LBPED45

Title

Is having healthcare coverage enough to increase viral suppression among men who have sex with men in the United States?: Results from HPTN 078

Presenter

Jowanna Malone

Authors

J. Malone¹, Z. Wang², J.P. Hughes², K. Mayer³, J.E. Farley⁴, C. Del Rio⁵, D.S. Batey⁶, V. Cummings⁷, R.H. Remien⁸, C. Beyrer⁹, the HPTN 078 Research Team

Institutions

¹Johns Hopkins Bloomberg School of Public Health, Epidemiology, Baltimore, United States, ²Fred Hutchinson Cancer Research Center, Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Seattle, United States, ³Fenway Institute, Boston, United States, ⁴Johns Hopkins University School of Nursing, Infectious Diseases, Baltimore, United States, ⁵Emory University, Rollins School of Public Health, Epidemiology, Atlanta, United States, ⁶University of Alabama at Birmingham, Social Work, Birmingham, United States, ⁷Johns Hopkins School of Medicine, Pathology, Baltimore, United States, ⁸Columbia University, Psychiatry, New York, United States, ⁹Johns Hopkins Bloomberg School of Public Health, Epidemiology, Center for Health and Human Rights, Baltimore, United States

Background: Men who have sex with men (MSM) continue to account for the majority of HIV infections in the United States (U.S.). Access and adherence to HIV treatment among those infected are key to stopping transmission. As having health insurance can facilitate access to treatment, we analyzed the association between reported health coverage and viral suppression among MSM living with HIV screened for HPTN 078.
Methods: We used cross-sectional data from 1,305 MSM screened for the HPTN 078 trial, of whom 902 were HIV-infected. Participants were recruited through both direct and respondent driven sampling methods from clinics across four U.S. cities, including two located in states with Medicaid expansion. Sexual health and sociodemographic characteristics were collected. Participants answered “Yes” or “No” to whether or not they had health coverage (regardless of type). We assessed the association between reported health coverage and viral suppression (< 1000 copies/mL) at screening using multivariable logistic regression adjusting for age, race, employment, household income, education, and recruitment method into the study. We then assessed factors associated with having health coverage using multivariable logistic regression.
Results: Among the 902 participants with HIV, 864 had available viral load measurements at screening. Among these 864, the median age was 46, 79% were Black (n=684), 87% had health coverage (n=754), and 82% were virally suppressed (n=710). After covariate adjustment, having health coverage was significantly associated with higher odds of being virally suppressed [OR: 1.67, 95% CI: 1.02, 2.71, p=0.04]. Older participants (>35 years) had significantly higher odds of being insured [OR: 3.88, 95% CI:2.56, 5.89, p= < 0.001], while those with low household income (< =$20,000 per year) had marginally lower odds of being insured [OR: 0.57, 95% CI: 0.33, 1.00, p=0.05].
Conclusions: In this analysis, participants with HIV who had healthcare coverage had a higher odds of viral suppression. The association between healthcare coverage and viral suppression has important implications as the Trump Administration has made a commitment to end the HIV/AIDS epidemic. These results suggest that programs such as the Ryan White Care Act and Medicaid expansion can positively contribute to viral suppression rates among MSM in the U.S.