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Clin Infect Dis. 2018 Oct 15;67(9):1403-1410. doi: 10.1093/cid/ciy296.

National Survey of United States Human Immunodeficiency Virus Medical Providers' Knowledge and Attitudes About the Affordable Care Act.

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Division of Infectious Diseases and International Health, Charlottesville.
Center for Health Policy, University of Virginia, Charlottesville.
Royal College of Surgeons in Ireland, Dublin.



The Affordable Care Act (ACA) affects United States' healthcare by offering Medicaid expansion and tax subsidies to persons with low incomes, and its interaction with the current human immunodeficiency virus (HIV) healthcare delivery system is complex. The objective was to explore HIV medical providers' knowledge and attitudes about the ACA.


HIV medical providers were emailed a weblink to a survey. Descriptive statistics, Mann-Whitney U tests, and binary logistic regression were performed.


Of the 253 survey participants, the majority (61%) answered all 4 knowledge questions correctly. About 70% knew whether or not their state had decided to expand Medicaid. About 1 in 10 did not know if the ACA eliminated the Ryan White Program. When rating whether the ACA would improve their patients' HIV outcomes from 1-5 with 5 as "strongly agree," the providers' mean responses varied by state Medicaid status: 3.78 (standard deviation [SD], 0.83) for Medicaid expansion compared with 3.37 (SD, 1.00) for Medicaid nonexpansion (P = .002). Adjusting for medical provider type, years of HIV practice, and sources of ACA information, correct ACA knowledge was associated with providing care in a Medicaid nonexpansion state (adjusted odds ratio [aOR], 2.07; 95% confidence interval [CI], 1.11-3.88), obtaining knowledge from case managers (aOR, 1.89; 95% CI, 1.03-3.48), and obtaining knowledge from newspapers/magazines (aOR, 1.94; 95% CI, .99-3.81).


Medical providers in Medicaid expansion states were more optimistic about the ACA's likelihood to improve their patients' HIV outcomes. There are gaps in HIV medical providers' understanding of the ACA. Education could enhance systems-based practice.

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