2018 National Ryan White HIV/AIDS Program Part B & ADAP Monitoring Project Annual Report

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

The National Alliance of State & Territorial AIDS Directors ("NASTAD") earlier this year released its annual report on the AIDS Drug Assistance Program ("ADAP"), 2018 National Ryan White HIV/AIDS Program (RWHAP) Part B and ADAP Monitoring Project Annual Report. It includes state-level program-related major findings, tables, with data, and thus it provides the most comprehensive snapshot on all 50 states, District of Columbia, Puerto Rico, U.S. Virgin Islands, and the six U.S. Pacific Territories. It is a must-read for ADAP stakeholders!

Photo Source: NASTAD

Upon releasing the 2018 National Ryan White HIV/AIDS Program (RWHAP) Part B and ADAP Monitoring Project Annual Report, NASTAD issued the following statement:

"Building on the 22-year history of reporting on the AIDS Drug Assistance Program (ADAP), the National ADAP Monitoring Project, including the Annual Report, has evolved to include the program under which ADAP falls – the Ryan White HIV/AIDS Program (RWHAP) Part B program.  The Annual Report has thus been renamed and reimagined.  The 2018 National RWHAP Part B and ADAP Monitoring Project Annual Report (The Report) includes narrative and findings that span the totality of the RWHAP Part B program and reflect the reality that the achievements of ADAPs and other elements of the RWHAP Part B programs are inextricably linked."[1]

The report includes relevant information about ADAP's funding and structure, as well as key programmatic details — such as number of clients served, viral load suppression rates, and medical program expenditures. This year's report also includes important sections on structural inequities and the changing health care landscape. Infographics once again accompanied this year's report. In addition, a glossary of key ADAP terms can be found on the NASTAD website.

In FY2017, Congress appropriated $1.4 billion for RWHAP Part B programs, with $898.8 million appropriated to ADAP specifically. Funding was also allocated to 24 Part B Supplemental grants, 9 Part B ADAP Supplemental Treatment grants, and 9 ADAP Emergency Relief grants. Additional funding sources included Part A contribution allocated to Part B (2), State contributions (31), drug rebates (46), and other State/Federal funds (23).[2]

Some key findings include:

• Fourth open enrollment period via Affordable Care Act insurance marketplace ended on April 30, 2017[3]
• Part B estimated drug rebates = $193,335,704[4]
• ADAP estimated drug rebates = $723,825,912[5]
• $398.2 million in estimated expenditures insurance purchasing/continuation[6]
• 48% ADAP clients served by full-pay prescription program only[7]
• 38% ADAP clients served by ADAP-funded insurance program only[8]
• 14% ADAP clients served by ADAP-funded insurance and full-pay prescription programs[9]
• 273,680 RWHAP Part B & ADAP clients enrolled[10]

Other key component of the report include valuable information about clients co-infected with HIV and Hepatitis C ("HCV"), incarcerated and formerly incarcerated populations, aging populations (and related morbidity and mortality), and clients impacted by substance use. As is customary, NASTAD should be applauded for their amazing work on pulling together all of this information for ADAP stakeholders.

To download the 2018 National Ryan White HIV/AIDS Program (RWHAP) Part B and ADAP Monitoring Project Annual Report, go to https://www.nastad.org/PartBADAPreport.

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[1] National Alliance of State & Territorial AIDS Directors (2018, May). 2018 National Ryan White HIV/AIDS Program (RWHAP) Part B and ADAP Monitoring Project Annual Report. Retrieved from https://www.nastad.org/PartBADAPreport.
[2] National Alliance of State & Territorial AIDS Directors (2018, May). 2018 National Ryan White HIV/AIDS Program (RWHAP) Part B and ADAP Monitoring Project Annual Report (p. 9). Retrieved from https://www.nastad.org/PartBADAPreport.
[3] National Alliance of State & Territorial AIDS Directors (2018, May). 2018 National Ryan White HIV/AIDS Program (RWHAP) Part B and ADAP Monitoring Project Annual Report (p. 11). Retrieved from https://www.nastad.org/PartBADAPreport.
[4] National Alliance of State & Territorial AIDS Directors (2018, May). 2018 National Ryan White HIV/AIDS Program (RWHAP) Part B and ADAP Monitoring Project Annual Report (p. 15). Retrieved from https://www.nastad.org/PartBADAPreport.
[5] National Alliance of State & Territorial AIDS Directors (2018, May). 2018 National Ryan White HIV/AIDS Program (RWHAP) Part B and ADAP Monitoring Project Annual Report (p. 15). Retrieved from https://www.nastad.org/PartBADAPreport.
[6] National Alliance of State & Territorial AIDS Directors (2018, May). 2018 National Ryan White HIV/AIDS Program (RWHAP) Part B and ADAP Monitoring Project Annual Report (p. 25). Retrieved from https://www.nastad.org/PartBADAPreport.
[7] National Alliance of State & Territorial AIDS Directors (2018, May). 2018 National Ryan White HIV/AIDS Program (RWHAP) Part B and ADAP Monitoring Project Annual Report (p. 27). Retrieved from https://www.nastad.org/PartBADAPreport.
[8] National Alliance of State & Territorial AIDS Directors (2018, May). 2018 National Ryan White HIV/AIDS Program (RWHAP) Part B and ADAP Monitoring Project Annual Report (p. 27). Retrieved from https://www.nastad.org/PartBADAPreport.
[9] National Alliance of State & Territorial AIDS Directors (2018, May). 2018 National Ryan White HIV/AIDS Program (RWHAP) Part B and ADAP Monitoring Project Annual Report (p. 27). Retrieved from https://www.nastad.org/PartBADAPreport.
[10] National Alliance of State & Territorial AIDS Directors (2018, May). 2018 National Ryan White HIV/AIDS Program (RWHAP) Part B and ADAP Monitoring Project Annual Report (p. 30). Retrieved from https://www.nastad.org/PartBADAPreport.

Combatting the Dual Epidemic of Substance Use and HIV-Infection

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

Since the earliest days of the AIDS epidemic, there has been a significant link between substance use, abuse, and dependence and HIV-infection. Aside from injection drug use ("IDU") -- which can cause direct exposure to the virus -- substance use, abuse, and dependance "can affect people’s overall health and make them more susceptible to HIV infection and, in those already infected with HIV, substance use can hasten disease progression and negatively affect adherence to treatment."[1]

Photo Source: We Do Recover

According to the CDC, some of the populations most vulnerable populations include people who live in disadvantaged neighborhoods, gay, bisexual and transgender men, people with mental illness, and people who have experienced sexual, physical, or emotional abuse. Among some of the most common substances used are alcohol, crack cocaine, heroin, Methamphetamine ("Meth"), and poppers.[2]

Unfortunately, many prevention strategies -- otherwise known has Harm Reduction -- often fall victim to the political kickball because many right wing conservatives view them as condoning drug use. Also, often the scarcity of available funding in public health can push these programs to the back burner. The lack of prevention dollars has long plagued the fight against the AIDS epidemic, and it is one that continues today (though some progress has been achieved over the last decade in this area).

To that end, earlier this month the National Alliance of State & Territorial AIDS Directors (NASTAD) released a Fact Sheet on ADAP Formulary Coverage of Substance Use Treatment. The fact sheet demonstrates how AIDS Drug Assistance Programs (ADAPs) cover substance use treatment medications, related client services, as well as drug-specific information for medications.[3]

It includes the following sections:

• Substance Use Treatment Needs among PLWH
• Use of Ryan White Part B and ADAP Funds to Expand Access to Substance Use Treatment
• Substance Use Treatment Medications: Drug-Specific Information

NASTAD summarized the important role played by ADAPs: "When used in combination with behavioral therapy, substance use treatment medications allow individuals to manage addiction or dependency by reducing their risk for overdose, cravings, and/or symptoms of withdrawal.  For PLWH who use substances, these treatments bolster multiple “bars” within the HIV care continuum, including adherence to ARV treatment and viral load suppression."[4] 

The fact sheet can be downloaded online at https://www.nastad.org/resource/adap-formulary-coverage-substance-use-treatment.

There is no one-size-fits-all to the prevention and treatment of substance use, abuse, and dependence. One thing is certain though, there isn't enough being done in this area. Resources and tools -- such as the one made available by NASTAD -- are important to community leaders trying to tackle the dual epidemic of substance use and HIV-infection.

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[1] U.S. Centers for Disease Control & Prevention (CDC), "HIV and Substance Use in the Unite," March 2013; available online at http://www.cdc.gov/hiv/pdf/risk_HIV_Substance.pdf.
[2] U.S. Centers for Disease Control & Prevention (CDC), "HIV and Substance Use in the Unite," March 2013; available online at http://www.cdc.gov/hiv/pdf/risk_HIV_Substance.pdf.
[3] National Alliance of State & Territorial AIDS Directors (NASTAD), "ADAP Formulary Coverage of Substance Use Treatment," July 5, 2016; available online at https://www.nastad.org/resource/adap-formulary-coverage-substance-use-treatment.
[4] Bowes, Amanda, National Alliance of State & Territorial AIDS Directors (NASTAD), "AIDS DRUG ASSISTANCE PROGRAMS’ (ADAPS) SUPPORT OF SUBSTANCE USE TREATMENT FOR THE CLIENTS THEY SERVE," July 5, 2016; available online at https://www.nastad.org/blog/aids-drug-assistance-programs-adaps-support-substance-use-treatment-clients-they-serve.