Search

BACKGROUND The Ryan White HIV/AIDS Program (RWHAP) provides persons infected with human immunodeficiency virus (HIV) with services not covered by other healthcare payer types. Limited data exist to inform policy decisions about the most appropriate role for RWHAP under the Patient Protection and Affordable Care Act (ACA). METHODS We assessed associations between RWHAP assistance and antiretroviral therapy (ART) prescription and viral suppression. We used data from the Medical Monitoring Project, a surveillance system assessing characteristics of HIV-infected adults receiving medical care in the United States. Interview and medical record data were collected in 2009-2013 from 18 095 patients. RESULTS Nearly 41% of patients had RWHAP assistance; 15% relied solely on RWHAP assistance for HIV care. Overall, 91% were prescribed ART, and 75% were virally suppressed. Uninsured patients receiving RWHAP assistance were significantly more likely to be prescribed ART (52% vs 94%; P < .01) and virally suppressed (39% vs 77%; P < .01) than uninsured patients without RWHAP assistance. Patients with private insurance and Medicaid were 6% and 7% less likely, respectively, to be prescribed ART than those with RWHAP only (P < .01). Those with private insurance and Medicaid were 5% and 12% less likely, respectively, to be virally suppressed (P ≤ .02) than those with RWHAP only. Patients whose private or Medicaid coverage was supplemented by RWHAP were more likely to be prescribed ART and virally suppressed than those without RWHAP supplementation (P ≤ .01). CONCLUSIONS Uninsured and underinsured HIV-infected persons receiving RWHAP assistance were more likely to be prescribed ART and virally suppressed than those with other types of healthcare coverage.

During the 2004-2005 influenza season, the supply of vaccine to the United States was significantly reduced. In response, the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices issued interim recommendations for prioritizing vaccination. Given trends in racial/ethnic disparities in vaccination for influenza, the authors assessed the impact of the shortage on those historically less likely to be vaccinated. Using data from the Behavioral Risk Factor Surveillance System, they considered vaccination coverage among those non-Hispanic Whites, non-Hispanic Blacks, and Hispanics who had priority for being vaccinated during the 2004-2005 influenza season. The vaccine shortage had a significant negative effect on coverage among adults aged 65 years or older across the three racial/ethnic groups. Yet, the magnitude of the disparities in coverage did not change significantly from previous seasons. This finding may imply similar patterns of vaccine-seeking behavior during shortage and nonshortage years. No racial/ethnic differences were seen among adults aged 18-64 years, which likely reflects the higher percentage of health-care workers in this age group. Yearly monitoring of influenza vaccine coverage is important to assess the long-term impact of shortages on overall coverage and gaps in coverage between racial/ethnic groups.

To describe the characteristics of persons in the United States who smoke but do not smoke daily, we analyzed 1997-1998 data from the National Health Interview Survey (NHIS). The NHIS collects self-reported information on cigarette smoking from a representative sample of the U.S. civilian, noninstitutionalized population aged 18 years or older through in-home surveys. Nondaily smokers were defined as persons who had ever smoked 100 cigarettes, smoked "some days," and smoked on fewer than 30 of the past 30 days. In 1997-1998, an estimated 16.0% of current smokers were nondaily smokers. Being a nondaily smoker was more common among smokers aged 18-24 years (19.9%) than among those aged 45-64 years (12.0%), more common among Black and Hispanic smokers (19.2% and 29.9%, respectively) than among White smokers (13.9%), and more common among smokers with at least a college education (28.2%) than among those with 9-11, 12, or 13-15 years of education (10.0%, 12.5%, or 15.9%, respectively). Mean cigarettes smoked per day for those who had smoked on 1-9, 10-19, and 20-29 of the past 30 days equaled 3.9, 5.3, and 7.0, respectively, compared with 19.0 for daily smokers. Nondaily smokers were more likely than daily smokers to have a quit attempt in the past year (55.2% vs. 40.0%). In conclusion, rates of nondaily smoking vary substantially by age, race/ethnicity, and educational attainment. Differences by education suggest that this behavior may be influenced by knowledge and social norms. Nondaily smoking may be a useful intermediate outcome for assessing changes in smoking prevalence. Cessation interventions need to be tailored for nondaily smokers, who may differ from daily smokers in important ways.