Impact of the Affordable Care Act on the HIV Care Continuum

Impact of the Affordable Care Act on the HIV Care Continuum by Ebere N. Erugo MPH, Kaplan University, 2013 BSN, Mountain State University, 2010 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health—Epidemiology Walden University December 2017 Abstract People living with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS; PLWHA) are at increased risk of insufficient medical care due to lack of insurance. Inadequate medical care for PLWHA contributes to increases in HIV transmission rates. The U.S. Surveillance Report noted that in 2015, over 1.2 million people were living with HIV infection, and there were approximately 50,000 new infections every year. The report further stated that about 675,000 people have died from HIV-related illnesses since its discovery in 1981. The implementation of the Affordable Care Act (ACA) in 2014 was intended to provide Americans, including people at risk of or living with HIV, options for health insurance coverage and better access to health care. It was also designed to allow people with existing health conditions such as HIV to reach for optimal health, irrespective of the severity of their condition. Andersen’s behavioral model and economic theory provided the theoretical framework and conceptual foundation for this study’s assessment of the impact of the ACA on the HIV care continuum. This quantitative study used secondary data with a retrospective correlational design. Data from the Health Resources Service Administration and the Behavioral Risk Factor Surveillance System were analyzed. Overall, chi-square tests indicated a steady increase in the number of PLWHA who achieved viral suppression (χ2 (1) = 105, p < . 001) between 2010 and 2015. Future research should include the general American population to assess the impact of the ACA. This study could lead to positive social change as PLWHA are made more aware of the benefits of comprehensive health care coverage and increase healthcare utilization, leading to improved health for those infected and less transmission of the virus.People living with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS; PLWHA) are at increased risk of insufficient medical care due to lack of insurance. Inadequate medical care for PLWHA contributes to increases in HIV transmission rates. The U.S. Surveillance Report noted that in 2015, over 1.2 million people were living with HIV infection, and there were approximately 50,000 new infections every year. The report further stated that about 675,000 people have died from HIV-related illnesses since its discovery in 1981. The implementation of the Affordable Care Act (ACA) in 2014 was intended to provide Americans, including people at risk of or living with HIV, options for health insurance coverage and better access to health care. It was also designed to allow people with existing health conditions such as HIV to reach for optimal health, irrespective of the severity of their condition. Andersen’s behavioral model and economic theory provided the theoretical framework and conceptual foundation for this study’s assessment of the impact of the ACA on the HIV care continuum. This quantitative study used secondary data with a retrospective correlational design. Data from the Health Resources Service Administration and the Behavioral Risk Factor Surveillance System were analyzed. Overall, chi-square tests indicated a steady increase in the number of PLWHA who achieved viral suppression (χ2 (1) = 105, p < . 001) between 2010 and 2015. Future research should include the general American population to assess the impact of the ACA. This study could lead to positive social change as PLWHA are made more aware of the benefits of comprehensive health care coverage and increase healthcare utilization, leading to improved health for those infected and less transmission of the virus. Impact of the Affordable Care Act on the HIV Care Continuum by Ebere N. Erugo MPH, Kaplan University, 2013 BSN, Mountain State University, 2010 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health—Epidemiology Walden University December 2017 Dedication This study is lovingly dedicated to my children, Unique, Jewel, Destiny, and Joshua Erugo. You are my loudest cheerleaders. You continued to cheer me on and propelled me to keep moving even when I thought I had reached my limit. You are truly my inspiration, and you showed your faith in me when you expressed that when you grow up, you would like to be just “like Mommy because she is getting her doctorate degree even with all the challenges she is facing. ” I thank you for believing in me; I thank you for constantly praying for me; I thank you for allowing me have some time to myself to complete my school work each time I requested it. I thank you for your support and unconditional love, and most of all, I thank you for sharing your world with me. I love you all more than words can ever express, and I believe in all of you to reach every goal you set for yourselves. Acknowledgments First and foremost, I would like to acknowledge and give thanks and glory to Almighty God, who has made it possible for me to go through this journey successfully. Without Him, I can do nothing, but my strength is anchored in the knowledge that “I can do all things through Christ which strengthens me. ” I would like to thank my committee chair, Dr. Ernest Ekong; committee member, Dr. Peter Anderson; and URR representative, Dr. Lori L. Dewald, for agreeing to work with me and working tirelessly to make sure that I completed this dissertation. I especially want to express my deep appreciation to Dr. Peter Anderson for taking so much time to correct my papers over and over without showing his frustration. To my sisters and backbones, Ezioma and Ngozi; I say thank you for providing the shoulders to lay my weary head on when I could not hold it up any longer. Thank you for all the support and encouragement you have continually provided to me—you rock! To my sister’s husband, Ike Onwukanjo, thank you so much for being there for my children and me during the hardest season of our lives. You are more than a brother-inlaw. To my mother, my sister, Ijeoma, my brothers—Barrister Azubuike Okorie, the late Anozie Okorie, and Chinedu Okorie and their families—I couldn’t ask for a better family. To my church family at Calvary Gospel Church in Waldorf, MD, thank you for providing spiritual covering for me. To my friends, Jewel Klass-Kendall, Dr. Ellis Opusunju, Malaika Oliver, Lisa Adams, Uche Onyeka, Lydie Bianda, and Lesley Morgan, thank you for providing me with support and encouragement. Last but not least, thank you Dr. Elisabeth Johnson-Kallos for accepting to serve as my external editor.