The UVA healthcare effort aims to improve HIV care across America

School of Medicine researcher Kathleen McManus, MD, MS, studies ways to improve HIV care.

A UVA health physician is launching an ambitious effort to evaluate and improve HIV care for low-income people across the nation, a campaign that could also help prevent transmission.

Kathleen McManus, MD, MS, of the University of Virginia School of Medicine, and her collaborators plan to identify specific policies and programs that can increase the number of patients who keep the HIV virus in their blood at undetectable levels. This desirable state, known as undetectable or sustained viral suppression, is associated with improved health outcomes for individuals and reduced risk of transmitting HIV to other people.

As part of their effort, the researchers will examine state AIDS drug assistance programs (ADAPs) to identify disparities in viral suppression between states and between different patient groups. One goal is to understand how ADAPs help with health equity and ensure that diverse groups, including patients of different races or ethnicities, receive high-quality care and good health outcomes. This work will allow researchers to determine which policies and programs are most effective so they can be implemented on a larger scale, helping improve care for more people living with HIV in the United States.

HIV drugs are safe and highly effective, but unless we can get them into the hands of patients, they have no impact. HIV medications are incredibly expensive and our healthcare system is difficult to navigate. We are studying the impact of a federally mandated and state-implemented public health safety net program that provides sustainable and affordable access to HIV medications for low-income people with HIV. It is essential that no group is left behind as the United States strives to improve the health of people living with HIV and end the HIV epidemic, said McManus, of UVA’s Division of Infectious Diseases and International Health. While this program provides drugs to about a quarter of people living with HIV in the United States, it is understudied. By quantifying the impact of ADAPs, we can help policymakers and advocates understand its critical role in HIV care in the United States. Additionally, by identifying specific best practices, we can help state health departments improve their programs and federal policymakers identify areas for technical assistance or support.

Improving HIV care

ADAPs are a vital safety net for people living with HIV. Serving lower-income patients, ADAPs provide essential antiretroviral therapy (HIV drugs) free of charge or by subsidizing insurance plans. The programs are estimated to support more than a quarter of people living with HIV in the United States.

Implementation of the programs varies by state, however, and McManus’ new project aims to shed light on best practices that improve outcomes and help programs get the most bang for their buck. She and her team received 4 years$2.9 millionNational Institutes of Healths National Institute of Allergy and Infectious Diseases award, grant R01AI170093-01A1.

With McManus, the research team includes Jessica Keim Malpass, Andrew Strumpf and Amber Steen of UVA Health; Tim Horn and Aunt Hamp; Emory Elizabeth Rogawski McQuade; and public health consultant Amy Killelea.

For their research, McManus and his collaborators partnered with 10 state health departments, providing them with anonymous information on 25 percent of ADAP clients. It is a first-of-its-kind multi-state database, built on State Department of Health partnerships, with information on approximately 60,000 people living with HIV over 10 years.

The research team will work with state health departments to evaluate how different ways the programs are implemented affect viral suppression and other patient outcomes. The team also plans to interview AIDS/ADAP leaders in many states for additional insights that could lead to cost-effective strategies for equitable care.

Inform future efforts

The researchers say their findings will allow ADAPs, state legislators and other key players, such as nationalEnd of the HIV epidemicinitiative, to make wise choices about how to achieve the best results. It will also help facilitate the development of new initiatives to benefit people living with HIV. (This kind of ambitious work to improve care for Virginians and beyond is a key component of recently unveiled UVA Healths,first ten-year strategic plan.)

Our goal is to quantify the impact of ADAPs on individuals, including people of different racial and ethnic groups, and the impact of ADAPs for HIV care in the United States. State ADAPs implement the program differently and also achieve different rates of good health outcomes. We will help identify best practices so state ADAPs can adapt policies and associated practices for success, McManus said. This project will turn data into action, and we are so fortunate to have built a strong interdisciplinary team that will work with state health departments to measure the impact of ADAPs and ultimately help improve HIV care in the United States.

McManus and his colleagues plan to work on this project for the next four years.

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