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The Role of Government-Funded Assistance Programs on HIV Testing among Poor Adults in the US

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Findings from the National Health Interview Survey 2016-2018

Veröffentlicht in: Gesundheit & Medizin
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The Role of Government-Funded Assistance Programs on HIV Testing among Poor Adults in the US

  1. 1. November 5, 2019 2019 APHA - Philadelphia, PA Session 4037.0: Politics of HIV Prevention and Care The Role of Government-Funded Assistance Programs on HIV Testing among Poor Adults in the US: Findings from the National Health Interview Survey 2016-2018 Emeka Oraka; Iddrisu Abdallah; Tamara Carree; Peter Dakutis; Fengjue Shu; Nixon Arauz 1ICF *No conflicts of interest to disclose
  2. 2. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. HIV in Economically Challenged Communities More than 1.1 million Americans are currently living with HIV and even more at risk  Nearly 40% of PLWH do not know they have HIV or know but are not in care account for 80% of new diagnoses Within communities hardest hit by HIV infection, impoverished neighborhoods are more affected than affluent areas  3rd leading cause of death among Black men and women between ages 35 and 44  4th leading cause of death among Latinos of the same age group  Nearly half of all people living with HIV residing in ten metropolitan areas 2 The Role of Government-Funded Assistance Programs and HIV Testing Among Poor US Adults
  3. 3. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Health Disparities Framework for HIV Infection Social- Economic Status (SES) Education Occupation Income Social Capital Psychological Influences Negative Expectations Lack of Resilience Perceived Discrimination Adverse Health Behaviors HIV Health Outcomes Mortality Disease Trajectory Comorbidities 10/29/2019 The Role of Government-Funded Assistance Programs and HIV Testing Among Poor US Adults 3
  4. 4. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Ending the HIV Epidemic: A Plan for America (EHE) National plan for reducing the number of new HIV infections by 90% by 2030 Calls for increasing investments in programs that serve economically disadvantaged persons at risk of getting HIV HIV screening is the most important step to accomplishing the EHE goals Despite higher testing rates, socioeconomically disadvantaged are among the hardest-to-reach populations in need of HIV treatment and care 4 The Role of Government-Funded Assistance Programs and HIV Testing Among Poor US Adults
  5. 5. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. US Government-Funded Assistance Programs Government-funded/Public assistance programs may play an important role in HIV prevention In 2016, 52% of people ages 18 or older in the US resided in households in which one or more persons received benefits Most common assistance programs include:  Medicaid  Supplemental Nutrition Assistance Program (SNAP)  Human Services (housing assistance, job training/placement, childcare, transportation)  Temporary Assistance for Needy Families (TANF) 5 The Role of Government-Funded Assistance Programs and HIV Testing Among Poor US Adults
  6. 6. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Public Assistance Beneficiaries Overlap between population of public assistance beneficiaries and population at-risk for HIV infection Population of beneficiaries is mostly comprised of:  Children under age 18  Minority groups (mainly African American and Hispanic)  Female heads of household  Non-high school graduates  The unemployed 6 The Role of Government-Funded Assistance Programs and HIV Testing Among Poor US Adults
  7. 7. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Study Objectives and Rationale Study Objectives: –Government-funded assistance programs provide services to low-income communities and may play an important role in preventing the spread of HIV –Our objective was to assess the impact of government funded assistance programs on HIV testing among poor adults in the US Rationale: –Study findings can support future HIV prevention efforts that support the goals of the EHE 7 The Role of Government-Funded Assistance Programs and HIV Testing Among Poor US Adults
  8. 8. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. National Health Interview Survey (NHIS) One of the major data collection programs of the National Center for Health Statistics (NCHS) Used to monitor trends in illness and track progress toward achieving national health objectives Data collected annually from a nationally representative sample of US residents 8 The Role of Government-Funded Assistance Programs and HIV Testing Among Poor US Adults
  9. 9. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Analysis Methods – Study Sample Respondents [N = 61,654 (72.4%) out of 85,187 respondents] Adults (18-64) living in households in the United States Non-institutionalized Sub-analysis restricted to adults living in poverty according to standards set by Census Bureau –Poor (< 100% US Federal Poverty Threshold [FPL]) –Near Poor (100% - 250% FPL) –Not Poor (> 250% FPL) Average response rate from 2016–2018: 54% 9 The Role of Government-Funded Assistance Programs and HIV Testing Among Poor US Adults
  10. 10. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Analysis Methods – Classifying Public Assistance Enrollment Survey Participants provided yes/no responses when asked if they were a beneficiary of any of the following publicly- provided programs:  Medicaid  Human Services (e.g. job-placement/training, transportation, or childcare)  Temporary Assistance for Needy Families (TANF) Respondents who answered “Yes” were coded as being a beneficiary of the respective program  A composite variable of “Any Public Assistance” used to classify respondents receiving benefits from 1 or more programs 10 The Role of Government-Funded Assistance Programs and HIV Testing Among Poor US Adults
  11. 11. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Independent Variables 11  Age  18 – 29; 30 – 49; 50 – 64  Race/Ethnicity  Hispanic; Non-Hispanic White; Non-Hispanic Black; Non-Hispanic Other Race  Education Level  < High School; High School Graduate; Some College; College Graduate or More  Sexual Identity  Gay/Bisexual; Straight  Gender  Male; Female  Marital Status  Married; Not Married  Region  Northeast; Midwest; South; West The Role of Government-Funded Assistance Programs and HIV Testing Among Poor US Adults
  12. 12. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Statistical Analysis Outcome variable Ever tested for HIV, not including blood donation (Yes/No) Multivariable logistic regression model design Yielded adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) Assessed associations of receiving government assistance with ever tested for HIV as outcome 12 The Role of Government-Funded Assistance Programs and HIV Testing Among Poor US Adults
  13. 13. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. HIV Testing Prevalence And Associated Factors 47% of US adults 18 years to 64 have ever tested for HIV 13% were living in poverty of those 50% have ever tested Government-Funded Assistance Programs Enrollment –Medicaid: 44%; Human Services (e.g. job-placement/training, transportation, or childcare): 3%; Temporary Assistance for Needy Families (TANF): 4%; Any Assistance: 45% 13 The Role of Government-Funded Assistance Programs and HIV Testing Among Poor US Adults
  14. 14. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. HIV Testing Prevalence by Poverty Level 10/29/2019 14 50% 49% 46% 40 42 44 46 48 50 52 54 Ever Tested for HIV Prevalence(%) Prevalence of US adults aged 18 - 64 ever tested for HIV by poverty level: National Health Interview Survey 2016-2018 Poor (< 100%FPL) Near Poor (100% - 250%FPL) Not Poor (>250% FPL) The Role of Government-Funded Assistance Programs and HIV Testing Among Poor US Adults
  15. 15. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. HIV Testing Prevalence by Selected Government Assistance Program 10/29/2019 15 58% 58% 65% 67% 43% 44% 50% 49% 0 10 20 30 40 50 60 70 80 Any Public Assistance Medicaid Human Services TANF/Welfare Prevalence% Prevalence of ever testing for HIV among various forms of government assistance received by US adults living in poverty; National Health Interview Survey 2016 - 2018 Receives Govt Assistance and Tested for HIV Does not Receive Govt Assistance and Tested for HIV The Role of Government-Funded Assistance Programs and HIV Testing Among Poor US Adults
  16. 16. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Summary of Results Study findings highlight the impact of public assistance programs on HIV prevention efforts Beneficiaries tend to test more than those who are not regardless of program Despite elevated testing rates, program beneficiaries were still not testing at the 90% threshold proposed by the EHE 16 The Role of Government-Funded Assistance Programs and HIV Testing Among Poor US Adults
  17. 17. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Summary of Results (cont.) Differences in HIV testing rates among public assistance programs highlight pathways to improve HIV prevention efforts among historically hard-to-reach populations  African American women  The homeless or those with transient housing  Young African American men who have sex with men Elevated testing among Human Services beneficiaries indicates possible direct and indirect benefits of public assistance programs on enrollees.  Pathways to improved health outcomes warrant further study 17 The Role of Government-Funded Assistance Programs and HIV Testing Among Poor US Adults
  18. 18. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Public Health and Policy Implications Federal funding for public assistance programs is vital in order to achieve the objectives of the EHE Continued research needed to understand how program enrollment results in higher likelihood of testing and how this association can be improved Some factors that may increase testing include perinatal services, Medicaid expansion, and provider incentives 18 The Role of Government-Funded Assistance Programs and HIV Testing Among Poor US Adults
  19. 19. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Limitations 19 Potential recall bias Unable to account for duration of time that respondents received government assistance or behaviors that may increase risk of HIV Unable to determine causal pathway of association due to cross-sectional data The Role of Government-Funded Assistance Programs and HIV Testing Among Poor US Adults
  20. 20. ICF proprietary and confidential. Do not copy, distribute, or disclose.ICF proprietary and confidential. Do not copy, distribute, or disclose. Discussion Public assistance programs may have unintended benefits that impact other dimensions of health Proposed federal budget cuts for safety net programs are counter-productive to current and proposed HIV prevention efforts Public assistance programs should be funded at full capacity and incorporated into future EHE efforts 20 The Role of Government-Funded Assistance Programs and HIV Testing Among Poor US Adults
  21. 21. Questions? Contact Information: Emeka Oraka, MPH Data Analytics Specialist IV Emeka.Oraka@ICF.com Eoraka@cdc.gov

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