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Chow JY, Nijhawan AE, Mathews WC, Raifman J, Fleming J, Gebo KA, Moore RD, Berry SA. Brief Report: Hospitalization Rates Among Persons With HIV Who Gained Medicaid or Private Insurance After the Affordable Care Act in 2014. J Acquir Immune Defic Syndr 2021; 87:776-780. [PMID: 33587511 PMCID: PMC8131212 DOI: 10.1097/qai.0000000000002645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is unknown whether gaining inpatient health care coverage had an effect on hospitalization rates among persons with HIV (PWH) after implementation of the Affordable Care Act in 2014. METHODS Hospitalization data from 2015 were obtained for 1634 adults receiving longitudinal HIV care at 3 US HIV clinics within the HIV Research Network. All patients were engaged in care and previously uninsured and supported by the Ryan White HIV/AIDS Program in 2013. We evaluated whether PWH who transitioned to either Medicaid or private insurance in 2014 tended to have a change in hospitalization rate compared with PWH who remained uncovered and Ryan White HIV/AIDS Program supported. Analyses were performed by negative binomial regression with robust standard errors, adjusting for gender, race/ethnicity, age, HIV risk factor, CD4 count, viral load, clinic site, and 2013 hospitalization rate. RESULTS Among PWH without inpatient health care coverage in 2013, transitioning to Medicaid [adjusted incidence rate ratio 1.26, (0.71, 2.23)] or to private insurance [0.48 (0.18, 1.28)] in 2014 was not associated with 2015 hospitalization rates, after accounting for demographics, HIV characteristics, and prior hospitalization rates. The factors significantly associated with higher hospitalization rates include age 55-64, CD4 <200 cells/µL, viral load >400 copies/mL, and 2013 hospitalization rate. CONCLUSIONS Acquiring inpatient coverage was not associated with a change in hospitalization rates. These results provide some evidence to allay the concern that acquiring inpatient coverage would lead to increased inpatient utilization.
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Affiliation(s)
- Jeremy Y Chow
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ank E Nijhawan
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - W Christopher Mathews
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego, San Diego, CA
| | - Julia Raifman
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | | | - Kelly A Gebo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; and
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; and
| | - Stephen A Berry
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Siegler AJ, Mehta CC, Mouhanna F, Giler RM, Castel A, Pembleton E, Jaggi C, Jones J, Kramer MR, McGuinness P, McCallister S, Sullivan PS. Policy- and county-level associations with HIV pre-exposure prophylaxis use, the United States, 2018. Ann Epidemiol 2020; 45:24-31.e3. [PMID: 32336655 DOI: 10.1016/j.annepidem.2020.03.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/18/2020] [Accepted: 03/27/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE HIV pre-exposure prophylaxis (PrEP) is highly efficacious, and yet most individuals indicated for it are not currently using it. To provide guidance for health policymakers, researchers, and community advocates, we developed county-level PrEP use estimates and assessed locality and policy associations. METHODS Using data from a national aggregator, we applied a validated crosswalk procedure to generate county-level estimates of PrEP users in 2018. A multilevel Poisson regression explored associations between PrEP use and (1) state policy variables of Medicaid expansion and state Drug Assistance Programs (PrEP-DAPs) and (2) county-level characteristics from the U.S. Census Bureau. Outcomes were PrEP per population (prevalence) and PrEP-to-need ratio (PnR), defined as the ratio of PrEP users per new HIV diagnosis. Higher levels of PrEP prevalence or PnR indicate more PrEP users relative to the total population or estimated need, respectively. RESULTS Our 2018 county-level data set included a total of 188,546 PrEP users in the United States. Nationally, PrEP prevalence was 70.3/100,000 population and PnR was 4.9. In an adjusted model, counties with a 5% higher proportion of black residents had 5% lower PnR (rate ratio (RR): 0.95, 95% confidence interval (CI): 0.93, 0.96). Similarly, counties with higher concentration of residents uninsured or living in poverty had lower PnR. Relative to states without Medicaid expansion or PrEP-DAPs, states with only one of those programs had 25% higher PrEP prevalence (RR: 1.25, 95% CI: 1.09, 1.45), and states with both programs had 99% higher PrEP prevalence (RR: 1.99, 95% CI: 1.60, 2.48). There was a significant linear trend across the three policy groups, and similar findings for the relation between PnR and the policy groups. CONCLUSIONS In a data set comprising approximately 80% of PrEP users in the United States, we found that Medicaid expansion and PrEP-DAPs were associated with higher PrEP use in states that adopted those policies, after controlling for potential confounders. Future research should identify which components of PrEP support programs have the most success and how to best promote PrEP among groups most impacted by the epidemic. States should support the admirable health decisions of their residents to get on PrEP by implementing policies that facilitate access.
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Affiliation(s)
- Aaron J Siegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA.
| | - C Christina Mehta
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Farah Mouhanna
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA; Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | | | - Amanda Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Elizabeth Pembleton
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Chandni Jaggi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Jeb Jones
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Pema McGuinness
- Department of Epidemiology, Gilead Sciences, Foster City, CA, 94404
| | | | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Geter A, Sutton MY, Armon C, Durham MD, Palella FJ, Tedaldi E, Hart R, Buchacz K. Trends of racial and ethnic disparities in virologic suppression among women in the HIV Outpatient Study, USA, 2010-2015. PLoS One 2018; 13:e0189973. [PMID: 29293632 PMCID: PMC5749722 DOI: 10.1371/journal.pone.0189973] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/05/2017] [Indexed: 12/02/2022] Open
Abstract
In the United States, women accounted for 19% of new HIV diagnoses in 2015 and were less likely to reach virologic suppression when compared to men. We assessed trends and disparities in virologic suppression among HIV-positive women to inform HIV treatment strategies. Data were from a prospective cohort of the HIV Outpatient Study and collected at nine United States HIV clinics. We included women aged ≥18 years, with ≥1 visit, who were prescribed antiretroviral therapy, and had ≥1 viral load test performed between 2010 and 2015. We defined virologic suppression as viral load <50 copies/mL and calculated adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) for virologic suppression by race/ethnicity and year of measure. Generalized estimating equations were used for multivariable analyses to assess factors associated with virologic suppression. Among 809 women (median age = 44 years), 482 (60%) were black, 177 (22%) white, 150 (19%) Hispanic/Latina. Virologic suppression was less prevalent among black women (73%) compared with Hispanic/Latina women (83%) and white women (91%). In multivariable analyses, not achieving virologic suppression was more likely among black women (aPR = 2.13; CI = 1.50–3.02) or Hispanic/Latina women (aPR = 1.66; CI = 1.08–2.56) compared with white women, and among women who attended public clinics (aPR = 1.42; CI = 1.07–1.87) compared with those who attended a private clinic. Between 2010 and 2015, virologic suppression among HIV-positive women increased from 68% to 83%, but racial/ethnic disparities persisted. Black and Hispanic/Latina women had significantly lower rates of virologic suppression than white women. Interventions targeting virologic suppression improvement among HIV-positive women of color, especially those who attend public clinics, are warranted.
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Affiliation(s)
- Angelica Geter
- Epidemiology Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Madeline Y. Sutton
- Epidemiology Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Carl Armon
- Cerner Corporation, Kansas City, MO, United States of America
| | - Marcus D. Durham
- Epidemiology Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Frank J. Palella
- Infectious Diseases Division, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Ellen Tedaldi
- Department of Internal Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America
| | - Rachel Hart
- Cerner Corporation, Kansas City, MO, United States of America
| | - Kate Buchacz
- Epidemiology Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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Risher KA, Kapoor S, Daramola AM, Paz-Bailey G, Skarbinski J, Doyle K, Shearer K, Dowdy D, Rosenberg E, Sullivan P, Shah M. Challenges in the Evaluation of Interventions to Improve Engagement Along the HIV Care Continuum in the United States: A Systematic Review. AIDS Behav 2017; 21:2101-2123. [PMID: 28120257 PMCID: PMC5843766 DOI: 10.1007/s10461-017-1687-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In the United States (US), there are high levels of disengagement along the HIV care continuum. We sought to characterize the heterogeneity in research studies and interventions to improve care engagement among people living with diagnosed HIV infection. We performed a systematic literature search for interventions to improve HIV linkage to care, retention in care, reengagement in care and adherence to antiretroviral therapy (ART) in the US published from 2007-mid 2015. Study designs and outcomes were allowed to vary in included studies. We grouped interventions into categories, target populations, and whether results were significantly improved. We identified 152 studies, 7 (5%) linkage studies, 33 (22%) retention studies, 4 (3%) reengagement studies, and 117 (77%) adherence studies. 'Linkage' studies utilized 11 different outcome definitions, while 'retention' studies utilized 39, with very little consistency in effect measurements. The majority (59%) of studies reported significantly improved outcomes, but this proportion and corresponding effect sizes varied substantially across study categories. This review highlights a paucity of assessments of linkage and reengagement interventions; limited generalizability of results; and substantial heterogeneity in intervention types, outcome definitions, and effect measures. In order to make strides against the HIV epidemic in the US, care continuum research must be improved and benchmarked against an integrated, comprehensive framework.
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Affiliation(s)
- Kathryn A Risher
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615N. Wolfe St, W6604, Baltimore, MD, 20205, USA.
| | - Sunaina Kapoor
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alice Moji Daramola
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jacek Skarbinski
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kate Doyle
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kate Shearer
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615N. Wolfe St, W6604, Baltimore, MD, 20205, USA
| | - David Dowdy
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615N. Wolfe St, W6604, Baltimore, MD, 20205, USA
| | - Eli Rosenberg
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Patrick Sullivan
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Maunank Shah
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Impact of Health Insurance, ADAP, and Income on HIV Viral Suppression Among US Women in the Women's Interagency HIV Study, 2006-2009. J Acquir Immune Defic Syndr 2017; 73:307-312. [PMID: 27763995 DOI: 10.1097/qai.0000000000001078] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Implementation of the Affordable Care Act motivates assessment of health insurance and supplementary programs, such as the AIDS Drug Assistance Program (ADAP) on health outcomes of HIV-infected people in the United States. We assessed the effects of health insurance, ADAP, and income on HIV viral load suppression. METHODS We used existing cohort data from the HIV-infected participants of the Women's Interagency HIV Study. Cox proportional hazards models were used to estimate the time from 2006 to unsuppressed HIV viral load (>200 copies/mL) among those with Medicaid, private, Medicare, or other public insurance, and no insurance, stratified by the use of ADAP. RESULTS In 2006, 65% of women had Medicaid, 18% had private insurance, 3% had Medicare or other public insurance, and 14% reported no health insurance. ADAP coverage was reported by 284 women (20%); 56% of uninsured participants reported ADAP coverage. After accounting for study site, age, race, lowest observed CD4, and previous health insurance, the hazard ratio (HR) for unsuppressed viral load among those privately insured without ADAP, compared with those on Medicaid without ADAP (referent group), was 0.61 (95% CI: 0.48 to 0.77). Among the uninsured, those with ADAP had a lower relative hazard of unsuppressed viral load compared with the referent group (HR, 95% CI: 0.49, 0.28 to 0.85) than those without ADAP (HR, 95% CI: 1.00, 0.63 to 1.57). CONCLUSIONS Although women with private insurance are most likely to be virally suppressed, ADAP also contributes to viral load suppression. Continued support of this program may be especially critical for states that have not expanded Medicaid.
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Doblecki-Lewis S, Jones D. Community Federally Qualified Health Centers as Homes for HIV Preexposure Prophylaxis: Perspectives from South Florida. J Int Assoc Provid AIDS Care 2016; 15:522-528. [PMID: 27502831 DOI: 10.1177/2325957416661422] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Preexposure prophylaxis (PrEP) for HIV has the potential to reduce HIV incidence in highly affected areas. The Southeastern United States is disproportionately impacted by HIV, and 3 counties in South Florida have the highest incidence of new HIV infections in the United States. This study explored the feasibility, acceptability, and uptake of PrEP in South Florida. Focus groups consisting of providers, administrators, and case managers at HIV-servicing community health centers and federally qualified health centers in South Florida reported broad support but low implementation of PrEP. Generally, participants indicated that the centers were appropriate locations for implementation. However, practical concerns and perceived limitations due to financial, insurance, and immigration status of those who would potentially benefit from the intervention were widely reported. Addressing provider concerns appears necessary for successful expansion of PrEP implementation in highly impacted areas such as South Florida.
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Affiliation(s)
- Susanne Doblecki-Lewis
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deborah Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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7
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Rebeiro PF, Gange SJ, Horberg MA, Abraham AG, Napravnik S, Samji H, Yehia BR, Althoff KN, Moore RD, Kitahata MM, Sterling TR, Curriero FC. Geographic Variations in Retention in Care among HIV-Infected Adults in the United States. PLoS One 2016; 11:e0146119. [PMID: 26752637 PMCID: PMC4708981 DOI: 10.1371/journal.pone.0146119] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 12/14/2015] [Indexed: 11/18/2022] Open
Abstract
Objective To understand geographic variations in clinical retention, a central component of the HIV care continuum and key to improving individual- and population-level HIV outcomes. Design We evaluated retention by US region in a retrospective observational study. Methods Adults receiving care from 2000–2010 in 12 clinical cohorts of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) contributed data. Individuals were assigned to Centers for Disease Control and Prevention (CDC)-defined regions by residential data (10 cohorts) and clinic location as proxy (2 cohorts). Retention was ≥2 primary HIV outpatient visits within a calendar year, >90 days apart. Trends and regional differences were analyzed using modified Poisson regression with clustering, adjusting for time in care, age, sex, race/ethnicity, and HIV risk, and stratified by baseline CD4+ count. Results Among 78,993 adults with 444,212 person-years of follow-up, median time in care was 7 years (Interquartile Range: 4–9). Retention increased from 2000 to 2010: from 73% (5,000/6,875) to 85% (7,189/8,462) in the Northeast, 75% (1,778/2,356) to 87% (1,630/1,880) in the Midwest, 68% (8,451/12,417) to 80% (9,892/12,304) in the South, and 68% (5,147/7,520) to 72% (6,401/8,895) in the West. In adjusted analyses, retention improved over time in all regions (p<0.01, trend), although the average percent retained lagged in the West and South vs. the Northeast (p<0.01). Conclusions In our population, retention improved, though regional differences persisted even after adjusting for demographic and HIV risk factors. These data demonstrate regional differences in the US which may affect patient care, despite national care recommendations.
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Affiliation(s)
- Peter F. Rebeiro
- Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- * E-mail:
| | - Stephen J. Gange
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Michael A. Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, United States of America
| | - Alison G. Abraham
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sonia Napravnik
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Hasina Samji
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Baligh R. Yehia
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Keri N. Althoff
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Richard D. Moore
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Mari M. Kitahata
- University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Timothy R. Sterling
- Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Frank C. Curriero
- Johns Hopkins University, Baltimore, Maryland, United States of America
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Snider JT, Goldman DP, Rosenblatt L, Seekins D, Juday T, Sanchez Y, Wu Y, Peneva D, Romley JA. The Impact of State AIDS Drug Assistance Policies on Clinical and Economic Outcomes of People With HIV. Med Care Res Rev 2015; 73:329-48. [PMID: 26537525 DOI: 10.1177/1077558715614479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 08/13/2015] [Indexed: 11/16/2022]
Abstract
We investigated the effect of changes to state AIDS Drug Assistance Programs (ADAP) policies, which govern access to antiretroviral therapy (ART), on clinical and economic outcomes among low-income people living with HIV/AIDS. Retrospective analyses of ART access were conducted on state ADAP policies, using data from ADAP Monitoring Reports and Kaiser Family Foundation from 2006 to 2010. We found stricter eligibility requirements reduce the number of HIV-positive individuals with ART access through ADAP, and decreased ART use increases mortality by 2.67 quality-adjusted life years (QALYs) per beneficiary. If the ADAP income eligibility cutoff were decreased by 50 percentage points in each state, 4,626 individuals would lose ART access nationwide. Based on a $22,143 cost/QALY, this policy would save $274 million in health care expenditures (2012 dollars), but result in 12,352 QALYs lost, valued at $1.2 billion. Therefore, states should exercise caution in restricting programs that increase ART access for low-income people living with HIV/AIDS.
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Affiliation(s)
| | | | | | | | | | | | - Yanyu Wu
- Precision Health Economics, Los Angeles, CA, USA
| | - Desi Peneva
- Precision Health Economics, Los Angeles, CA, USA
| | - John A Romley
- University of Southern California, Los Angeles, CA, USA
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Horberg MA, Hurley LB, Klein DB, Towner WJ, Kadlecik P, Antoniskis D, Mogyoros M, Brachman PS, Remmers CL, Gambatese RC, Blank J, Ellis CG, Silverberg MJ. The HIV Care Cascade Measured Over Time and by Age, Sex, and Race in a Large National Integrated Care System. AIDS Patient Care STDS 2015; 29:582-90. [PMID: 26505968 DOI: 10.1089/apc.2015.0139] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
HIV care cascades can evaluate programmatic success over time. However, methodologies for estimating cascade stages vary, and few have evaluated differences by demographic subgroups. We examined cascade performance over time and by age, sex, and race/ethnicity in Kaiser Permanente, providing HIV care in eight US states and Washington, DC. We created cascades for HIV+ members' age ≥13 for 2010-2012. We measured "linkage" (a visit/CD4 within 90 days of being diagnosed for new patients; ≥1 medical visit/year if established); "retention" (≥2 medical visits ≥60 days apart); filled ART (filled ≥3 months of combination ART); and viral suppression (HIV RNA <200 copies/mL last measured in year). The cascades were stratified by calendar year, sex, age, and race/ethnicity. We found men had statistically (p < 0.05) higher percent linkage, filled ART, and viral suppression for 2010 and 2011 but not for 2012. Women had significantly greater retention for all years. Annually, older age was associated (p < 0.05) with retention, filled ART, and viral suppression but not linkage. Latinos had greater (p < 0.05) retention than whites or blacks in all years, with similar retention comparing blacks and whites. Filled ART and viral suppression was increased (p < 0.05) for whites compared with all racial/ethnic groups in all years. Cascade methodology requiring success at upstream stages before measuring success at later stages (i.e., "dependent" methodology) underreported performance by up to 20% compared with evaluating each stage separately ("independent"). Thus, care results improved over time, but significant differences exist by patient demographics. Specifically, retention efforts should be targeted toward younger patients and blacks; women, blacks, and Latinos require greater ART prescribing.
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Affiliation(s)
- Michael Alan Horberg
- 1 Division of Infectious Diseases, Kaiser Permanente Mid-Atlantic States , Washington, District of Columbia
- 2 Kaiser Permanente, Mid-Atlantic Permanente Research Institute , Rockville, Maryland
- 3 Kaiser Permanente HIV Initiative , Oakland, California
| | - Leo Bartemeier Hurley
- 3 Kaiser Permanente HIV Initiative , Oakland, California
- 4 Division of Research , Kaiser Permanente Northern California, Oakland, California
| | - Daniel Benjamin Klein
- 3 Kaiser Permanente HIV Initiative , Oakland, California
- 5 Division of Infectious Diseases , Kaiser Permanente Northern California, Hayward, California
| | - William James Towner
- 3 Kaiser Permanente HIV Initiative , Oakland, California
- 6 Kaiser Permanente Southern California, Los Angeles Medical Center , Los Angeles, California
| | - Peter Kadlecik
- 1 Division of Infectious Diseases, Kaiser Permanente Mid-Atlantic States , Washington, District of Columbia
- 3 Kaiser Permanente HIV Initiative , Oakland, California
| | - Diana Antoniskis
- 3 Kaiser Permanente HIV Initiative , Oakland, California
- 7 Immunodeficiency Clinic , Kaiser Permanente Northwest, Portland, Oregon
| | - Miguel Mogyoros
- 3 Kaiser Permanente HIV Initiative , Oakland, California
- 8 Division of Infectious Diseases, Kaiser Permanente Colorado , Denver, Colorado
| | - Philip Sigmund Brachman
- 3 Kaiser Permanente HIV Initiative , Oakland, California
- 9 Division of Infectious Diseases, Kaiser Permanente Georgia , Atlanta, Georgia
| | | | | | - Jackie Blank
- 2 Kaiser Permanente, Mid-Atlantic Permanente Research Institute , Rockville, Maryland
- 3 Kaiser Permanente HIV Initiative , Oakland, California
| | - Courtney Georgiana Ellis
- 3 Kaiser Permanente HIV Initiative , Oakland, California
- 4 Division of Research , Kaiser Permanente Northern California, Oakland, California
| | - Michael Jonah Silverberg
- 3 Kaiser Permanente HIV Initiative , Oakland, California
- 4 Division of Research , Kaiser Permanente Northern California, Oakland, California
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