Ryan White–Funded Facilities Improve Services and Outcomes for Poor Patients with HIV Infection

Carlos del Rio, MD, Wendy S. Armstrong, MD reviewing Weiser J et al. JAMA Intern Med 2015 Aug 31.

Most HIV-infected individuals in care in the U.S. are treated at a Ryan White–funded facility; their outcomes are comparable to those of patients at other facilities.

When the Ryan White CARE Act was enacted in 1990, HIV infection was uniformly fatal. Now, with appropriate management, HIV-infected people can enjoy long lives. But because HIV infection disproportionately affects individuals with less access to care, including racial/ethnic minorities, the poor, and the uninsured, many do not benefit from recent treatment gains. Using Medical Monitoring Project data, investigators evaluated the characteristics and outcomes of a probability sample of 8038 HIV patients in care in the U.S. in 2009 and 2011 and the 989 facilities serving them.

The 34% of facilities that were Ryan White–funded (RWF) provided care for 73% of all patients. These facilities were commonly publicly owned (e.g., community health centers, state or local health departments) and were more likely than non-RWF ones to serve >400 patients. They were also more likely to offer additional services, including mental health and substance abuse treatment, dental care, and case management.

RWF-facility patients were more likely than others to be young (ages 18–39), female, black or Hispanic, born outside the U.S., poor, uninsured, and previously homeless or incarcerated. They were also more likely to be depressed and to use noninjection drugs. Although equally likely to have been prescribed antiretroviral therapy during the previous year (90% vs. 91%), RWF-facility patients were less likely to be virologically suppressed (74% vs. 79%). Nonetheless, RWF-facility patients living in poverty and those aged 30 to 39 were more likely to be virologically suppressed than similar patients in non-RWF facilities.

Citation(s):

Weiser J et al. Service delivery and patient outcomes in Ryan White HIV/AIDS Program–funded and –nonfunded health care facilities in the United States. JAMA Intern Med 2015 Aug 31; [e-pub].