Assessing antiretroviral use during gaps in HIV primary care using multisite medicaid claims and clinical data

Anne K. Monroe, John A. Fleishman, Cindy C. Voss, Jeanne C Keruly, Ank E. Nijhawan, Allison Lorna Agwu, Judith A. Aberg, Richard M. Rutstein, Richard D Moore, Kelly Gebo

Research output: Contribution to journalArticle

Abstract

Background: Some individuals who appear poorly retained by clinic visit-based retention measures are using antiretroviral therapy (ART) and maintaining viral suppression. We examined whether individuals with a gap in HIV primary care (≥180 days between HIV outpatient clinic visits) obtained ART during that gap after 180 days. Setting: HIV Research Network data from 5 sites and Medicaid Analytic Extract eligibility and pharmacy data were combined. Methods: Factors associated with having both an HIV primary care gap and a new (ie, nonrefill) ART prescription during a gap were evaluated with multinomial logistic regression. Results: Of 6892 HIV Research Network patients, 6196 (90%) were linked to Medicaid data, and 4275 had any Medicaid ART prescription. Over half (54%) had occasional gaps in HIV primary care. Women, older people, and those with suppressed viral load were less likely to have a gap. Among those with occasional gaps (n = 2282), 51% received a new ART prescription in a gap. Viral load suppression before gap was associated with receiving a new ART prescription in a gap (odds ratio = 1.91, 95% confidence interval: 1.57 to 2.32), as was number of days in a gap (odds ratio = 1.04, 95% confidence interval: 1.02 to 1.05), and the proportion of months in the gap enrolled in Medicaid. Conclusions: Medicaid-insured individuals commonly receive ART during gaps in HIV primary care, but almost half do not. Retention measures based on visit frequency data that do not incorporate receipt of ART and/or viral suppression may misclassify individuals who remain suppressed on ART as not retained.

LanguageEnglish (US)
Pages82-89
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume76
Issue number1
DOIs
StatePublished - Sep 1 2017

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Medicaid
Primary Health Care
HIV
Prescriptions
Therapeutics
Ambulatory Care
Viral Load
Odds Ratio
Confidence Intervals
Ambulatory Care Facilities
Research
Logistic Models

Keywords

  • antiretroviral therapy
  • HIV
  • Medicaid
  • retention in care

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Assessing antiretroviral use during gaps in HIV primary care using multisite medicaid claims and clinical data. / Monroe, Anne K.; Fleishman, John A.; Voss, Cindy C.; Keruly, Jeanne C; Nijhawan, Ank E.; Agwu, Allison Lorna; Aberg, Judith A.; Rutstein, Richard M.; Moore, Richard D; Gebo, Kelly.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 76, No. 1, 01.09.2017, p. 82-89.

Research output: Contribution to journalArticle

Monroe, Anne K. ; Fleishman, John A. ; Voss, Cindy C. ; Keruly, Jeanne C ; Nijhawan, Ank E. ; Agwu, Allison Lorna ; Aberg, Judith A. ; Rutstein, Richard M. ; Moore, Richard D ; Gebo, Kelly. / Assessing antiretroviral use during gaps in HIV primary care using multisite medicaid claims and clinical data. In: Journal of Acquired Immune Deficiency Syndromes. 2017 ; Vol. 76, No. 1. pp. 82-89.
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