December 5, 2019

Administration Proposes Free PrEP; Researchers Link Free Care Access to Viral Suppression

On December 3, 2019, the Trump Administration announced its intention to provide free PrEP for uninsured Americans at high risk of HIV, as a part of its larger “Ending the HIV Epidemic” (EtHE) initiative unveiled last February 2019. This announcement came incidentally on the heels of research released on November 19 showing the feasibility of increasing viral suppression (VS) rates among indigent people living with HIV (PLWH) by purchasing Qualified Health Plans (QHP) for them through state AIDS Drug Assistance Programs (ADAPs).

The research, published by Oxford University Press, found that PLWH enrolled in an ADAP-funded QHPs were more likely to achieve viral suppression than people on ADAP without enrollment in a QHP. The study by McManus et al. was based on a multistate comparison that included 7,776 participants in total; most of them living in Virginia (59%) and South Carolina (37%), with a few from Nebraska (4.7%). Extrapolating from the data they collected, McManus calculated that, if all 114,394 direct ADAP clients in the United States in 2017 shifted to ADAP-funded QHPs, an additional 5,719 PLWH would potentially achieve VS. If QHP enrollment directly leads to improvements in VS, then this would translate to an additional 2.4% of ADAP patients achieving VS nationally.

McManus decided to examine differences between the experiences of people in the three states where ADAP-funded QHPs coverage was offered and those with “regular” care through Medicaid expansion. She found that those who received ADAP-funded QHP coverage had a viral suppression rate of 86%, while those who received medication directly from an ADAP had a viral suppression rate of 80%.

Based on interviews of the study participants, McManus hypothesized that the PLWH enrolled in a QHP may have experienced viral suppression as a result of one or more of the following: “1) either perceived or actual improved medication coverage, 2) improved method of obtaining medication for those who preferred receiving medications by mail, and 3) increases access to overall healthcare leading to improved engagement in healthcare, including HIV care.”

This study suggests that low-income PLWH may benefit more from ADAP-funded Quality Health Plans than through “regular” care provided through Medicaid expansion. If this can be validated with further research, if could help pave the way toward longer and healthier lives. Combined with the new imitative to provide PrEP to those at highest risk, we will hopefully see a decrease in HIV transmission rates as well.