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State AIDS Drug Assistance Programs' Contribution to the United States' Viral Suppression, 2015-2022
Kathleen A McManus1, Amy Killelea1, Erin Q Rogers1
1Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, Virginia.
Medrxiv : the Preprint Server for Health Sciences
|April 16, 2025
Summary
State AIDS Drug Assistance Programs (ADAPs) significantly boost viral suppression rates among people with HIV (PWH). ADAP clients achieve higher viral suppression, contributing substantially to overall public health goals.
Area of Science:
- Public Health
- HIV/AIDS Research
- Health Services Research
Background:
- State AIDS Drug Assistance Programs (ADAPs) are crucial for providing HIV medications to low-income individuals in the US.
- Understanding the contribution of ADAP clients to overall viral suppression (VS) is essential for public health strategy.
- This study quantifies the impact of ADAPs on viral suppression rates among people with HIV (PWH).
Purpose of the Study:
- To quantify the proportion of viral suppression (VS) attributable to clients of State AIDS Drug Assistance Programs (ADAPs).
- To compare viral suppression rates between ADAP clients and the general population of people with HIV (PWH).
- To assess the role of ADAPs in achieving national HIV/AIDS public health objectives.
Main Methods:
- Utilized publicly available, jurisdiction-level data from 2015-2022.
- Analyzed viral load (VL) test results and VS data for both ADAP clients and the broader PWH population.
- Calculated descriptive statistics on the proportion of PWH with VL tests and VS, specifically identifying ADAP client contributions.
Main Results:
- Viral suppression (VS) rates among ADAP clients ranged from 81.2% to 91.4% annually, significantly higher than the general PWH population (60-66.3%).
- ADAP clients represented an average of 23.1% of PWH, 22.2% of PWH with reported VLs, and a substantial 30.8% of PWH achieving VS.
- Despite serving less than 25% of PWH, ADAP clients accounted for nearly a third of the total viral suppression rate.
Conclusions:
- ADAPs play a disproportionately large role in achieving viral suppression among people with HIV (PWH).
- The higher VS rates among ADAP clients are not due to overrepresentation among those with reported viral loads.
- ADAPs' significant impact warrants consideration for integration into federal initiatives like the Ending the HIV Epidemic (EHE) Initiative, despite not directly receiving EHE funding.
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