风险比[ARR]，1.39；1.28-1.52)和在2015年加入QHP(ARR，1.06；0.99-1.14)与VS相关。一旦注册了ADAP资助的QHP，ADAP客户将继续注册。注册与各州/人口统计组之间的VS相关联。ADAP，特别是在南方和医疗补助计划不扩大的州，应该考虑投资于QHP，因为增加注册可以提高相对于费率。这种基于证据的干预可能是ethe的一部分。在多个州的队列中，合格的健康计划(QHP)与艾滋病药物援助计划(ADAP)客户的病毒抑制有关。州ADAP，特别是那些没有扩大医疗补助的州，应该考虑投资QHP作为一种基于证据的干预措施，以改善病毒抑制。
Healthcare delivery changes associated with viral suppression (VS) could contribute to the United States’ “Ending the HIV Epidemic” (EtHE) initiative. This study aims to determine whether Qualified Health Plans (QHPs) purchased by AIDS Drug Assistance Programs (ADAPs) are associated with VS for low-income people living with HIV (PLWH) across 3 states. A multistate cohort of ADAP clients eligible for ADAP-funded QHPs were studied (2014–2015). A log-binomial model was used to estimate the association of demographics and healthcare delivery factors with QHP enrollment prevalence and 1-year risk of VS. A number needed to treat/enroll (NNT) for 1 additional person to achieve viral suppression was calculated. Of the cohort (n = 7776), 52% enrolled in QHPs. QHP enrollment in 2015 was associated with QHP coverage in 2014 (adjusted PR [aPR], 3.28; 95% confidence intervals [CIs], 3.06–3.53) and engagement in care in 2014 (aPR, 1.16; 1.04–1.28). PLWH who were engaged in care (n = 4597) and had QHPs had a higher VS rate than those who received medications from Direct ADAP (86.0% vs 80.2%). QHPs’ NNT for an additional person to achieve VS is 20 (14.1–34.5). Starting undetectable (adjusted risk ratio [aRR], 1.39; 1.28–1.52) and enrolling in QHPs in 2015 (aRR, 1.06; 0.99–1.14) was associated with VS. Once enrolled in ADAP-funded QHPs, ADAP clients stay enrolled. Enrollment is associated with VS across states/demographic groups. ADAPs, especially in the South and in Medicaid nonexpansion states, should consider investing in QHPs because increased enrollment could improve VS rates. This evidence-based intervention could be part of EtHE. In a multistate cohort, Qualified Health Plans (QHPs) are associated with viral suppression for AIDS Drug Assistance Program (ADAP) clients. State ADAPs, especially those without Medicaid expansion, should consider investing in QHPs as an evidence-based intervention to improve viral suppression.
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影响因子：
168.9
作者：
Lester, Richard T.;Ritvo, Paul;Plummer, Francis A.
通讯作者：
Plummer, Francis A.
影响因子：
11.8
作者：
McManus, Kathleen A.;Rhodes, Anne;Dillingham, Rebecca
通讯作者：
Dillingham, Rebecca
影响因子：
39
作者：
Skarbinski, Jacek;Rosenberg, Eli;Mermin, Jonathan H.
通讯作者：
Mermin, Jonathan H.
影响因子：
9.7
作者：
Sommers, Benjamin D.;Maylone, Bethany;Epstein, Arnold M.
通讯作者：
Epstein, Arnold M.
影响因子：
3.7
作者：
Furl R;Watanabe-Galloway S;Lyden E;Swindells S
通讯作者：
Swindells S