The Impact of ACA and Medicaid Expansion on Progress Toward UNAIDS 90-90-90 Goals

Abstract

Purpose of Review

Passage of the Affordable Care Act (ACA) in 2010 and subsequent Medicaid expansion has influenced access to HIV treatment and care in the USA. This review aims to evaluate whether the implementation of these policies has impacted progress toward UNAIDS 90-90-90 goals.

Recent Findings

Preliminary evidence has emerged suggesting that the ACA and Medicaid expansion has increased the likelihood of HIV testing and diagnosis, reduced the number of people unaware of HIV infection, and increased the number of people on antiretroviral therapy (ART) who are virally suppressed.

Summary

While the ACA is associated with some progress toward 90-90-90 goals, more years of data after policy implementation are needed for robust analysis. Methods including difference-in-differences, instrumental variables, and propensity scores are recommended to minimize bias from unmeasured confounders and make causal inference about non-random Medicaid expansion among states.

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Abbreviations

ACA:

Affordable Care Act

ADAP:

AIDS Drug Assistance Program

ART:

antiretroviral therapy

BRFSS:

Behavioral Risk Factor Surveillance System

CDC:

Centers for Disease Control and Prevention

DID:

difference-in-differences analysis

FPL:

Federal Poverty Level

HIV:

human immunodeficiency virus

MSM:

men who have sex with men

PLWH:

people living with HIV

RWHAP:

Ryan White HIV/AIDS Program

UNAIDS:

Joint United Nations Program on HIV/AIDS

US:

United States

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Acknowledgments

We would like to thank Anirban Basu for the input on policy analysis methods for causal inference using observational data. Lisa McLoughlin provided technical editing.

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Correspondence to Blythe Adamson.

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Adamson, B., Lipira, L. & Katz, A.B. The Impact of ACA and Medicaid Expansion on Progress Toward UNAIDS 90-90-90 Goals. Curr HIV/AIDS Rep 16, 105–112 (2019). https://doi.org/10.1007/s11904-019-00429-6

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Keywords

  • Affordable Care Act
  • Medicaid expansion
  • HIV
  • 90-90-90
  • Viral suppression
  • Policy analysis