Determinants of facilitated health insurance enrollment for patients with HIV disease, and impact of insurance enrollment on targeted health outcomes

Renae Furl, Shinobu Watanabe-Galloway, Elizabeth Lyden, Susan Swindells

Research output: Contribution to journalArticle

5 Scopus citations


Background: The introduction of the Affordable Care Act (ACA) has provided unprecedented opportunities for uninsured people with HIV infection to access health insurance, and to examine the impact of this change in access. AIDS Drug Assistance Programs (ADAPs) have been directed to pursue uninsured individuals to enroll in the ACA as both a cost-saving strategy and to increase patient access to care. We evaluated the impact of ADAP-facilitated health insurance enrollment on health outcomes, and demographic and clinical factors that influenced whether or not eligible patients enrolled. Methods: During the inaugural open enrollment period for the ACA, 284 Nebraska ADAP recipients were offered insurance enrollment; 139 enrolled and 145 did not. Comparisons were conducted and multivariate models were developed considering factors associated with enrollment and differences between the insured and uninsured groups. Results: Insurance enrollment was associated with improved health outcomes after controlling for other variables, and included a significant association with undetectable viremia, a key indicator of treatment success (p < .0001). We found that minority populations and unstably housed individuals were at increased risk to not enroll in insurance. Conclusion: The National HIV/AIDS Strategy calls for new interventions to improve HIV health outcomes for disproportionately impacted populations. This study provides evidence to prioritize future ADAP-facilitated insurance enrollment strategies to reach minority populations and unstably housed individuals.

Original languageEnglish (US)
Article number132
JournalBMC Infectious Diseases
Issue number1
StatePublished - Mar 16 2018



  • AIDS drug assistance program
  • Affordable care act
  • And health disparities
  • HIV infection
  • Health outcomes

ASJC Scopus subject areas

  • Infectious Diseases

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