Dataset Information

Underutilization of the AIDS Drug Assistance Program: associated factors and policy implications.

ABSTRACT:

Background

The AIDS Drug Assistance Program (ADAP) provides antiretroviral medications to low-income individuals with HIV infection.

Methods

A prospective cohort study of ADAP utilization, measured using medication possession ratio (MPR), was conducted during the 2008 calendar year at the University of Alabama at Birmingham 1917 HIV Clinic. Multivariable ordinal logistic regression evaluated factors associated with ADAP utilization.

Results

Among 245 patients, MPR quartiles (Q) were the following: Q1<69 percent, Q2=69-83 percent, Q3=84-93 percent, Q4>93 percent. In ordinal logistic regression, younger age (OR=0.59 per 10 years; 95 percent CI=0.44-0.79), nonwhite males (2.18; 1.18-4.04), lower CD4 count (2.79 for <200 cells/mm(3) ; 1.44-5.43), and a history of alcohol abuse (2.11; 1.02-4.37) were associated with poor ADAP utilization.

Conclusions

One quarter of ADAP enrollees had MPR below 69 percent, a level well below that associated with optimal HIV treatment outcomes, indicating a need for programmatic interventions to improve ADAP utilization.

SUBMITTER: Godwin NC

PROVIDER: S-EPMC3097412 | biostudies-literature | 2011 Jun

REPOSITORIES: biostudies-literature

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Publications

Underutilization of the AIDS Drug Assistance Program: associated factors and policy implications.

Godwin Noah C NC Willig James H JH Nevin Christa R CR Lin Hui-Yi HY Allison Jeroan J Gaddis Kathy K Peterson Jennifer J Saag Michael S MS Mugavero Michael J MJ Raper James L JL

Health services research 20110106 3

<h4>Background</h4>The AIDS Drug Assistance Program (ADAP) provides antiretroviral medications to low-income individuals with HIV infection.<h4>Methods</h4>A prospective cohort study of ADAP utilization, measured using medication possession ratio (MPR), was conducted during the 2008 calendar year at the University of Alabama at Birmingham 1917 HIV Clinic. Multivariable ordinal logistic regression evaluated factors associated with ADAP utilization.<h4>Results</h4>Among 245 patients, MPR quartiles ...[more]

PMID: 21210795

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Project description:BackgroundIn the United States, mortality from cardiovascular disease has become increasingly common among HIV-infected persons. One-third of HIV-infected persons in care may rely on state-run AIDS Drug Assistance Programs (ADAPs) for cardiovascular disease-related prescription drugs. There is no federal mandate regarding ADAP coverage for non-HIV medications.ObjectiveTo assess the consistency of ADAP coverage for type 2 diabetes, hypertension, hyperlipidemia, and smoking cessation using clinical guidelines as the standard of care.DesignCross-sectional survey of 53 state and territorial ADAP formularies.Main measuresADAPs covering all first-line drugs for a cardiovascular risk factor were categorized as "consistent" with guidelines, while ADAPs covering at least one first-line drug, but not all, for a cardiovascular risk factor, were categorized as "partially consistent". ADAPs without coverage were categorized as "no coverage".Key resultsOf 53 ADAPs, four (7.5%) provided coverage consistent with guidelines (coverage for all first-line drugs) for all four cardiovascular risk factors. Thirteen (24.5%) provided no coverage for all four risk factors. Thirty-six (68%) provided at least partially consistent coverage for at least one surveyed risk factor. State ADAPs provided coverage consistent with guidelines most frequently for type 2 diabetes (28%), followed by hypertension (25%), hyperlipidemia (15%) and smoking cessation (8%). Statins (66%) were most commonly covered and nicotine replacement therapies (9%) least often. Many ADAPs provided no first-line treatment coverage for hypertension (60%), type 2 diabetes (51%), smoking cessation (45%), and hyperlipidemia (32%).ConclusionsConsistency of ADAP coverage with guidelines for the surveyed cardiovascular risk factors varies widely. Given the increasing lifespan of HIV-infected persons and restricted ADAP budgets, we recommend ADAP coverage be consistent with guidelines for cardiovascular risk factors.

Dataset Information

Underutilization of the AIDS Drug Assistance Program: associated factors and policy implications.

Background

Methods

Results

Conclusions

Publications

Underutilization of the AIDS Drug Assistance Program: associated factors and policy implications.

Similar Datasets

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