The provision of medication to reduce the risk of
cardiovascular disease by AIDS Drug Assistance Programs in the US is patchy and
inconsistent, research published in the Journal
of General Internal Medicine shows.
Only four state AIDS Drug Assistance Programs (ADAPs)
provided medication that was consistent with national guidelines for the
treatment of type-2 diabetes, hypertension, hyperlipidaemia and smoking
cessation. Most states provided treatment that was at least partially compliant
with guidelines for at least one of the risk factors, but a quarter of ADAPs
provided no coverage at all.
“Our findings indicate that most ADAPs do not provide
guideline-consistent prescription drug coverage for type-2 diabetes,
hypertension, hyperlipidemia, or smoking cessation,” comment the investigators.
Cardiovascular disease is an increasingly important cause
of serious illness and death in patients with HIV. Routine HIV care should include
screening for cardiovascular risks so that appropriate medication can be
offered to reduce the risk of disease and mortality.
Approximately a third of HIV-positive individuals in the US
rely on their state ADAPs for their antiretroviral therapy. ADAPs are legally
obliged to provide at least one drug in each antiretroviral class, but do not
have to provide access to any additional therapies.
Many ADAPs provide neither treatment for hepatitis C nor
HIV-related opportunistic infections. Investigators therefore wished to see if
ADAP provision of therapies to reduce the risk of cardiovascular disease was
consistent with national guidelines.
Their analysis was conducted in 2010 and included all 50
states as well as Washington DC, Puerto Rico and the US Virgin Islands.
Provision of cardiovascular therapies was categorised as
consistent, partially consistent, or “no coverage” when compared to national
Only four state ADAPs – Massachusetts, New Jersey, New York
and Pennsylvania – provided prescription drug coverage consistent with
guidelines for all four cardiovascular risk factors.
However, 68% of states and territories provided therapy that
was at least partially consistent with guidance for one risk factor. No
coverage was provided by 25% of ADAPs.
Analysis by risk factor showed that 28% of states provided
therapy that was consistent with guidelines for type-2 diabetes, with a fifth
of ADAPs giving access to treatment that was at least partially consistent with
guidance. However, 51% of ADAPs provided no therapy for type-2 diabetes.
A quarter of ADAPs offered treatment for hypertension
according to guidelines. A further 15% provided access to therapy that was at
least partially compliant with guidance, but 60% did not provide risk-reduction
therapy for high blood pressure.
In all 15% of ADAPs had treatment formularies that were
consistent with national guidelines for hyperlipidaemia. The majority (53%)
provided therapy that was partially consistent, but almost a third had no
ADAPs in only four states (8%) provided smoking-cessation
therapy that was consistent with national guidance. Approximately half (47%)
offered treatment that was partially compliant guideline, and 45% provided no
access to this type of treatment.
“In our systematic survey of ADAP formularies, we identified
only four states that provided prescription drug coverage consistent with
clinical practice guidelines for all four modifiable cardiovascular risk
factors,” write the investigators.
They believe that financial pressures and cost cutting could
mean that some ADAPs are restricting their access to non-HIV medications.
However, they note non-HIV drugs account for “less than 10% of the prescription
The researchers conclude that policymakers should address
the “root causes” for the variations in coverage and “provide a comprehensive
ADAP formulary informed by clinical guidelines.”