Unmet needs for HIV ancillary care services by healthcare coverage and Ryan White HIV/AIDS program assistance

Abstract

Objective:To investigate unmet needs for HIV ancillary care services by healthcare coverage type and Ryan White HIV/AIDS Program (RWHAP) assistance among adults with HIV.Design:We analyzed data using the 2017–2019 cycles of the CDC Medical Monitoring Project, an annual, cross-sectional study designed to produce nationally representative estimates of characteristics among adults with diagnosed HIV.Methods:Unmet need was defined as needing, but not receiving, one or more HIV ancillary care services. We estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) using predicted marginal means to examine associations between healthcare coverage type and unmet needs for HIV ancillary care services, adjusting for age. Associations were stratified by receipt of RWHAP assistance.Results:Unmet needs for HIV ancillary care services were highest among uninsured persons (58.7%) and lowest among those with private insurance living with at least 400% of the federal poverty level (FPL; 21.7%). Uninsured persons who received RWHAP assistance were less likely than those who did not receive RWHAP assistance to have unmet needs for HIV clinical support services (aPR: 0.21; 95% CI: 0.16–0.28) and other medical services (aPR: 0.75; 95% CI: 0.59–0.96), but not subsistence services (aPR: 0.97; 95% CI: 0.74–1.27). Unmet needs for other medical services and subsistence services did not differ by RWHAP assistance among those with Medicaid, Medicare, or other healthcare coverage.Conclusions:RWHAP helped reduce some needs for uninsured persons. However, with growing socioeconomic inequities following the coronavirus disease 2019 pandemic, expanding access to needed services for all people with HIV could improve key outcomes.

Unmet Needs for HIV Ancillary Services Among Persons With Diagnosed HIV Aged 55 years and Older

“…30 In addition, although the RWHAP provides funding to communities for HIV support services, funding is limited and local programs might not be able to serve all who qualify for services or meet the needs of all clients served. 15 Although overall unmet needs were higher among PWH aged 55 years or older who were publicly insured only or who were uninsured or wholly relied on the RWHAP for their care, we found no difference in unmet needs by insurance status among cisgender women. This lack of difference may, in part, be due to small sample sizes.…”

“…This result is perhaps unsurprising given that a one-person household income of 100%–399% FPL, in 2021, represented an annual income of only $12,880–$51,391, and studies have demonstrated an association between low income and unmet needs. 15,31,32 Although the prevalence of unmet need among persons with household incomes of 100%–138% FPL and 139%–399% FPL were slightly higher and not statistically different than those <100% FPL, respectively, unmet need among each group was substantial. Although the reason behind this pattern of association is unclear, it is possible that persons with household income of 100%–138% FPL do not qualify for income-based services that would otherwise meet some of their unmet needs causing them to have higher unmet needs than persons below 100% FPL.…”

“…This finding is similar to findings from a 2022 MMP study of unmet needs by health care coverage among all adults with diagnosed HIV. 15 High levels of unmet needs seen by insurance status might be due to greater disease burden associated with being underinsured or being able to access only public safety-net payers' programs. For example, an analysis of the HIV Outpatient Study (a multicenter prospective cohort study) found that publicly insured PWH who were both taking ART and virally suppressed were approximately twice as likely as privately insured PWH to have a variety of comorbid conditions.…”

“…12 Although several studies have examined ancillary services in varied PWH populations, we are unaware of any recent US study that has focused on unmet needs for ancillary services in the older PWH population. 10,11,[13][14][15][16][17] As such, the objective of our study was to use representative data from the Centers of Disease Control and Prevention's Medical Monitoring Project (MMP) to describe the prevalence of unmet needs for ancillary services among persons with diagnosed HIV aged 55 years or older, overall and by selected characteristics. Because some social determinants of health, mental, and other health conditions disproportionately affect men versus women, which might result in differential need for ancillary services, the analysis was also broken down by gender.…”

Ryan White programming that primarily supports clinical care falls short when core people needs are not met: further evidence from the medical monitoring project

“…In the paper by Dasgupta et al [1], the authors examine the unmet needs for ancillary services for people with HIV (PWH). These services were categorized as HIV clinical support services (i.e.…”