Brief Report: The Role of Ryan White HIV/AIDS Program Services in Sustaining Viral Suppression Among People Living with HIV: Insights from South Carolina.

BACKGROUND

The Ryan White HIV/AIDS Program (RW) serves as a critical safety net for low-income and underinsured people living with HIV (PWH). We assessed the relationship between the utilization of comprehensive RW services (core, support, and AIDS Drug Assistance Program) and sustained HIV viral suppression.

SETTING

Despite the expansion of Medicaid under the Affordable Care Act, South Carolina failed to expand its eligibility, leaving many vulnerable PWH without coverage. We used a statewide cohort of PWH to identify epidemiologic trends and develop predictive models to improve clinical HIV and public health services.

METHODS

We analyzed data from 8489 PWH diagnosed in South Carolina (2005-2020) to identify sustained viral suppression (consecutive undetectable viral load tests within a year). We report the descriptive statistics and bivariate associations with sustained viral suppression. Subsequently, using generalized linear mixed modeling, we modeled the relationship between RW service utilization and sustained viral suppression, controlling for key sociodemographic, substance use, mental health, and HIV clinical care variables.

RESULTS

Our sample of PWH (n = 8489) was primarily young (18-30 years, 42%), men (75%), Black (71%), urban (83%), and 88.3% achieved sustained viral suppression. RW service utilization was more frequent for core (65%) and support services (53%), whereas only 3% used comprehensive (core, support, and AIDS Drug Assistance Program) services. Our adjusted model revealed that comprehensive utilization significantly increased the odds of sustained viral suppression by 41% (AOR = 1.41, 95% CI = 1.09 to 1.84).

CONCLUSIONS

Our findings highlight the importance of structural support and comprehensive low-barrier services for achieving HIV progress in a shifting landscape of health care coverage.