By: Ranier Simons, ADAP Blog Guest Contributor
The population of people living with HIV/AIDS (PWLHA) is not monolithic. Their demographics vary as much as their needs. The Ryan White HIV/AIDS Program (RWHAP) provides funding for many HIV care and support services supporting over half of the people diagnosed with HIV in the United States.[1] The program is a safety-net ‘last-resort’ source of funding for those designated as low-income, who have no insurance, who are underinsured, or who have insurance limitations. However, there are restrictions to what RWHAP funds can be used for, leaving some needs unsupported. The advent of the Ending the HIV Epidemic Initiative (EHE) in 2020 required additional funding support to enhance the service delivery system.
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| Photo Source: TargetHIV |
The focus of the EHE is 47 geographic jurisdictions where HIV has the highest transmission rates. The additional funding for these areas allows RWHAP recipients to expand their capability to reach those unaware of their status and those who have fallen out of or are not in regular care. The EHE funds are more flexible in their allowed usage, enabling tailored approaches not included in RWHAP statutes. Not only do they support additional efforts to reach new and different subpopulations, but they also provide training to expand the workforce in those EHE-identified areas.
HRSA recently released a data report highlighting diverse characteristics and successful outcomes of clients served who are new to care or have been re-engaged to care with the providers who have received the EHE funds. The report also highlights EHE-funding-enabled efforts by providers.
One significant hurdle EHE funding enables providers to overcome is rapid initiation of care, which directly impacts viral suppression. This is notable since in 2022, EHE-funded providers served 22,001 clients new to care and 19,204 re-engaged into care.[1] Research shows that getting a person into treatment and care as soon as possible after HIV diagnosis provides the best possible health outcomes.[2] EHE funding enabled providers to link patients new to care to treatment more quickly after identification and/or diagnosis without having to wait until the completion of RWHAP eligibility assessments. The assessments can take up to 30 days. With the EHE funding, providers are guaranteed reimbursement if a potential client ends up not being RWHAP eligible.[1] Therefore, a newly diagnosed client can get into almost immediate care, has medication and care linkage, and is given the gift of time to navigate services if found ineligible.
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| Photo Source: HRSA |
A notable data finding in the report is differences of socioeconomic factors. Regarding housing, newly diagnosed and re-engaging clients of EHE-funded providers faired poorer than RWHAP clients overall.[1] Approximately 15% of new EHE clients and 11% of re-engaged EHE clients were dealing with temporary housing situations compared to 6.9% of all clients served by the RWHAP.[1] Concerning unstable housing, 9.4% of new EHE clients and 4.3% of re-engaged EHE clients reported experiencing housing instability in contrast to 5.2% of all clients served by the RWHAP.[1]
The same trend continued regarding poverty. Approximately 68.9% of new clients and 64.3% of re-engaged clients of those served by EHE-funded providers lived at or below 100% of the federal poverty level compared to 58.6% of the overall RWHAP population.[1] This is indicative of comparative insurance trends between the two groups. Approximately 43.8% of new EHE clients had no health insurance coverage compared to 18.2% of overall RWHAP clientele.[1] New and re-engaged clients of EHE-funded providers also had lower rates of viral suppression. Approximately 79.2% of new clients and 85.1% of re-engaged clients had achieved viral suppression in contrast to 89.6% of RWHAP clients overall.[1] One caveat to this data metric is that the reported numbers are based on what is achieved by the end of the year. People who are new or returning to care may not have had time to achieve viral suppression yet.
In addition to client-level statistics, the data report details many ways EHE funding facilitated extended means of support, education, and expansion for recipients, helping them better target their communities' specific needs. EHE funding enabled providers to create programming and provide staffing in ways not permitted with RWHAP funds. Some clients were able to improve access to care by extending hours and days of service, providing funds for clients with transportation issues to use Lyft to get to facilities, and even using funding to pay for additional staff to meet needs that were currently not being satisfied.[1]
Providing community-specific services is paramount to assisting the populations the EHE is focused on. EHE funding allowed recipients to not only hire needed medical professionals but also train community members to provide services for their peers, such as client navigation and Linkage-to-Care coordination.[1] One of the recipients reported, “Data and Linkage to Care (DLTC) personnel are funded through EHE for aiding any person living with HIV in [our area with] accessing care and supportive services … Community Health Workers-Case Manager Supervisor [CHW-CMS] roles were implemented through EHE for expansion of HIV workforce within the state to assist with non-medical case management services. CHW-CMSs are not supported through the [redacted] Ryan White Part B and [AIDS Drug Assistance Program].”[1]
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| Photo Source: HRSA |
In support of reaching EHE goals, EHE funding was also used by the RWHAP Part F AIDS Education and Training Center (AETC) Program to provide clinical training and organizational infrastructure education.[1] Regional AETC EHE-funded trainings were aimed at various providers and health professionals who were either new to servicing PLWHA or had limited experience due to low-volume exposure.[1] They also targeted professionals such as dentists, psychiatrists, nurse practitioners, and pharmacists. These practitioners encounter PLWHA and thus can benefit from training to enhance their ability to understand their clientele and provide appropriate care. EHE-funded AETC training topics included HIV prevention, PrEP education, STI screening in primary care, and even HIV stigma and discrimination education.[1]
The EHE initiative targets explicitly communities with the highest rates of HIV transmission. EHE funding creates new opportunities and avenues for those already utilizing RWHAP funds to do even more. Most importantly, EHE funds allow for services to be provided to clients in need who do not meet RWHAP income requirements. This data report shows that continued EHE funding is necessary to effectively end the HIV epidemic by enabling an arsenal of tools and solutions that are as varied as the populations in need.
[1] HRSA. (2024). Who We Are. Retrieved from https://ryanwhite.hrsa.gov/
[2] Benson, C., Emond, B., Romdhani, H., Lefebvre, P., Côté-Sergent, A., Shohoudi, A., Tandon, N., Chow, W., & Dunn, K. (2020). Long-Term Benefits of Rapid Antiretroviral Therapy Initiation in Reducing Medical and Overall Health Care Costs Among Medicaid-Covered Patients with Human Immunodeficiency Virus. Journal of managed care & specialty pharmacy, 26(2), 117–128. https://doi.org/10.18553/jmcp.2019.19174
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.
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