ADAP Shortfall Relief - Virginia, a medium-sized southeastern state, consists of 95 counties and 38 independent cities and ranked twelfth in population size. Its population estimate in 2023 of 8,715,698 accounted for 2.6% of the nation’s total population of over 334 million. In the Commonwealth of Virginia, the Virginia Department of Health (VDH) oversees the public health services of the Commonwealth and resources 39 health districts and 119 local health departments. The Office of Epidemiology houses the Division of Disease Prevention, which oversees the HIV Care Services unit that administers the Ryan White HIV/AIDS Program Part B (RWHAP B). The RWHAP B receives an annual formula award of approximately $8M, including the Emerging Communities funds the VDH allocates to 36 unique service providers and vendors to provide the allowable RWHAP services throughout the five health regions of the state. Virginia also receives almost $18M annually earmarked for the RWHAP B AIDS Drugs Assistance Program, ADAP, to provide medication access for the treatment of HIV and related illnesses for eligible clients. Funded services include 21 allowable core medical and support services, including medication access services through ADAP. Virginia’s system delivery system focuses on improving earlier linkage to care, retention in care, and viral suppression for low-income HIV-positive clients. The Virginia RWHAP B currently provides nearly 8,900 people with HIV (PWH) with core medical and support services for their HIV care and treatment during the grant year 2024. This is a 31% increase in the number of clients served since grant year 2021. As such, the need for services has increased, despite the expansion of Medicaid in Virginia. In grant year 2023, Virginia expended $57M in contracts to meet the needs of the 8,444 PWH with the majority going to ADAP services for 4,175 PWH. Clients must demonstrate and maintain their eligibility for services. The network of providers includes medical providers, community-based organizations (CBOs), AIDS services organizations, university and hospital health systems, free clinics, and federally qualified health centers (FQHCs). Further, Virginia maintains robust collaborations with other RWHAP cross-parts for services planning and allocations including the RWHAP Part A planning bodies in the District of Columbia Emerging Metropolitan Area and Norfolk Transitional Grant Area. Demographic data show continued need for ongoing and increasing efforts in HIV care and treatment overall. People over the age of 45 make up 42.1% of all PWH and 33% of all late diagnoses. In 2023, there were 27,712 PWH in Virginia, representing 0.3% of the state’s population and approximately 2.6% of the nation’s total number of HIV disease cases. PWH remain relatively consistent with previous trends with 75% being male (20,886), and the age distribution rates were highest among the 45-54 age group at 508.0 per 100,000, followed by the age group 55+ at 467.0 per 100,000 persons. By race, Blacks comprise 20% of Virginia’s population but represent 56.6% of PWH (n=10,838). This is a decrease of 1.4% since 2020. Seventy-two percent of PWH are currently 40 years of age or older (n=19,960) and 41.5% are 55 years of age or older (n=11,504). Virginia utilizes Ryan White-related resources generated from its ADAP (i.e. pharmaceutical rebates) to fund additional RWHAP B core medical and support services. The landscape for generating pharmaceutical rebates is changing and impacting the ability to maintain the program’s responsiveness to PWH’s needs, those needs impacted by social determinants. The goal of the supplemental funds is to maintain the comprehensive system of HIV care and treatment in Virginia made available through the RWHAP Part B program. The supplemental funding will support Virginia’s PWH for improved health outcomes along the HIV Care Continuum and support other goals toward Virginia becoming the healthiest state in the nation.
