Date of Conferral

2020

Date of Award

2021

Degree

Ph.D.

School

Health Services

Advisor

David Segal

Abstract

The Ryan White HIV/AIDS Program (RWHAP) provides HIV care to uninsured people living with HIV/AIDS (PLWHA). Although the RWHAP has helped PLWHA achieve a viral suppression rate of 84%, this does not meet the 90% target goals under the U.N. 90-90-90 plan to end the AIDS epidemic. The Affordable Care Act (ACA) was enacted to enhance access and health status, but outcomes have not been measured for PLWHA. The purpose of this quantitative correlational cross-sectional study was to determine whether PLWHA enrolled in an ACA qualified health plan (ACAQHP) achieved improved health status compared to PLWHA enrolled in the RWHAP. Andersen’s behavioral model of health services use provided the theoretical framework for this study. Research questions addressed variables such as demographic factors, difficulty in paying out-of-pocket medical expenses, health status, coverage status, treatment compliance, and engagement in care. A purposeful convenience sample of weighted secondary data from 30,670 PLWHA residing in Florida who participated in the 2015-2017 Medical Monitoring Project survey was used. Multiple linear regression only showed a statistically significant relationship between engagement in care and health status. Mann-Whitney U tests indicated a statistically significant difference in treatment compliance and engagement in care, but not in health status between RWHAP and ACAQHP enrollees. Findings also showed that those enrolled in the ACAQHP had less difficulty in paying their health care expenses than those in the RWHAP. Study results may be used to encourage enrollment in an ACAQHP and improve health outcomes due to access to more affordable comprehensive services.

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