CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

1001 Reliance on RyanWhite Coverage for Provider Visits Following the Affordable Care Act Stephen A. Berry 1 ; John Fleishman 2 ; Baligh R.Yehia 3 ; Richard Moore 1 ; Allison L. Agwu 1 ;Wm. Christopher Mathews 4 ;Todd Korthuis 5 ; Ank E. Nijhawan 6 ; Kelly A. Gebo 1 ; for the HIV Research Network 1 Johns Hopkins Univ, Baltimore, MD, USA; 2 Agency for Hlthcare Rsr and Quality, Rockville, MD, USA; 3 Univ of Pennsylvania, Philadelphia, PA, USA; 4 Univ of California San Diego, San Diego, CA, USA; 5 Oregon Hlth & Sci Univ, Portland, OR, USA; 6 Univ of Texas Southwestern Med Cntr, Dallas, TX, USA Background: Prior to 2014, over 100,000 low-income, uninsured adults living with HIV relied on a safety net of Ryan White Program support, local charities, or uncompensated care (collectively, “RWP/Uncomp”) to cover visits to HIV providers. The Affordable Care Act (ACA) may have reduced reliance on RWP/Uncomp through shifts into Medicaid or private health insurance coverage. We compared coverage for provider visits before and after the ACA (2011-2013 vs. 2014) in 10 geographically diverse clinics stratified by state Medicaid expansion status. Methods: Analyses included all patients engaged in care at 4 sites in Medicaid expansion states (CA [2 sites], OR, MD), 4 sites in a state (NY) that expanded Medicaid in 2001, and 2 sites in non-expansion states (TX, FL). Visit coverage was classified as RWP/Uncomp, Medicaid, private insurance, or Medicare. Multinomial logistic models were used to examine changes in coverage patterns using Medicare as a referent and adjusting for age, race, gender, HIV risk factor, and site of care. Results: In total, 30,121 patients contributed 80,770 person years (PY). The cohort was 76%male, 44% Black, 26% Hispanic, 27%White, 47%MSM, 12% IDU, and had a median age of 45 (IQR 35-52) years in 2011. RWP coverage constituted 86% of RWP/Uncomp across the 4 year interval. Clinics in states with Medicaid expansion experienced a decrease in RWP/Uncomp from 29% of PY during 2011-2013 to 12% in 2014, adjusted relative risk ratio (ARRR) 0.41 (0.38, 0.45); Medicaid coverage increased from 23% to 39%, ARRR 2.07 (1.94, 2.21), and private coverage increased modestly from 20% to 22%, ARRR 1.20 (1.12, 1.29) (Figure). In NY sites, RWP/Uncomp decreased slightly (20% to 18%, ARRR 0.88 [0.83, 0.94]). In non-expansion sites, RWP/Uncomp was the dominant form of coverage and decreased from 58% to 50%, ARR 0.82 [0.78, 0.86]), with increases in both Medicaid (16% to 19%, ARRR 1.14 [1.07, 1.21]) and private (4% to 8%, ARRR 1.92 [1.73, 2.12]). Conclusions: In expansion state sites in 2014, shifts from RWP/Uncomp to Medicaid were substantial. In NY sites and in non-expansion state sites, decreases in RWP/Uncomp were relatively small. Overall, many PLWH in all sites continued to rely entirely on RWP/Uncomp for provider visits, with the greatest reliance occurring in non-expansion state sites. The ACA has not eliminated the need for the RWP’s safety net provider visit coverage.

1002 Receipt of RyanWhite Care Services Is AssociatedWith Improved Long-Term Outcomes Tanner Nassau ; Melissa Miller; ColemanTerrell; Sebastian Branca; Kathleen Brady Philadelphia Dept of PH, Philadelphia, PA, USA

Background: The HIV care continuum is an effective framework for improving the care of persons living with HIV (PLWH). We sought to examine how utilization of Ryan White(RW) care, medical case management (MCM) and other supportive services predicted long-term retention in care, viral suppression(VS), and durable VS. Methods: Data were used from the electronic HIV/AIDS Reporting System (eHARS) from 2010-2014 for Philadelphia residents 18+ years old who had at least 1 viral load (VL) or CD4 completed in 2009. Retention was defined as 1 lab in each 6 months of the year with at least 60 days between the two. VS was defined as evidence of 1 VL/year and the last VL of each year <200 copies/mL. Durable VS was defined as evidence of 1 VL/year and all VLs < 200 copies/mL. eHARS data was linked with RW service utilization data. Univariate and stepwise logistic regression determined predictors for long term retention and VS, and durable VS. Models were adjusted for RW care status, race, sex, gender, age, risk, AIDS status, RW ambulatory care, MCM, and average number of RW contacts and services/year. Insurance status and FPL were also included in a sub-analysis. Results: 8,375 PLWH were included, 3,410 of which received care at a RW funded facility and 4,965 who did not. Those who received RW care were more likely to be retained for all years(OR: 3.40; CI: 2.87-4.04), suppressed at the end of each year(OR:3.77; CI:3.36-4.23) and durably suppressed(OR: 2.92; CI:2.45-3.47) compared to those who did not receive RW care. Those who received MCM during each year of follow-up were more likely to be retained each year(OR: 1.70; CI:1.44-2.01) but significantly less likely to be suppressed each year (OR:0.72; CI:0.61-0.85) or durably suppressed(0.58; CI:0.50-0.67). Multivariate logistic regression among those who received RW care showed that individuals with an average of 20+ contacts a year were more likely to be retained in care each year(OR:3.26; CI:2.35-4.52), but less likely to be durably suppressed(OR:0.68; CI:0.48-0.88). Poverty level was a significant predictor of VS and durable VS, but not retention in care. Conclusions: Utilization of the RW system is a significant predictor for long term retention in care, VS, and durable VS. Use of multiple RW services or increased contact with the RW systemmay be a marker for greater social and medical complexity leading to difficulty maintaining VS. Data will inform improvements to the system of care and drive further evaluation of supportive services on outcomes.

Poster Abstracts

427

CROI 2016