The health equity implications of the HRSA Ryan White HIV/AIDS Program

Abstract

Objective: Investigate the role of the Ryan White HIV/AIDS Program (RWHAP) – which funds services for vulnerable and historically disadvantaged populations with HIV – in reducing health inequities among people with HIV over a 10-year horizon. Design: We use an agent-based microsimulation model to incorporate the complexity of the program and long-time horizon. Methods: We use a composite measure (the Theil index) to evaluate the health equity implications of the RWHAP for each of four subgroups (based on race and ethnicity, age, gender, and HIV transmission category) and two outcomes (probability of being in care and treatment and probability of being virally suppressed). We compare results with the RWHAP fully funded versus a counterfactual scenario, in which the medical and support services funded by the RWHAP are not available. Results: The model indicates the RWHAP will improve health equity across all demographic subgroups and outcomes over a 10-year horizon. In Year 10, the Theil index for race and ethnicity is 99% lower for both outcomes under the RWHAP compared to the non-RWHAP scenario; 71–93% lower across HIV transmission categories; 31–44% lower for age; and 73–75% lower for gender. Conclusion: Given the large number of people served by the RWHAP and our findings on its impact on equity, the RWHAP represents an important vehicle for achieving the health equity goals of the National HIV/AIDS Strategy (2022–2025) and the Ending the HIV Epidemic Initiative goal of reducing new infections by 90% by 2030.