Association between U.S. state AIDS Drug Assistance Program (ADAP) features and HIV antiretroviral therapy initiation, 2001-2009.
<h4>Background</h4>U.S. state AIDS Drug Assistance Programs (ADAPs) are federally funded to provide antiretroviral therapy (ART) as the payer of last resort to eligible persons with HIV infection. States differ regarding their financial contributions to and ways of implementing these pro...
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Public Library of Science (PLoS)
2013-01-01
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| Online Access: | https://doi.org/10.1371/journal.pone.0078952 |
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| author | David B Hanna Kate Buchacz Kelly A Gebo Nancy A Hessol Michael A Horberg Lisa P Jacobson Gregory D Kirk Mari M Kitahata P Todd Korthuis Richard D Moore Sonia Napravnik Pragna Patel Michael J Silverberg Timothy R Sterling James H Willig Ann Collier Hasina Samji Jennifer E Thorne Keri N Althoff Jeffrey N Martin Benigno Rodriguez Elizabeth A Stuart Stephen J Gange North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) |
| author_facet | David B Hanna Kate Buchacz Kelly A Gebo Nancy A Hessol Michael A Horberg Lisa P Jacobson Gregory D Kirk Mari M Kitahata P Todd Korthuis Richard D Moore Sonia Napravnik Pragna Patel Michael J Silverberg Timothy R Sterling James H Willig Ann Collier Hasina Samji Jennifer E Thorne Keri N Althoff Jeffrey N Martin Benigno Rodriguez Elizabeth A Stuart Stephen J Gange North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) |
| author_sort | David B Hanna |
| collection | DOAJ |
| description | <h4>Background</h4>U.S. state AIDS Drug Assistance Programs (ADAPs) are federally funded to provide antiretroviral therapy (ART) as the payer of last resort to eligible persons with HIV infection. States differ regarding their financial contributions to and ways of implementing these programs, and it remains unclear how this interstate variability affects HIV treatment outcomes.<h4>Methods</h4>We analyzed data from HIV-infected individuals who were clinically-eligible for ART between 2001 and 2009 (i.e., a first reported CD4+ <350 cells/uL or AIDS-defining illness) from 14 U.S. cohorts of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). Using propensity score matching and Cox regression, we assessed ART initiation (within 6 months following eligibility) and virologic suppression (within 1 year) based on differences in two state ADAP features: the amount of state funding in annual ADAP budgets and the implementation of waiting lists. We performed an a priori subgroup analysis in persons with a history of injection drug use (IDU).<h4>Results</h4>Among 8,874 persons, 56% initiated ART within six months following eligibility. Persons living in states with no additional state contribution to the ADAP budget initiated ART on a less timely basis (hazard ratio [HR] 0.73, 95% CI 0.60-0.88). Living in a state with an ADAP waiting list was not associated with less timely initiation (HR 1.12, 95% CI 0.87-1.45). Neither additional state contributions nor waiting lists were significantly associated with virologic suppression. Persons with an IDU history initiated ART on a less timely basis (HR 0.67, 95% CI 0.47-0.95).<h4>Conclusions</h4>We found that living in states that did not contribute additionally to the ADAP budget was associated with delayed ART initiation when treatment was clinically indicated. Given the changing healthcare environment, continued assessment of the role of ADAPs and their features that facilitate prompt treatment is needed. |
| format | Article |
| id | doaj-art-b6f5549438a54d83985697df8a2de8cc |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Public Library of Science (PLoS) |
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| spelling | doaj-art-b6f5549438a54d83985697df8a2de8cc2025-08-20T03:10:45ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-01811e7895210.1371/journal.pone.0078952Association between U.S. state AIDS Drug Assistance Program (ADAP) features and HIV antiretroviral therapy initiation, 2001-2009.David B HannaKate BuchaczKelly A GeboNancy A HessolMichael A HorbergLisa P JacobsonGregory D KirkMari M KitahataP Todd KorthuisRichard D MooreSonia NapravnikPragna PatelMichael J SilverbergTimothy R SterlingJames H WilligAnn CollierHasina SamjiJennifer E ThorneKeri N AlthoffJeffrey N MartinBenigno RodriguezElizabeth A StuartStephen J GangeNorth American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of the International Epidemiologic Databases to Evaluate AIDS (IeDEA)<h4>Background</h4>U.S. state AIDS Drug Assistance Programs (ADAPs) are federally funded to provide antiretroviral therapy (ART) as the payer of last resort to eligible persons with HIV infection. States differ regarding their financial contributions to and ways of implementing these programs, and it remains unclear how this interstate variability affects HIV treatment outcomes.<h4>Methods</h4>We analyzed data from HIV-infected individuals who were clinically-eligible for ART between 2001 and 2009 (i.e., a first reported CD4+ <350 cells/uL or AIDS-defining illness) from 14 U.S. cohorts of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). Using propensity score matching and Cox regression, we assessed ART initiation (within 6 months following eligibility) and virologic suppression (within 1 year) based on differences in two state ADAP features: the amount of state funding in annual ADAP budgets and the implementation of waiting lists. We performed an a priori subgroup analysis in persons with a history of injection drug use (IDU).<h4>Results</h4>Among 8,874 persons, 56% initiated ART within six months following eligibility. Persons living in states with no additional state contribution to the ADAP budget initiated ART on a less timely basis (hazard ratio [HR] 0.73, 95% CI 0.60-0.88). Living in a state with an ADAP waiting list was not associated with less timely initiation (HR 1.12, 95% CI 0.87-1.45). Neither additional state contributions nor waiting lists were significantly associated with virologic suppression. Persons with an IDU history initiated ART on a less timely basis (HR 0.67, 95% CI 0.47-0.95).<h4>Conclusions</h4>We found that living in states that did not contribute additionally to the ADAP budget was associated with delayed ART initiation when treatment was clinically indicated. Given the changing healthcare environment, continued assessment of the role of ADAPs and their features that facilitate prompt treatment is needed.https://doi.org/10.1371/journal.pone.0078952 |
| spellingShingle | David B Hanna Kate Buchacz Kelly A Gebo Nancy A Hessol Michael A Horberg Lisa P Jacobson Gregory D Kirk Mari M Kitahata P Todd Korthuis Richard D Moore Sonia Napravnik Pragna Patel Michael J Silverberg Timothy R Sterling James H Willig Ann Collier Hasina Samji Jennifer E Thorne Keri N Althoff Jeffrey N Martin Benigno Rodriguez Elizabeth A Stuart Stephen J Gange North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Association between U.S. state AIDS Drug Assistance Program (ADAP) features and HIV antiretroviral therapy initiation, 2001-2009. PLoS ONE |
| title | Association between U.S. state AIDS Drug Assistance Program (ADAP) features and HIV antiretroviral therapy initiation, 2001-2009. |
| title_full | Association between U.S. state AIDS Drug Assistance Program (ADAP) features and HIV antiretroviral therapy initiation, 2001-2009. |
| title_fullStr | Association between U.S. state AIDS Drug Assistance Program (ADAP) features and HIV antiretroviral therapy initiation, 2001-2009. |
| title_full_unstemmed | Association between U.S. state AIDS Drug Assistance Program (ADAP) features and HIV antiretroviral therapy initiation, 2001-2009. |
| title_short | Association between U.S. state AIDS Drug Assistance Program (ADAP) features and HIV antiretroviral therapy initiation, 2001-2009. |
| title_sort | association between u s state aids drug assistance program adap features and hiv antiretroviral therapy initiation 2001 2009 |
| url | https://doi.org/10.1371/journal.pone.0078952 |
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