Ryan White HIV/AIDS Program Assistance and Racial/Ethnic Disparities in the HIV Continuum of Care in Virginia

BACKGROUND: The Ryan White HIV/AIDS Program (RWHAP) provides funding to support coordinated medical care for persons living with HIV (PLWH). Across a variety of settings, RWHAP assistance has been positively associated with select outcomes along the HIV Continuum of Care (HCC), yet little is known about how RWHAP assistance mitigates racial/ethnic disparities observed in the HCC. We examined how RWHAP assistance affects multiple outcomes and racial/ethnic disparities along the HCC in Virginia.

METHODS: We utilized Virginia’s Care Markers database, which captures person-level data from 2014 for PLWH, to examine three outcomes: linkage to care among persons diagnosed with HIV in 2014 and retention in care and viral suppression (most recent viral load < 200 copies/mL) for the year 2014 among PLWH as of December 31, 2014. Descriptive analyses were conducted for the overall population and stratified by presence or absence of RWHAP assistance, which was defined as receiving any core/support service funded by Ryan White in 2014. Multivariate logistic regression estimated the association between RWHAP and each HCC outcome, with interaction terms used to assess racial/ethnic disparities in outcomes. Outcomes were adjusted for sex, age, race, transmission risk, AIDS diagnosis and region of residence. Time since HIV diagnosis was included for retention in care and viral suppression estimates to account for changing care engagement practices over time.

RESULTS: Individuals who received RWHAP assistance had higher odds of linkage to care (OR=7.71, 95% CI: 4.59, 12.95), retention in care (OR=7.46, 95% CI: 7.01, 7.93) and viral suppression (OR=5.06, 95% CI: 4.76, 5.38) compared to those who did not receive RWHAP assistance. The interaction between Hispanic race and RWHAP was significant for both retention in care (p=0.04) and viral suppression (p=0.01): Hispanics were less likely to be retained in care than Whites, but the effect estimate was larger in the non RWHAP group (log OR= -0.30) than among those who received RWHAP assistance (log OR= -0.03). Likewise, the effect estimate for viral suppression comparing Hispanics to Whites was larger in the non RWHAP group (log OR= -0.26) than among those who received RWHAP assistance (log OR= 0.05).

CONCLUSIONS: Receipt of RWHAP assistance is significantly associated with linkage to care, retention in care and viral suppression. Disparities in retention and viral suppression between Hispanics and Whites were attenuated by receiving RWHAP assistance. Coordinated HIV care, as provided through the RWHAP, increases engagement in HIV care and may minimize racial/ethnic disparities in HCC outcomes.