ACA Improved HIV Outcomes in Study from Virginia

Moving patients to ACA insurance helped the Virginia ADAP use federal and state funds to cover a larger number of patients and help avoid waitlists for medications and services, according to a presenter.

SAN DIEGO — Patients with HIV who were enrolled in Affordable Care Act (ACA) health care plans had higher rates of viral suppression than those who received only medications for HIV through the state’s direct AIDS Drug Assistance Program (ADAP), according to a study from the University of Virginia being presented at IDWeek 2015. 

“The most important finding we had was that ACA enrollment … resulted in better virologic suppression. In addition, we found it was a dose-related response, in that each additional month that the patient was on treatment gave us 5.6% more of a chance to achieve virologic suppressoin,” Kathleen McManus, MD, MS, lead author of the study and a fellow physician in the Division of Infectious Diseases and International Health at the University of Virginia School of Medicine, Charlottesville, said during a press event about the study. 

Since the passage of the ACA, there are two mechanisms through which ADAP can support care, Dr McManus explained. Through direct ADAP, the state pays for patients’ medications, and the patients typically receive treatment through Ryan White-funded clinics, which provide medical care and essential support services to people with HIV/AIDS who have insufficient health care coverage. The other option is for patients to sign up with an ACA health plan. Virginia ADAP then pays patients’ premiums, deductibles and medication copays. 

The two-year study included the 3,933 ACA-eligible ADAP patients in Virginia, comparing the outcomes of the 1,849 (47.1%) who enrolled in ACA plans to the 2,084 (52.9%) who continued to receive medications through direct ADAP. Viral suppression was achieved by 85.5% of those enrolled in the ACA, vs. 78.7% of those in the direct ADAP. Because HIV medications are so expensive, the researchers noted that providing ACA insurance is more cost-effective than paying for those medications directly.

Dr McManus said that they are still gathering data as to why the ACA group had better suppression rates, but she said it could be that the type of services the patients were getting in ACA, including access to different types of medications, could have contributed. Patients who have to reenroll in Ryan White every six months, as opposed to a year under ACA, may have also played a factor as there may have been a lag in access to care for some patients.

“Moving patients to ACA insurance helps the Virginia ADAP use federal and state funds to cover a larger number of patients and help avoid waitlists for medications and services,” said Dr McManus. Every state has an ADAP, and while eligibility and coverage differ by state, all provide a safety net for people with HIV. One-third of people with HIV in the United States receive medications through a state ADAP. 

Dr McManus noted that her data highlight the importance of reducing disparities and increasing access to care. She said their group is planning to do interviews with patients and individual clinics to see what barriers they encountered. 


1.  McManus K, Rhodes A, Yerkes L, et al. Abstract 728. Affordable Care Act Enrollment of AIDS Drug Assistance Program Clients and Associated HIV Outcomes. Presented at: ID Week 2015. Oct. 7-11, 2015; San Diego.