JMIR Publications

ABSTRACT

Background:

AIDS Drug Assistance Programs (ADAPs), a key part of the federally funded Ryan White HIV/AIDS Program (RWHAP), provide antiretroviral therapy (ART) to low-income and uninsured/underinsured people with HIV (PWH). As long as they meet federal regulations, jurisdictions maintain flexibility in implementing ADAPs, allowing a range of operational and programmatic options, including eligibility criteria, formulary design for ART (and non-ART) drugs, and the nature and character of insurance support. These programmatic and policy decisions ultimately impact ADAP client outcomes, including engagement in care, differences in populations benefiting from ADAP, and viral suppression rates. Despite ADAPs achieving an 85% national average viral suppression rate, this falls short of the 90% goal needed to end the HIV epidemic, and no formal evaluation has examined how specific operational or policy factors drive success across states.

Objective:

This qualitative study aims to examine how operational, organizational, and contextual factors shape the ability of ADAPs to improve viral suppression rates among PWH enrolled in ADAPs, specifically identifying the mechanisms that facilitate high performance and viral suppression for all PWH. Results will inform how viral suppression outcomes could be improved with policy, program, operational, and organizational changes in ADAP design and implementation.

Methods:

Using a qualitative descriptive approach guided by the Consolidated Framework for Implementation Research (CFIR), we will conduct semi-structured interviews with state-level ADAP leaders, operational and programmatic decision-makers, and staff. Interview questions cover five domains: leadership and staffing; operation, integration, and collaboration; formulary and treatment; eligibility and enrollment; and innovation and implementation.

Results:

We anticipate that the study will spotlight features, organizational practices, and operational norms that contribute to the successes of ADAPs with high rates of viral suppression. Successful completion of this analysis will provide evidence to inform state and federal regulations, program development, resource allocation, and prioritization to advance the goal of helping people achieve viral suppression and interrupt HIV transmission — a vital public health objective.

Conclusions:

We anticipate that the results of this study will be disseminated to improve viral suppression, which will improve health for the individual and have public health benefits. Using other data alongside our qualitative findings, we can provide context for the environment in which these programs or policies impact ADAP clients and the broader public health objectives that accompany the RWHAP.