Address correspondence to Noah C. Godwin, B.A., University of Alabama School of Medicine (UASOM), 908 20th St. So CCB 165, Birmingham, AL 35294; e-mail: email@example.com. James H. Willig, M.D., Michael S. Saag, M.D., and Michael J. Mugavero, M.D., M.P.H., are with the UASOM Division of Infectious Diseases, Birmingham, AL. Christa R. Nevin, M.P.H., is with the UASOM, Birmingham, AL. Hui-Yi Lin, Ph.D., is with the UASOM Medical Statistics Section, Birmingham, AL. Jeroan Allison, M.D., M.P.H., is with the UASOM Division of Preventive Medicine, Birmingham, AL. Kathy Gaddis, M.S.W., Jennifer Peterson, Pharm.D., and James L. Raper, D.S.N., J.D., are with the UAB 1917 Clinic, Birmingham, AL.
Underutilization of the AIDS Drug Assistance Program: Associated Factors and Policy Implications
Article first published online: 6 JAN 2011
© Health Research and Educational Trust
Health Services Research
Volume 46, Issue 3, pages 982–995, June 2011
How to Cite
Godwin, N. C., Willig, J. H., Nevin, C. R., Lin, H.-Y., Allison, J., Gaddis, K., Peterson, J., Saag, M. S., Mugavero, M. J. and Raper, J. L. (2011), Underutilization of the AIDS Drug Assistance Program: Associated Factors and Policy Implications. Health Services Research, 46: 982–995. doi: 10.1111/j.1475-6773.2010.01223.x
- Issue published online: 3 MAY 2011
- Article first published online: 6 JAN 2011
- public health
Background. The AIDS Drug Assistance Program (ADAP) provides antiretroviral medications to low-income individuals with HIV infection.
Methods. A prospective cohort study of ADAP utilization, measured using medication possession ratio (MPR), was conducted during the 2008 calendar year at the University of Alabama at Birmingham 1917 HIV Clinic. Multivariable ordinal logistic regression evaluated factors associated with ADAP utilization.
Results. Among 245 patients, MPR quartiles (Q) were the following: Q1<69 percent, Q2=69–83 percent, Q3=84–93 percent, Q4>93 percent. In ordinal logistic regression, younger age (OR=0.59 per 10 years; 95 percent CI=0.44–0.79), nonwhite males (2.18; 1.18–4.04), lower CD4 count (2.79 for <200 cells/mm3; 1.44–5.43), and a history of alcohol abuse (2.11; 1.02–4.37) were associated with poor ADAP utilization.
Conclusions. One quarter of ADAP enrollees had MPR below 69 percent, a level well below that associated with optimal HIV treatment outcomes, indicating a need for programmatic interventions to improve ADAP utilization.