HRSA Releases Inaugural Ryan White Patient-Level Report

By: Marcus J. Hopkins, Policy Consultant

The Health Resources and Services Administration (HRSA) – the U.S. government organization responsible for overseeing the Ryan White HIV/AIDS Program and the AIDS Drug Assistance Program (ADAP) – released its first report focused on providing client-level demographic data and how ADAP-funded services were used from 2014-2017 (Cheever, 2019).

The finding of this new annual report found that ADAP served 268,174 clients in 2017, 77.7% of whom were Male, 21.1% Female, and 1.2% Transgender. The data also indicate that over 2/3 of ADAP clients are from racial/ethnic minority populations – 39.5% African American, 25.4% Hispanic/Latinx, and less than 2% each are Asian, American Indian/Native Alaskan, Native Hawaiian/Pacific Islander, and persons identifying as multiracial – and that these racial/ethnic demographics have remained largely unchanged since 2014 (HRSA, 2019).

The data also found that racial/ethnic minority clients tend to be younger than White clients, with 56.9% of White clients being aged 50 years or older, compared with nearly 2/3 of Black and Hispanic/Latinx clients being under the age of 50. This holds consistent with HIV infection rates – the majority of new HIV infections in 2017 occurred in patients aged 20-39, with a majority of new infections occurring in African Americans and Hispanic/Latinx infection numbers coming in 3rd-highest (Centers for Disease Control and Prevention, 2019).

In addition to racial/ethnic demographic information, the report also found that more than 38.6% of ADAP clients had no health care coverage in 2017, down from 44.4% in 2014. This may be a result of state Ryan White programs being authorized by HRSA to use ADAP funds to purchase health insurance (“insurance continuation”) for clients, as well as to pay co-pays and premiums.

The most troubling data found that racial/ethnic minorities were more likely than white clients to be living at or below 100% of the Federal Poverty Level (FPL), with 51.8% of Hispanic/Latinx meeting this criteria, 49.5% American Indians/Alaska Natives, 48.3% of African Americans, 45.8% of Multiracial clients, 40.5% of Native Hawaiians/Pacific Islanders, 35.7% of Asians, and 33.7% of White clients. These data comport with long-held evidence that the people most likely to become infected or living with HIV, particularly among minorities, are those in lower income brackets.

Photo Source: njdc.info

Another concerning data point found that only one in five (20.4%) of ADAP clients received medication co-pay/deductible assistance in 2017, compared to just 12.3% in 2014. This is troubling because, even though HRSA has authorized funds to be used to purchase health insurance from clients, the vast majority were not utilizing this option which would allow them to access other healthcare services for which the Ryan White program could feasibly pay. Many of these services are already covered in urban areas under Ryan White Part A, but in more rural areas, like many Southern states where the majority of new HIV infections occur, access to Ryan White clinics is far more limited. Purchasing health insurance for clients opens far more options, in terms of places to go to receive healthcare services.

I look forward to seeing the 2018 report, once more data are available, as these reports will be an invaluable tool for tracking how Ryan White funds are utilized in the coming years.

References:

• Centers for Disease Control and Prevention. (2019, April 12). Statistics Overview – Diagnoses of HIV Infection, by Age. Atlanta, GA: United States Department of Health and Human Services: Centers for Disease Control and Prevention: National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention: Division of HIV/AIDS Prevention: HIV: Statistics Center. Retrieved from: https://www.cdc.gov/hiv/statistics/overview/index.html#targetText=Prevalence%20is%20the%20number%20of,infections%20had%20not%20been%20diagnosed.&targetText=CDC.
• Cheever, L. (2019, September 18). HRSA Releases Inaugural Report of Ryan White HIV/AIDS Program AIDS Drug Assistance Program Client-Level Data. Washington, DC: United States Department of Health and Human Services: Office of HIV/AIDS and Infectious Disease Policy. Retrieved from: https://www.hiv.gov/blog/hrsa-releases-inaugural-report-ryan-white-hivaids-program-aids-drug-assistance-program-client?utm_source=twitter&utm_medium=social&utm_campaign=blog
• Health Resources and Services Administration. (2019, September). Ryan White HIV/AIDS Program AIDS Drug Assistance Program (ADAP) Annual Client-Level Data Report 2017. Rockville, MD: United States Department of Health and Human Services: Health Resources and Services Administration: Data: Data Reports and Slide Decks. Retrieved from: https://hab.hrsa.gov/sites/default/files/hab/data/datareports/2017-hrsa-adr-data-report.pdf

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.