Survey: ACA-Related Knowledge Gaps Exist Among HIV Providers

A national survey demonstrated gaps in medical providers’ knowledge about changes to HIV health care delivery due to the Affordable Care Act.

A recent national survey pointed to surprising gaps in knowledge among medical providers about changes to HIV health care delivery related to the Affordable Care Act (ACA).

The survey, published in Clinical Infectious Diseases, collected health care providers’ views on the effects of the ACA. Although levels of knowledge varied, providers were least likely to know whether their state had expanded Medicaid, with more than 25% unaware of this information.

The anonymous survey asked 4 questions designed to test providers’ knowledge of the ACA. Across a total of 253 HIV care providers in the United States, 61% answered all 4 questions correctly and approximately one-third answered “I don’t know” to at least 1 question.

Based on the findings:

  • 86% knew that the ACA provided subsidies for those with limited incomes to obtain health insurance.
  • 90% knew that the ACA made it illegal for insurance plans to deny patients coverage because of a pre-existing condition.
  • 91% knew that the act did not eliminate the federal Ryan White Program.
  • 74% knew whether their state had opted to expand Medicaid.

Providers in Medicaid expansion states were more likely to answer all 4 questions correctly than providers in non-expansion states, according to the survey.

Additionally, the providers were asked to rate whether the ACA would improve their patients’ HIV outcomes on a scale of 1 to 5, with 5 as “strongly agree.” In Medicaid expansion states, providers were more likely to agree, with a mean response of 3.8. In states that opted not to expand Medicaid, the mean response was 3.4. Providers in all states agreed that the ACA would improve health outcomes in general for patients with HIV.

When asked about their sources of information, providers most commonly cited websites and newspapers, but 32% reported that they had learned ACA information from their patients. However, the providers’ primary source of information was not found to be associated with the likelihood of answering all 4 questions correctly.

According to researcher Kathleen A. McManus, MD, of the University Virginia School of Medicine, obtaining ACA-related information from clinic case managers was associated with correct ACA knowledge. She noted that clinic case managers should be engaged by HIV medical providers to improve knowledge of health system shifts and to enhance systems-based practice.

“Additionally, this work highlights that HIV medical providers may need specific education on systems-based practice, possibly either through the AIDS Education and Training Center Program’s National HIV Curriculum or through a Ryan White HIV/AIDS Program-sponsored training module,” Dr McManus said in a statement.


McManus KA, McManus K, Dillingham R. National survey of United States human immunodeficiency virus medical providers’ knowledge and attitudes about the Affordable Care Act. Clinical Infectious Diseases. 2018. Doi:

Affordable Care Act: Study finds surprising gaps in HIV care providers' knowledge [news release]. University of Virginia Health System. Accessed September 20, 2018.