Impact of a Ryan White Clinic on Statewide New HIV Infections

Introduction The Ryan White (RW) program is a cohort of services for underinsured, uninsured, and low-income patients with human immunodeficiency virus (HIV) infection. Although the RW program is known to enhance patient engagement and continuity of care, there are no studies that have investigated the direct impact of a RW clinic on statewide HIV transmission. Methods A retrospective review of 372 patients was undertaken at an HIV clinical site receiving RW funds in West Virginia (WV) in 2009-2019. Demographics, comorbid conditions, and details regarding disease acquisition were noted. In-state transmission was measured as the proportion of patients with newly diagnosed HIV who self-reported HIV acquisition within WV. With high rates of viral suppression and patient retention in our clinic, our hypothesis was that this proportion should decrease over time. Results Despite maintaining a greater than 90% retention of care and viral suppression rate over the study period, our data did not show a significant decline in the ratio of patients newly infected with HIV within WV over time (54.2% at the beginning of the study period vs 58.6% at the end, p-value 0.199). Conclusion Our results show that maintenance of high retention of care and viral suppression rates in one RW clinical site did not significantly reduce in-state transmission of HIV. Additional studies are needed to determine if maintaining high engagement in clinical services and sustained viral suppression across all HIV providers can reduce spread of in-state HIV infection.