Dr. Kathleen McManus of the University of Virginia School of Medicine and her colleagues plan to identify specific policies and programs that can increase the number of patients with undetectable levels of HIV in their blood. This desirable state, known as “undetectable” or “sustained viral suppression,” results in better health outcomes for individuals and a reduced risk of transmitting HIV to others.
As part of the effort, the researchers will examine state AIDS Drug Assistance Programs, or ADAPs, to identify differences in viral suppression between states and different patient groups. One goal is to understand how the programs affect health equity and ensure that diverse groups, including patients of different races or ethnicities, receive high-quality care and good health outcomes.
This work will allow the researchers to determine which policies and programs should be implemented more widely, which will help improve care for many people living with HIV in the United States.
“HIV drugs are safe and very effective, but unless we get the drugs into the hands of patients, they won’t have any effect. HIV drugs are incredibly expensive, and our health care system is difficult to navigate,” said McManus of UVA’s Department of Infectious Diseases and Global Health.
“We are studying the impact of a federally mandated and state-implemented public health safety net program on affordable, sustainable access to HIV medication for low-income people living with HIV,” she said. As the United States strives to improve the health of people living with HIV and end the HIV epidemic, it is important that no group is left behind.
McManus says ADAPs provide drugs to about a quarter of people living with HIV in the United States, but the federally funded program has not been studied.
“By measuring the impact of ADAPs, we can help policymakers and advocates understand their critical role in HIV care in the United States,” she said. “Furthermore, by identifying specific best practices, we can help state health departments improve their programs and help federal policymakers identify areas for technical assistance or support.”
Improving HIV care
ADAPs programs are a critical safety net for people living with HIV. Serving low-income patients, they provide essential antiretroviral therapy in HIV drugs, free of charge or subsidized by insurance plans.
Implementation of the programs varies by state, but McManus’ new project aims to shine a light on best practices that improve outcomes and help programs get the most bang for their buck. She and her team were awarded a four-year, $2.9 million grant from the National Institutes of Allergy and Infectious Diseases (grant R01AI170093-01A1).
Along with McManus, the research team includes UVA Health’s Jessica Kim Malpas, Andrew Strumpf and Amber Stein. National State and Territory AIDS Directors, Tim Horne and Andre Hamp; Elizabeth Rogowski McQuade of Emory; and Public Health Advisor Amy Killelia.
For their research, McManus and her colleagues partnered with 10 state health departments to provide 25 percent of program clients with anonymous information. This is a first-of-its-kind multistate database, based on a partnership of state health departments, with more than 10 years of data on nearly 60,000 people living with HIV.
The research team will work with state health departments to evaluate how different programs are implemented and how they affect viral suppression and other patient outcomes. The team also plans to interview AIDS/ADAP leaders in multiple states to gain additional insights that may guide cost-effective strategies for delivering equitable care.
Inform future efforts
The researchers say their findings will enable ADAPs, state legislators and other key actors, such as leaders of the National HIV Epidemic Initiative, to make informed choices about how to achieve optimal outcomes. It also helps develop new initiatives to benefit people living with HIV. This kind of ambitious work to improve care for Virginians and beyond is a key component of UVA Health’s recently announced 10-year strategic plan.