INTRODUCTION AIDS Drug Assistance Programs (ADAPs) provide financial support for medical care for people living with HIV (PLWH) in the US. Federal policy requires that clients recertify for the program every 6 months, which has been described as a barrier to care access. Our objective was to describe the prevalence and factors associated with ADAP disenrollment in Washington State. METHODS Between 2017 and 2019, we categorized ADAP clients by the success of their recertification applications as: 1) continuously enrolled, 2) ruled ineligible, or 3) disenrolled if they failed to recertify. We compared individuals who were disenrolled to those who were continuously enrolled by demographic and socioeconomic characteristics and engagement with case management using data from the Washington State HIV Surveillance and Ryan White data systems. RESULTS From 2017 to 2019, 5480 clients were enrolled in ADAP, of whom 1423 (26%) were disenrolled and 984 (18%) were ruled ineligible at least once. Compared to those who were continuously enrolled, disenrolled PLWH were more likely to be Black (unadjusted prevalence ratio (PR) vs White 1.31, 95% CI 1.17-1.46), uninsured (PR vs private insurance 1.24, 95% CI 1.10-1.40), and younger (PR 25-34 vs 35-44 years 1.23 95% CI 1.08-1.41). The median time to return after disenrollment was 12 months (95% CI 8-19 months). CONCLUSIONS Disenrollment after failure to recertify was the most common reason why PLWH lost ADAP coverage in Washington. ADAP recertification procedures disproportionately impact Black, young, and uninsured PLWH and may contribute to disparities in HIV outcomes.
Characterization of the Population Impacted by the 6-Month Recertification Criterion of the Ryan White HIV/AIDS Program's AIDS Drug Assistance Program in Washington State, 2017-2019.