State AIDS Drug Assistance Programs' Contribution to the United States' Viral Suppression, 2015-2022

BackgroundState AIDS Drug Assistance Programs (ADAPs) provide HIV medication access for people with HIV (PWH) with low incomes in the United States (US). We quantified the proportion of viral suppression (VS) that is from ADAP clients for 2015-2022. MethodsFor 2015-2022, we obtained viral load (VL) test results and VS data from publicly available, jurisdiction-level data on ADAP clients and PWH. We report descriptive statistics including the proportion of PWH with a VL who had VS and were supported by ADAPs. ResultsAfter excluding jurisdictions with missing data, PWH who were included in the analysis for each year was 63.7-96.4%. VS for PWH each year was 60-66.3%. VS for ADAP clients was 81.2%-91.4%. In all years, compared to all PWH, a lower proportion of ADAP clients had a reported VL and a higher proportion had VS. Over 2015-2022, the average proportion of PWH who were ADAP clients was 23.1%, the proportion of PWH with VLs who were ADAP clients was 22.2%, and the proportion of PWH with VS who were ADAP clients was 30.8%. ConclusionsAlmost a third of the entire VS rate was from ADAP clients, despite ADAP serving less than 25% of PWH. A much higher proportion of ADAP clients achieved VS, compared to PWH. ADAPs impact is not due to ADAP clients being over represented among PWH with reported VLs. ADAP does not directly receive any federal Ending the HIV Epidemic (EHE) Initiative funding. Policymakers should examine how ADAPs can support the EHE Initiative. SummaryDespite state AIDS Drug Assistance Programs (ADAPs) serving less than a quarter of people with HIV, almost a third of the viral suppression in the United States can be attributed to ADAPs. ADAPs are essential for ending the HIV epidemic.