JMIR Publications

ABSTRACT

Background:

AIDS Drug Assistance Programs (ADAPs) are a critical safety net within the federal Ryan White HIV/AIDS Program. ADAPs are operated by state and territorial health departments and provide HIV medication access and insurance assistance for low-income people with HIV (PWH). However, the most recent qualitative study assessment of ADAPs was over 14 years ago.

Objective:

The purpose of this study was to better understand administrative, programmatic, clinical, and financial considerations that enable ADAPs to support adherence to HIV medications and ultimately achieve viral suppression, treating uninterrupted structural access to medications as a proximate determinant of downstream adherence behavior.

Methods:

We conducted a secondary qualitative analysis of interviews with state health department HIV program leaders and ADAP staff; participation was at the state level, with 16 states and 33 individual participants enrolled using maximum variance sampling. Coding was guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS).

Results:

Our secondary analysis identified three domains of ADAP programmatic and policy decisions that support medication adherence: eligibility policies (income thresholds, recertification requirements, and re-enrollment flexibilities), formulary design (open vs. limited formularies, inclusion of newer long-acting therapies, and non-ART medications), and pharmacy access policies (network breadth, dispensing location, and multi-month dispensing). Across each domain, programs described facilitators that reduced medication interruptions and barriers that created gaps in ART access for low-income PWH.

Conclusions:

ADAPs play a central role in supporting medication adherence for low-income PWH through concrete programmatic and policy decisions. Flexible eligibility policies, broad formularies, and accessible pharmacy networks each reduce barriers to uninterrupted ART access. These findings are particularly timely: as of early 2026, at least two ADAPs have established waiting lists, and multiple states have reduced financial eligibility thresholds or formulary coverage in response to budget pressures. The policies described in this study as facilitators of adherence are the same policies being curtailed. Given this study’s findings, removal of these programs features would be expected to reduce the medication adherence and viral suppression gains ADAPs have achieved for the low-income PWH they serve.