Characterizing AIDS Drug Assistance Program Practices and Policies for Sustained Viral Suppression Using the Consolidated Framework for Implementation Research: Protocol for a Qualitative Study.

BACKGROUND: AIDS Drug Assistance Programs (ADAPs), a key part of the federally funded Ryan White HIV/AIDS Program, provide antiretroviral therapy (ART) to low-income and uninsured or underinsured people with HIV. As long as they meet federal regulations, jurisdictions maintain flexibility in implementing ADAPs, allowing for 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 the 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 people with HIV enrolled in ADAPs, specifically by identifying the mechanisms that facilitate high performance and viral suppression for all people with HIV. Results will inform how viral suppression outcomes could be improved through 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, we conducted semistructured interviews with state-level ADAP leaders, operational and programmatic decision-makers, and staff. Interview questions covered 5 domains: leadership and staffing; operations, integration, and collaboration; formulary design and treatment; eligibility and enrollment; and innovation and implementation. Qualitative data from the interviews will be analyzed using deductive and inductive approaches along with situational mapping.

RESULTS: This study was funded in April 2023. In total, 33 individuals from 16 states have participated in this qualitative study, resulting in a participation rate of 31.4% (16/51). States from all 4 US census regions were represented. Interviews were conducted between February 12, 2025, and March 20, 2025. As of March 2026, data analysis is underway.

CONCLUSIONS: We anticipate that the study will highlight 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, which is a vital public health objective. 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 of the Ryan White HIV/AIDS Program. Ultimately, we expect that disseminating these results will support improvements in viral suppression, enhancing both individual health outcomes and public health.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/90008.