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J Acquir Immune Defic Syndr. 2016 Nov 1;73(3):307-312.

Impact of Health Insurance, ADAP, and Income on HIV Viral Suppression Among US Women in the Women's Interagency HIV Study, 2006-2009.

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*Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC;Departments of †Epidemiology;‡Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC;§Departments of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY;‖Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco, CA;¶Department of Medicine, Cook County Health and Hospital System, Rush University, Chicago, IL;**Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA;††Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;‡‡Division of Infectious Diseases and Travel Medicine, Department of Medicine, Georgetown University, Washington, DC;§§Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS;‖‖Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY;¶¶Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA; and***Department of Community Health Sciences, School of Public Health, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY.



Implementation of the Affordable Care Act motivates assessment of health insurance and supplementary programs, such as the AIDS Drug Assistance Program (ADAP) on health outcomes of HIV-infected people in the United States. We assessed the effects of health insurance, ADAP, and income on HIV viral load suppression.


We used existing cohort data from the HIV-infected participants of the Women's Interagency HIV Study. Cox proportional hazards models were used to estimate the time from 2006 to unsuppressed HIV viral load (>200 copies/mL) among those with Medicaid, private, Medicare, or other public insurance, and no insurance, stratified by the use of ADAP.


In 2006, 65% of women had Medicaid, 18% had private insurance, 3% had Medicare or other public insurance, and 14% reported no health insurance. ADAP coverage was reported by 284 women (20%); 56% of uninsured participants reported ADAP coverage. After accounting for study site, age, race, lowest observed CD4, and previous health insurance, the hazard ratio (HR) for unsuppressed viral load among those privately insured without ADAP, compared with those on Medicaid without ADAP (referent group), was 0.61 (95% CI: 0.48 to 0.77). Among the uninsured, those with ADAP had a lower relative hazard of unsuppressed viral load compared with the referent group (HR, 95% CI: 0.49, 0.28 to 0.85) than those without ADAP (HR, 95% CI: 1.00, 0.63 to 1.57).


Although women with private insurance are most likely to be virally suppressed, ADAP also contributes to viral load suppression. Continued support of this program may be especially critical for states that have not expanded Medicaid.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

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