Affordable Care Act and Health Outcomes of People Living with HIV in Virginia

 描述(由申请人提供)：《平价医疗法案》(ACA)是联邦立法机构，旨在增加拥有医疗保险的人数并改善健康状况。艾滋病毒携带者(PLWH)通常没有保险或保险不足，因此理论上可以从ACA中受益。向长寿妇女提供艾滋病毒药物对个人长寿和减少艾滋病毒传播对公众都是有益的。在ACA通过之前，州艾滋病药物援助计划(ADAP)是负责向未参保或参保不足的PLWH提供关键药物(包括抗逆转录病毒治疗和机会性感染预防)的安全网资源。虽然被称为安全网，但州ADAP在全国范围内为超过19.3万名PLWH提供服务，2013年，据估计，接受艾滋病毒护理的PLWH中约有三分之一通过ADAP获得药物。弗吉尼亚ADAP大约80%的客户有资格参加ACA保险计划，利用这个机会，弗吉尼亚ADAP转变了角色，帮助其客户参加ACA保险计划，并正在支付ACA每月保费、药物共付金和免赔额，因为这是其客户获得关键药物的新途径。需要对ACA进行审查，看看它是如何实施的，并确保它产生了预期的效果。此外，鉴于联邦和州政府的资金支持ADAP，需要评估是否取得了良好的结果。这项工作将(1)描述参加ACA保险计划的弗吉尼亚州ADAP客户与那些在2013-2014年登记过程中符合条件但没有参加的客户之间的人口统计和系统水平差异，以及(2)定义参加ACA保险计划的月份与艾滋病毒结果之间的关系。这项研究将利用弗吉尼亚州卫生部的全州数据，为州和联邦政策提供重要信息。除了解决这些研究目标外，该奖学金还将包括一个严格的教学课程工作培训计划，以及由高级卫生服务研究人员、卫生经济学家、临床流行病学家和生物统计学家提供的密切研究指导。这项NRSA奖学金培训计划将使我作为一名调查员获得晋升，并成功竞争K系列职业发展奖。关于ACA保险登记的实施情况以及ACA对艾滋病毒结果的影响的研究结果将对卫生服务研究、卫生政策和艾滋病毒护理领域做出重大贡献。利用这一NRSA奖学金机会产生的研究将为州和联邦一级关于ACA注册和这项新政策所取得的成果的讨论提供信息。在预算紧张的情况下，需要以一种方式分配资金，以优化登记和实现最佳的健康结果。良好的艾滋病毒健康结果对个人和社会都有好处。

 DESCRIPTION (provided by applicant): The Affordable Care Act (ACA) is federal legislature that aims to increase the number of people with health insurance and to improve health outcomes. People living with HIV (PLWH) are often uninsured or underinsured, and therefore are positioned to theoretically benefit from the ACA. Providing HIV medications to PLWH is beneficial to the individual for his longevity and to the public in terms of reduced HIV transmission. Before the ACA passage, state AIDS Drug Assistance Programs (ADAPs) were the safety net resource responsible for providing key medications, including antiretroviral therapy and opportunistic infection prophylaxis, to uninsured or underinsured PLWH. While called a safety net, state ADAPs serve over 193,000 PLWH nationally, and in 2013, it was estimated that about one-third of PLWH receiving HIV care accessed medications through ADAP. Approximately 80% of Virginia ADAP clients were eligible for ACA insurance plans, and with this opportunity, Virginia ADAP shifted its role to help enroll its clients in ACA insurance plans, and it is paying ACA monthly premiums, medication copayments, and deductibles, as this is the new avenue for its clients to receive key medications. The ACA needs to be examined to see how it is being implemented and to ensure that it is having its intended effects. Moreover, given that federal and state funding supports ADAP, it needs to be assessed whether good outcomes are achieved. This work will (1) characterize the demographic and systems-level differences between Virginia ADAP clients who were enrolled in ACA insurance plans and those who were eligible but were not enrolled during the 2013- 2014 enrollment process and (2) define the relationship between months enrolled in an ACA insurance plan and HIV outcomes. This research will utilize Virginia Department of Health statewide data to provide important information for state and federal policy. In addition to addressing these research aims, this fellowship will also include a rigorous training program of didactic course work and close research mentoring by senior health services researchers, health economists, clinical epidemiologists and biostatisticians. This NRSA fellowship training plan will allow me to advance as an investigator and successfully compete for a K series career development award. Findings about the implementation of ACA insurance enrollment and the ACA's effects on HIV outcomes will be significant contributions to the fields of health services research, health policy and HIV care. The research generated with this NRSA fellowship opportunity will inform state and federal level discussions of ACA enrollment and outcomes achieved with this new policy. In a time of constrained budgets, funds need to be allocated in a way to optimize enrollment and achieve the best health outcomes. Good HIV health outcomes have benefits to the individual as well as to society.