The Need for Expanded Oral Health Care in an Effort to Increase Viral Load Suppression Among Ryan White HIV/AIDS Program Part B Clients

In the 2018 fiscal year, Ryan White HIV/AIDS Program (RWHAP) Part B programs spent over $409 million on core medical services, according to the 2019 National RWHAP Part B and ADAP Monitoring Project Annual Report. Oral Health Care is one of 13 core medical services offered and it supports outpatient services such as diagnosis, prevention, and therapy from dental health care professionals. The Annual Report shows that Oral Health Care was the third most expanded core medical service between 2017 and 2018 with 25 jurisdictions having expanded spending or clients served, only behind Medical Case Management (n=31) and Outpatient and Ambulatory Health Services (n=26).

Oral Health Care is particularly valuable to people living with HIV (PLWH). Although antiretroviral treatment has reduced the overall prevalence of oral manifestations of HIV, HIV-related oral conditions still occur in 30 to 80% of people living with HIV. HIV can cause dry mouth, gingivitis, mouth ulcers, and other painful oral symptoms that may lead to malnutrition and difficulty taking medications, including antiretrovirals. Prevention and management of these issues is possible through Oral Health Care. RWHAP Part B programs should consider how best to fund or expand access to Oral Health Care services to their clients.

The Arizona RWHAP Part A and Part B program has recently demonstrated how Oral Health Care can be successfully bolstered in a jurisdiction, as described in the case study included in the 2019 Annual Report. Due to expansions in insurance access following the implementation of the Affordable Care Act (ACA), Arizona has seen significant increases in insured low-income PLWH since 2014. This has allowed a decrease in the amount of money spent on core medical costs by the RWHAP Part B program. With this change in expenditures, Arizona has had the ability to move more funding to Oral Health Care in coordination with their RWHAP Part A program. This has shown incredibly promising results: 92% of Oral Health Care clients are virally suppressed compared to the 79% of all Arizona clients that are virally suppressed.

RWHAP Part B programs should continue to identify strategies to increase access to Oral Health Care services directly and/or through the provision of dental insurance coverage as part of ADAP-funded insurance and/or the RWHAP Part B category, Health Insurance Premium and Cost Sharing Assistance for Low-Income Individuals. Oral Health Care can contribute to efforts to achieve viral load suppression among RWHAP Part B program and ADAP clients. By expanding access to Oral Health Care, RWHAP Part B programs and ADAPs will meaningfully contribute to efforts to achieve an end to the HIV epidemic in their jurisdictions