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Ghaswalla PK, Marshall GS, Bengtson LGS, Buikema AR, Bancroft T, Koep E, Novy P, Hogea CS. Meningococcal Vaccination Rates Among People With a New Diagnosis of HIV Infection in the US. JAMA Netw Open 2022; 5:e228573. [PMID: 35486405 PMCID: PMC9055456 DOI: 10.1001/jamanetworkopen.2022.8573] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE In the United States, individuals with HIV infection have been recommended to receive a 2-dose series of the meningococcal A, C, W, Y (MenACWY) vaccine since 2016 owing to their increased risk of meningococcal disease. OBJECTIVE To examine uptake and time to receipt of the MenACWY vaccine among people with a new diagnosis of HIV. DESIGN, SETTING, AND PARTICIPANTS This cohort study used health insurance data from the US Optum Research Database from January 1, 2016, through March 31, 2018, to retrospectively identify 1208 individuals aged 2 years or older with 1 or more inpatient claim or 2 or more outpatient claims evidencing a new diagnosis of HIV infection and with continuous insurance enrollment for 12 or more months before and 6 or more months after diagnosis. Follow-up was 6 to 33 months. Statistical analysis was conducted from March 7, 2019, to January 5, 2022. EXPOSURE Receipt of the MenACWY vaccine. MAIN OUTCOMES AND MEASURES The coprimary outcomes were uptake and time to receipt of 1 or more doses of the MenACWY vaccine after a new HIV diagnosis. Secondary outcomes included uptake and time to receipt of 2 or more doses of the MenACWY vaccine. Vaccination uptake and receipt were estimated by Kaplan-Meier analysis; factors associated with receipt of 1 or more doses of the MenACWY vaccine were identified with multivariable Cox proportional hazards regression analysis. RESULTS Of 1208 individuals eligible for vaccination (1024 male patients [84.8%]; mean [SD] age, 38.8 [12.5] years; 35 [2.9%] Asian; 273 [22.6%] Black; 204 [16.9%] Hispanic; 442 [36.6%] White), 16.3% were estimated to have received a first dose of the MenACWY vaccine in the 2 years after a new HIV diagnosis. Among individuals who received a first dose, at 1 year or more of enrollment after the first dose, 66.2% were estimated to have received a second dose within 1 year of the first dose. Factors statistically significantly associated with uptake of the MenACWY vaccine included receipt of a pneumococcal vaccine (hazard ratio [HR], 23.03; 95% CI, 13.93-38.09), attendance at a well-care visit (HR, 3.67; 95% CI, 1.11-12.12), West or Midwest geographic region (West: HR, 2.24; 95% CI, 1.44-3.47; Midwest: HR, 1.78; 95% CI, 1.16-2.71), and male sex (HR, 2.72; 95% CI, 1.18-6.26), whereas age of 56 years or older was significantly associated with reduced uptake of the MenACWY vaccine (HR, 0.42; 95% CI, 0.18-0.97). CONCLUSIONS AND RELEVANCE This cohort study suggests that MenACWY vaccine uptake among people with a new diagnosis of HIV was low, highlighting the need to educate patients and clinicians about the recommendations for conditions such as HIV infection that increase the risk of meningococcal disease among high-risk populations.
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Affiliation(s)
- Parinaz K. Ghaswalla
- Vaccines, US Health Outcomes, GSK, Philadelphia, Pennsylvania
- now with Health Economics and Outcomes Research, Moderna Inc, Cambridge, Massachusetts
| | - Gary S. Marshall
- Norton Children’s, affiliated with the University of Louisville School of Medicine, Louisville, Kentucky
| | | | | | - Tim Bancroft
- Optum Life Sciences, HEOR, Eden Prairie, Minnesota
| | - Eleena Koep
- Optum Life Sciences, HEOR, Eden Prairie, Minnesota
- now with United Healthcare, Center for Health Care Research, Minnetonka, Minnesota
| | - Patricia Novy
- Vaccines, US Health Outcomes, GSK, Philadelphia, Pennsylvania
- now with Dynavax Technologies, Emeryville, California
| | - Cosmina S. Hogea
- Global Value, Evidence and Outcomes, Oncology, GSK, Philadelphia, Pennsylvania
- now with Bristol Myers Squibb, New York, New York
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Morgan JR, Quinn EK, Chaisson CE, Ciemins E, Stempniewicz N, White LF, Larochelle MR. Potential barriers to filling buprenorphine and naltrexone prescriptions among a retrospective cohort of individuals with opioid use disorder. J Subst Abuse Treat 2022; 133:108540. [PMID: 34148756 PMCID: PMC8693788 DOI: 10.1016/j.jsat.2021.108540] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/26/2021] [Accepted: 06/02/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Medications for opioid use disorder (MOUD) are highly effective, but barriers along the cascade of care for opioid use disorder (OUD) from diagnosis to treatment limit their reach. For individuals desiring MOUD, the final step in the cascade is filling a written prescription, and fill rates have not been described. METHODS We used data from a large de-identified database linking individuals' electronic medical records (EMR) and administrative claims data and employed a previously developed algorithm to identify individuals with a new diagnosis of OUD. We included individuals with a prescription for buprenorphine or naltrexone recorded in the EMR. The outcome was a prescription fill within 30 days as reported in claims data. We compared demographic and clinical characteristics between those who did and did not fill the prescription and used a Kaplan-Meier curve to assess whether fill rates differed based on patient copay. RESULTS We identified 264 individuals with a new diagnosis of OUD who had a prescription written for buprenorphine or oral naltrexone. Of these, 70% (184) filled the prescription within 30 days, and more than half (57%) filled the prescription on the day it was written. Individuals with prescription copay at or below the mean had a 75% fill rate at 30 days compared with 63% for those with copay above the mean (p < 0.05) and this difference was consistent across fill times (log rank p-value <0.05). CONCLUSIONS It is alarming that nearly 1 in 3 MOUD prescriptions go unfilled. More research is needed to understand and reduce barriers to this final step of the OUD cascade of care.
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Affiliation(s)
- Jake R Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA; OptumLabs Visiting Scholar, OptumLabs, Eden Prairie, MN, USA.
| | - Emily K Quinn
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | | | | | | | - Laura F White
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Marc R Larochelle
- Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
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Ward MK, de la Cruz Y, Fernandez SB, Ibañez GE, Jean-Gilles M, Dévieux JG, Brock P, Ladner R, Beach MC, Trepka MJ. Provider Perceptions of Barriers to HIV Care Among Women with HIV in Miami-Dade County, Florida, and Possible Solutions: A Qualitative Study. J Int Assoc Provid AIDS Care 2021; 20:23259582211053520. [PMID: 34825604 PMCID: PMC8640317 DOI: 10.1177/23259582211053520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In Miami-Dade County, women with HIV (WWH) enrolled in Ryan White Program (RWP) services belong to groups that have historically faced structural barriers to care. To examine provider perceptions of WWH's barriers to care and elicit possible solutions, we conducted semi-structured interviews (n = 20) with medical case managers and human immunodeficiency virus (HIV) healthcare providers from medical case management sites serving WWH enrolled in the Miami-Dade RWP. Verbatim transcripts were analyzed thematically by two coders through an iterative process; disagreements were resolved through consensus. Barriers included lack of disclosure and stigma, additional psychosocial barriers to care, structural and logistical barriers, and negative interactions with health care providers. Participant suggestions to address these barriers included strategies that support women and foster individualized services that are responsive to their lived experiences and needs. Other solutions, such as those related to transportation, housing, and general funding for the RWP, will require advocacy and policy change.
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Affiliation(s)
- Melissa K Ward
- Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA.,Research Center in Minority Institutions, 5450Florida International University, Miami, FL, USA
| | - Yazmine de la Cruz
- College of Osteopathic Medicine-Southern Utah, Rocky Vista University, Ivins, UT, USA
| | - Sofia B Fernandez
- Research Center in Minority Institutions, 5450Florida International University, Miami, FL, USA.,School of Social Work, Robert Stempel College of Public Health and Social Work, 145771Florida International University, Miami, FL, USA
| | - Gladys E Ibañez
- Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA.,Research Center in Minority Institutions, 5450Florida International University, Miami, FL, USA
| | - Michèle Jean-Gilles
- Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA
| | - Jessy G Dévieux
- Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA.,Research Center in Minority Institutions, 5450Florida International University, Miami, FL, USA
| | | | - Robert Ladner
- Behavioral Science Research Corporation, Coral Gables, FL, USA
| | | | - Mary Jo Trepka
- Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA.,Research Center in Minority Institutions, 5450Florida International University, Miami, FL, USA
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Bonett S, Meanley S, Elsesser S, Bauermeister J. State-Level Discrimination Policies And HIV Pre-Exposure Prophylaxis Adoption Efforts In The US. Health Aff (Millwood) 2021; 39:1575-1582. [PMID: 32897779 DOI: 10.1377/hlthaff.2020.00242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a drug regimen recommended for anyone at high risk of getting HIV to prevent them from being infected. Little research exists on how state-level policies might be related to differential PrEP uptake across the United States. To better understand the associations between state-level policies and PrEP uptake, we examined HIV criminalization, nondiscrimination laws for sexual and gender minorities, Medicaid expansion, Ryan White funding, and sociodemographic characteristics in relation to the PrEP-to-need ratio, a measure of PrEP uptake. Using a cross-sectional design, we analyzed data from all fifty states; Washington, D.C.; and Puerto Rico (all of which we categorize as states here) regarding policy, socioeconomic factors, and PrEP-to-need ratio in 2018. States with HIV criminalization laws had lower PrEP-to-need ratio, and states with more nondiscrimination laws for sexual and gender minorities had higher PrEP-to-need ratio. We found no association between Medicaid expansion, Ryan White funding, percentage Hispanic, percentage uninsured, median household income, percentage with high school education, or state population and PrEP uptake. Legislators should consider how laws concerning HIV and sexual and gender minorities might protect against discrimination and subvert fear and stigma, given the potential impact of these policies on HIV prevention.
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Affiliation(s)
- Stephen Bonett
- Stephen Bonett is a doctoral student in the School of Nursing at the University of Pennsylvania, in Philadelphia, Pennsylvania
| | - Steven Meanley
- Steven Meanley is a research associate in the School of Nursing at the University of Pennsylvania
| | - Steven Elsesser
- Steven Elsesser is a resident in the Department of Family Medicine and Community Health at the University of Pennsylvania
| | - José Bauermeister
- José Bauermeister is the Presidential Professor of Nursing in the School of Nursing at the University of Pennsylvania
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Early Impact of the Patient Protection and Affordable Care Act on People Living With HIV: A Systematic Review. J Assoc Nurses AIDS Care 2020; 30:259-269. [PMID: 31021962 DOI: 10.1097/jnc.0000000000000079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The US Patient Protection and Affordable Care Act (ACA) was the most influential policy-related change to the care of people living with HIV in decades. We systematically searched and analyzed peer-reviewed, empirical research reporting on ACA-related aspects of HIV care post-ACA full implementation, finding 12 articles that met search criteria. The results revealed largely positive evidence regarding the ACA impact on people living with HIV, particularly on their health care coverage in Medicaid expansion states. More recent reporting included improvement in virologic suppression. However, early evidence has been somewhat fragmented, and important questions concerning the impact of the ACA on HIV care quality, patients, and providers remain unanswered. As the political struggle over the ACA continues, future analyses should use national- and state-level data to examine ACA impact on HIV care quality and patient-centered health outcomes to provide in-depth, holistic understanding of HIV care in the wake of this policy change.
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Were LP, Hogan JW, Galárraga O, Wamai R. Predictors of Health Insurance Enrollment among HIV Positive Pregnant Women in Kenya: Potential for Adverse Selection and Implications for HIV Treatment and Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2892. [PMID: 32331351 PMCID: PMC7216063 DOI: 10.3390/ijerph17082892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 11/17/2022]
Abstract
Background: The global push to achieve the 90-90-90 targets designed to end the HIV epidemic has called for the removing of policy barriers to prevention and treatment, and ensuring financial sustainability of HIV programs. Universal health insurance is one tool that can be used to this end. In sub-Saharan Africa, where HIV prevalence and incidence remain high, the use of health insurance to provide comprehensive HIV care is limited. This study looked at the factors that best predict social health insurance enrollment among HIV positive pregnant women using data from the Academic Model Providing Access to Healthcare (AMPATH) in western Kenya. Methods: Cross-sectional clinical encounter data were extracted from the electronic medical records (EMR) at AMPATH. We used univariate and multivariate logistic regressions to estimate the predictors of health insurance enrollment among HIV positive pregnant women. The analysis was further stratified by HIV disease severity (based on CD4 cell count <350 and 350>) to test the possibility of differential enrollment given HIV disease state. Results: Approximately 7% of HIV infected women delivering at a healthcare facility had health insurance. HIV positive pregnant women who deliver at a health facility had twice the odds of enrolling in insurance [2.46 Adjusted Odds Ratio (AOR), Confidence Interval (CI) 1.24-4.87]. They were 10 times more likely to have insurance if they were lost to follow-up to HIV care during pregnancy [9.90 AOR; CI 3.42-28.67], and three times more likely to enroll if they sought care at an urban clinic [2.50 AOR; 95% CI 1.53-4.12]. Being on HIV treatment was negatively associated with health insurance enrollment [0.22 AOR; CI 0.10-0.49]. Stratifying the analysis by HIV disease severity while statistically significant did not change these results. Conclusions: The findings indicated that health insurance enrollment among HIV positive pregnant women was low mirroring national levels. Additionally, structural factors, such as access to institutional delivery and location of healthcare facilities, increased the likelihood of health insurance enrollment within this population. However, behavioral aspects, such as being lost to follow-up to HIV care during pregnancy and being on HIV treatment, had an ambiguous effect on insurance enrollment. This may potentially be because of adverse selection and information asymmetries. Further understanding of the relationship between insurance and HIV is needed if health insurance is to be utilized for HIV treatment and prevention in limited resource settings.
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Affiliation(s)
- Lawrence P.O. Were
- Department of Health Sciences, Boston University’s College of Health and Rehabilitation Sciences: Sargent College & Department of Global Health, Boston University School of Public Health, Boston, MA 02215, USA
| | - Joseph W Hogan
- School of Public Health, Brown University, Providence, RI 02912, USA; (J.W.H.); (O.G.)
| | - Omar Galárraga
- School of Public Health, Brown University, Providence, RI 02912, USA; (J.W.H.); (O.G.)
| | - Richard Wamai
- Department of Cultures, Societies and Global Studies, Northeastern University, Boston, MA 02115, USA;
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7
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Nunes EV, Shulman M. Commentary on Stein et al. (2020): Whither detoxification in the face of the opioid epidemic? Addiction 2020; 115:95-96. [PMID: 31724266 DOI: 10.1111/add.14834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/23/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Edward V Nunes
- New York State Psychiatric Institute, Columbia University Medical Center, New York, New York, United States
| | - Matisyahu Shulman
- New York State Psychiatric Institute, Columbia University Medical Center, New York, New York, United States
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Kay ES, Batey DS, Mugavero MJ. The Ryan White HIV/AIDS Program: Supplementary Service Provision Post-Affordable Care Act. AIDS Patient Care STDS 2019; 32:265-271. [PMID: 29985648 DOI: 10.1089/apc.2018.0032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The Ryan White HIV/AIDS program (RWHAP) provides essential primary and supplementary health services to people living with HIV (PLWH). We examined the relationship between supplementary RWHAP services (Part B) and two outcomes: viral suppression (VS) and two separate measures of retention in care (RiC) based on kept- and missed-visits. We used purposive sampling to identify adult patients who received primary medical care at an academically-affiliated HIV/AIDS clinic in the southeastern United States (N = 1159) and who attended at least one scheduled HIV primary care appointment at the study site during 2015. Unadjusted and adjusted logistic regression models were fit, in which RWHAP supplementary services were the primary independent variables of interest. Age, race, gender, education level, and income were control variables. Among 1159 PLWH, 45.3% received RWHAP supplementary services in addition to public insurance, private insurance, or primary RWHAP. Among participants, 91.4% were virally suppressed, 87.4% were retained in care using the Institute of Medicine (IOM) kept-visits measure, and 60% were retained in care using the missed-visits measure. In multivariable models, patients with RWHAP supplementary services had significantly higher odds of (1) VS [adjusted odds ratio (AOR) = 1.91], (2) RiC using the IOM kept-visits measure (AOR = 2.56), and (3) RiC using the missed-visits measure (AOR = 1.58). Receipt of supplementary RWHAP services is associated with increased odds of VS and two measures of RiC when adjusting for key sociodemographic variables. Policymakers should consider the vital role of RWHAP as continued funding is uncertain.
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Affiliation(s)
- Emma Sophia Kay
- School of Social Work, University of Michigan, Ann Arbor, Michigan
| | - D. Scott Batey
- Department of Social Work, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael J. Mugavero
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Strategies for the elimination of hepatitis C virus infection as a public health threat in the United States. ACTA ACUST UNITED AC 2018; 17:111-120. [PMID: 30294518 DOI: 10.1007/s11901-018-0394-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Purpose of Review Direct-acting antiviral regimens for chronic hepatitis C virus (HCV) became available in 2014, and these highly curative therapies have the potential to reduce HCV-associated morbidity and mortality, decrease transmission, and eliminate HCV infection as a public health problem. This review summarizes the recommendations by the National Academies of Sciences, Engineering, and Medicine for a US strategy for HCV elimination. Recent Findings To achieve proposed targets of reducing HCV incidence by 90% and decreasing HCV-related mortality by 60% by 2030, there is a critical need to improve HCV diagnosis and linkage to care; reduce HCV-related disease by antiviral treatment scale-up; reduce HCV incidence; and strengthen HCV surveillance to determine achievement of HCV elimination targets over time. Summary While HCV elimination is feasible, success of this national effort will require ongoing collaboration and critical resource investment by key stakeholders, including medical and public health communities, legislators, community organizers, and patient advocates.
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10
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Informing Targeted Interventions to Optimize the Cascade of HIV Care Using Cluster Analyses of Health Resource Use Among People Living with HIV/AIDS. AIDS Behav 2018; 22:234-244. [PMID: 28660380 DOI: 10.1007/s10461-017-1839-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Increased awareness of the secondary preventive benefits of antiretroviral treatment (ART) has strengthened the desire to optimize health care systems' response to HIV/AIDS. We identified clusters of health resource utilization (HRU) among people living with HIV (PLHIV) to inform targeted interventions aimed to optimize the cascade of HIV care. Using linked population-level health databases in British Columbia, Canada, we selected two analytic samples of PLHIV with 3 years of follow-up between 2006-2011 that were classified as intermittently retained in care or intermittently engaged in ART, and executed a probabilistic model-based clustering analysis for each sample with 5 and 9 quarterly HRU variables, respectively. We found clear HRU profile differences among both samples with similar HIV-related care: one featured active involvement in non-HIV care, the other little or no health care interaction following linkage to care. Differential reengagement intervention strategies capitalizing on missed opportunities in non-HIV care and further engaging physicians delivering HIV care are needed to optimize the response to the HIV epidemic.
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11
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Diepstra KL, Rhodes AG, Bono RS, Patel S, Yerkes LE, Kimmel AD. Comprehensive Ryan White Assistance and Human Immunodeficiency Virus Clinical Outcomes: Retention in Care and Viral Suppression in a Medicaid Nonexpansion State. Clin Infect Dis 2017; 65:619-625. [PMID: 28449128 PMCID: PMC5848228 DOI: 10.1093/cid/cix380] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 04/21/2017] [Indexed: 12/31/2022] Open
Abstract
Background Knowledge gaps remain about how the Ryan White human immunodeficiency virus (HIV)/AIDS Program (RW) contributes to health outcomes. We examined the association between different RW service classes and retention in care (RiC) or viral suppression (VS). Methods We identified Virginians engaged in any HIV care between 1 January and 31 December 2014. RW beneficiaries were classified by receipt of ≥1 service from 3 classes: Core medical, Support, and insurance and/or direct medication assistance through the AIDS Drug Assistance Program (ADAP). Receipt of all RW classes was defined as comprehensive assistance. We used multivariable logistic regression to compare the odds of RiC and of VS by comprehensive assistance and by RW classes alone and in combination. Results Among 13104 individuals, 58% received any RW service and 17% comprehensive assistance. Comprehensive assistance is significantly associated with RiC (adjusted odds ratio [aOR], 8.8 [95% confidence interval {CI}, 7.2-10.8]) and viral suppression (aOR, 3.3 [95% CI, 2.9-3.8]). Receiving any 2 RW classes or Core alone is significantly associated with RiC and VS, with the strength of association decreasing as the number of classes decreases. Recipients of Support alone are significantly less likely to have VS (aOR, 0.75 [95% CI, .59-.96]). For ADAP recipients also receiving Core and/or Support, insurance assistance is significantly associated with VS compared to receiving direct medication only (aOR, 1.6 [95% CI, 1.3-1.9]); this relationship is not significant for those who receive ADAP alone. Conclusions Receiving more classes of RW-funded services is associated with improved HIV outcomes. For some populations with insurance, RW-funded services may still be required for optimal health outcomes.
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Affiliation(s)
- Karen L Diepstra
- Virginia Department of Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Anne G Rhodes
- Virginia Department of Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Rose S Bono
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Sonam Patel
- Virginia Department of Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Lauren E Yerkes
- Virginia Department of Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - April D Kimmel
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
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Kay ES, Batey DS, Mugavero MJ. The HIV treatment cascade and care continuum: updates, goals, and recommendations for the future. AIDS Res Ther 2016; 13:35. [PMID: 27826353 PMCID: PMC5100316 DOI: 10.1186/s12981-016-0120-0] [Citation(s) in RCA: 190] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/31/2016] [Indexed: 11/10/2022] Open
Abstract
The HIV care continuum is a framework that models the dynamic stages of HIV care. The continuum consists of five main steps, which, at the population level, are depicted cross-sectionally as the HIV treatment cascade. These steps include diagnosis, linkage to care (LTC), retention in care (RiC), adherence to antiretroviral therapy (ART), and viral suppression. Although the HIV treatment cascade is represented as a linear, unidirectional framework, persons living with HIV (PLWH) often experience the care continuum in a less streamlined fashion, skip steps altogether, or even exit the continuum for a period of time and regress to an earlier stage. The proportion of PLWH decreases at each successive step of the cascade, beginning with an estimated 86% who are diagnosed and dropping dramatically to approximately 30% of PLWH who are virally suppressed in the United States (US). In this current issues review, we describe each step in the cascade, discuss targeted interventions that address weak points in the continuum, review domestic and international policies that help shape and direct HIV care strategies, and conclude with recommendations and future directions for HIV providers and policymakers. While we primarily examine issues related to domestic HIV care in the US, we also discuss international applications of the continuum in order to provide broader context.
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13
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Morrato EH, Brewer SE, Campagna EJ, Dickinson LM, Thomas DSK, Druss BG, Miller BF, Newcomer JW, Lindrooth RC. Glucose Testing for Adults Receiving Medicaid and Antipsychotics: A Population-Based Prescriber Survey on Behaviors, Attitudes, and Barriers. Psychiatr Serv 2016; 67:798-802. [PMID: 27032657 PMCID: PMC4939591 DOI: 10.1176/appi.ps.201500181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to assess provider attitudes about glucose testing for adults prescribed second-generation antipsychotic medication. METHODS Missouri Medicaid prescribers of antipsychotics in 2011 were surveyed (N=924, 25% response rate). Pearson's chi square test was used to compare responses between prescriber specialty setting. Multivariable log-binomial regression evaluated the association of factors hypothesized as barriers to screening. RESULTS Prescribers in community mental health centers were more likely than primary care providers to report that they would definitely order baseline testing (57% versus 39%, p<.001) and were greater promoters of screening to colleagues (76% versus 49%, p<.001). The strongest predictor of screening intent was disagreeing strongly that "metabolic screening is not a priority for me or my organization" (94% more likely to screen at drug initiation and 74% more likely at annual evaluation, both p<.001). CONCLUSIONS Establishing organizational priority across all treatment settings is important for achieving population-based diabetes screening goals for all Medicaid patients receiving antipsychotics.
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Affiliation(s)
- Elaine H Morrato
- Dr. Morrato and Dr. Lindrooth are with the Colorado School of Public Health and Dr. Dickinson and Dr. Miller are with the Department of Family Medicine, all at the University of Colorado Anschutz Medical Campus, Aurora (e-mail: ). Dr. Morrato and Dr. Dickinson are also with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, where Ms. Brewer and Ms. Campagna are affiliated. Dr. Thomas is with the Department of Geography and Environmental Sciences, University of Colorado Denver, Denver. Dr. Druss is with the Rollins School of Public Health, Emory University, Atlanta. Dr. Newcomer is with the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - Sarah E Brewer
- Dr. Morrato and Dr. Lindrooth are with the Colorado School of Public Health and Dr. Dickinson and Dr. Miller are with the Department of Family Medicine, all at the University of Colorado Anschutz Medical Campus, Aurora (e-mail: ). Dr. Morrato and Dr. Dickinson are also with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, where Ms. Brewer and Ms. Campagna are affiliated. Dr. Thomas is with the Department of Geography and Environmental Sciences, University of Colorado Denver, Denver. Dr. Druss is with the Rollins School of Public Health, Emory University, Atlanta. Dr. Newcomer is with the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - Elizabeth J Campagna
- Dr. Morrato and Dr. Lindrooth are with the Colorado School of Public Health and Dr. Dickinson and Dr. Miller are with the Department of Family Medicine, all at the University of Colorado Anschutz Medical Campus, Aurora (e-mail: ). Dr. Morrato and Dr. Dickinson are also with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, where Ms. Brewer and Ms. Campagna are affiliated. Dr. Thomas is with the Department of Geography and Environmental Sciences, University of Colorado Denver, Denver. Dr. Druss is with the Rollins School of Public Health, Emory University, Atlanta. Dr. Newcomer is with the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - L Miriam Dickinson
- Dr. Morrato and Dr. Lindrooth are with the Colorado School of Public Health and Dr. Dickinson and Dr. Miller are with the Department of Family Medicine, all at the University of Colorado Anschutz Medical Campus, Aurora (e-mail: ). Dr. Morrato and Dr. Dickinson are also with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, where Ms. Brewer and Ms. Campagna are affiliated. Dr. Thomas is with the Department of Geography and Environmental Sciences, University of Colorado Denver, Denver. Dr. Druss is with the Rollins School of Public Health, Emory University, Atlanta. Dr. Newcomer is with the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - Deborah S K Thomas
- Dr. Morrato and Dr. Lindrooth are with the Colorado School of Public Health and Dr. Dickinson and Dr. Miller are with the Department of Family Medicine, all at the University of Colorado Anschutz Medical Campus, Aurora (e-mail: ). Dr. Morrato and Dr. Dickinson are also with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, where Ms. Brewer and Ms. Campagna are affiliated. Dr. Thomas is with the Department of Geography and Environmental Sciences, University of Colorado Denver, Denver. Dr. Druss is with the Rollins School of Public Health, Emory University, Atlanta. Dr. Newcomer is with the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - Benjamin G Druss
- Dr. Morrato and Dr. Lindrooth are with the Colorado School of Public Health and Dr. Dickinson and Dr. Miller are with the Department of Family Medicine, all at the University of Colorado Anschutz Medical Campus, Aurora (e-mail: ). Dr. Morrato and Dr. Dickinson are also with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, where Ms. Brewer and Ms. Campagna are affiliated. Dr. Thomas is with the Department of Geography and Environmental Sciences, University of Colorado Denver, Denver. Dr. Druss is with the Rollins School of Public Health, Emory University, Atlanta. Dr. Newcomer is with the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - Benjamin F Miller
- Dr. Morrato and Dr. Lindrooth are with the Colorado School of Public Health and Dr. Dickinson and Dr. Miller are with the Department of Family Medicine, all at the University of Colorado Anschutz Medical Campus, Aurora (e-mail: ). Dr. Morrato and Dr. Dickinson are also with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, where Ms. Brewer and Ms. Campagna are affiliated. Dr. Thomas is with the Department of Geography and Environmental Sciences, University of Colorado Denver, Denver. Dr. Druss is with the Rollins School of Public Health, Emory University, Atlanta. Dr. Newcomer is with the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - John W Newcomer
- Dr. Morrato and Dr. Lindrooth are with the Colorado School of Public Health and Dr. Dickinson and Dr. Miller are with the Department of Family Medicine, all at the University of Colorado Anschutz Medical Campus, Aurora (e-mail: ). Dr. Morrato and Dr. Dickinson are also with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, where Ms. Brewer and Ms. Campagna are affiliated. Dr. Thomas is with the Department of Geography and Environmental Sciences, University of Colorado Denver, Denver. Dr. Druss is with the Rollins School of Public Health, Emory University, Atlanta. Dr. Newcomer is with the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - Richard C Lindrooth
- Dr. Morrato and Dr. Lindrooth are with the Colorado School of Public Health and Dr. Dickinson and Dr. Miller are with the Department of Family Medicine, all at the University of Colorado Anschutz Medical Campus, Aurora (e-mail: ). Dr. Morrato and Dr. Dickinson are also with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, where Ms. Brewer and Ms. Campagna are affiliated. Dr. Thomas is with the Department of Geography and Environmental Sciences, University of Colorado Denver, Denver. Dr. Druss is with the Rollins School of Public Health, Emory University, Atlanta. Dr. Newcomer is with the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
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Snider JT, Juday T, Romley JA, Seekins D, Rosenblatt L, Sanchez Y, Goldman DP. Nearly 60,000 uninsured and low-income people with HIV/AIDS live in states that are not expanding Medicaid. Health Aff (Millwood) 2016; 33:386-93. [PMID: 24590935 DOI: 10.1377/hlthaff.2013.1453] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Health insurance gives people living with HIV/AIDS access to medical care, including antiretroviral therapy, which in turn can dramatically improve health and reduce the risk of HIV transmission. Yet many people living with HIV/AIDS remain uninsured. The Affordable Care Act (ACA) seeks to decrease the number of uninsured Americans in part by extending Medicaid coverage to individuals with incomes of up to 138 percent of the federal poverty level. However, many states are not moving forward with this expansion. Using national HIV surveillance data and data from the National Health Interview Survey, we estimated that nearly 115,000 uninsured, low-income people living with HIV/AIDS would be eligible for Medicaid if all states adopted the expansion. Of these, nearly 60,000 live in states not moving forward with the Medicaid expansion. States' decisions about whether or not to participate in the expansion are likely to have important consequences for the health of this population and the evolution of the HIV epidemic.
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Abstract
Objective: Despite considerable advances in the prevention and treatment of HIV/AIDS, the burden of new infections of HIV and AIDS varies substantially across the country. Previous studies have demonstrated associations between increased healthcare spending and better HIV/AIDS outcomes; however, less is known about the association between spending on social services and public health spending and HIV/AIDS outcomes. We sought to examine the association between state-level spending on social services and public health and HIV/AIDS case rates and AIDS deaths across the United States. Design: We conducted a retrospective, longitudinal study of the 50 U.S. states over 2000–2009 using a dataset of HIV/AIDS case rates and AIDS deaths per 100 000 people matched with a unique dataset of state-level spending on social services and public health per person in poverty. Methods: We estimated multivariable regression models for each HIV/AIDS outcome as a function of the social service and public health spending 1 and 5 years earlier in the state, adjusted for the log of state GDP per capita, regional and time fixed effects, Medicaid spending as % of GDP, and socio-demographic, economic, and health resource factors. Results: States with higher spending on social services and public health per person in poverty had significantly lower HIV and AIDS case rates and fewer AIDS deaths, both 1 and 5 years post expenditure (P ≤ 0.05). Conclusion: Our findings suggest that spending on social services and public health may provide a leverage point for state policymakers to reduce HIV/AIDS case rates and AIDS deaths in their state.
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16
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Brennan-Ing M, Seidel L, Rodgers L, Ernst J, Wirth D, Tietz D, Morretti A, Karpiak SE. The Impact of Comprehensive Case Management on HIV Client Outcomes. PLoS One 2016; 11:e0148865. [PMID: 26849561 PMCID: PMC4744022 DOI: 10.1371/journal.pone.0148865] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 01/25/2016] [Indexed: 11/17/2022] Open
Abstract
In 1990, New York State instituted Comprehensive Medicaid Case Management, also known as Target Case Management (TCM), for people dealing with multiple comorbid conditions, including HIV. The goal of TCM is to assist clients in navigating the health care system to increase care engagement and treatment adherence for individuals with complex needs. HIV-positive individuals engaged in care are more likely to be virally suppressed, improving clinical outcomes and decreasing chances of HIV transmission. The purpose of this study was to understand the impact of TCM management on outcomes for people with HIV. Data were obtained from Amida Care, which operates not-for-profit managed care Medicaid and Medicare Special Needs Plans (SNPs) for HIV clients. Changes in clinical, cost, as well as medical and pharmacy utilization data among TCM clients were examined between January 2011 through September 2012 from the start of case management enrollment through the end of the study period (i.e., up to 6 months after disenrollment). Additionally, CD4 counts were compared between Amida Care TCM clients and non-TCM clients. Notable findings include increased CD4 counts for TCM clients over the one-year study period, achieving parity with non-TCM clients (i.e., Mean CD4 count > 500). When looking exclusively at TCM clients, there were increases in medication costs over time, which were concomitant with increased care engagement. Current findings demonstrate that TCM is able to achieve its goals of improving care engagement and treatment adherence. Subsequent policy changes resulting from the Affordable Care Act and the New York State Medicaid Redesign have made the Health Home the administrator of TCM services. Government entities charged with securing and managing TCM and care coordination for people with HIV should provide thoughtful and reasonable guidance and oversight in order to maintain optimal clinical outcomes for TCM clients and reduce the transmission of HIV.
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Affiliation(s)
- Mark Brennan-Ing
- Center on HIV and Aging, ACRIA, New York, New York, United States of America.,College of Nursing, New York University, New York, New York, United States of America
| | - Liz Seidel
- Center on HIV and Aging, ACRIA, New York, New York, United States of America.,Graduate School of Social Service, Fordham University, New York, New York, United States of America
| | | | - Jerome Ernst
- Center on HIV and Aging, ACRIA, New York, New York, United States of America.,Amida Care, Inc., New York, New York, United States of America
| | - Doug Wirth
- Amida Care, Inc., New York, New York, United States of America
| | - Daniel Tietz
- Human Resources Administration, City of New York, New York, New York, United States of America
| | - Antonio Morretti
- Columbia University, New York, New York, United States of America
| | - Stephen E Karpiak
- Center on HIV and Aging, ACRIA, New York, New York, United States of America.,College of Nursing, New York University, New York, New York, United States of America
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17
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Flynn MB, Atwood R, Greenberg JB, Ray T, Harris KK. A Survey of Texas HIV, Sexually Transmitted Disease, Tuberculosis, and Viral Hepatitis Providers' Billing and Reimbursement Capabilities. Am J Public Health 2015; 105 Suppl 5:S686-9. [PMID: 26447911 DOI: 10.2105/ajph.2015.302734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The Affordable Care Act presents financial challenges and opportunities for publicly funded service providers. We assessed billing practices and anticipated barriers to third-party billing among organizations in Texas that provide publicly funded HIV, sexually transmitted diseases, tuberculosis, and viral hepatitis services. One third to one half of the organizations did not bill for medical services. The most common barrier to third-party billing was lack of staff knowledge about billing and coding. Future research must evaluate options for organizations and communities to maintain access to infectious disease services for vulnerable populations.
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Affiliation(s)
- Matthew B Flynn
- Matthew B. Flynn is with the Department of Sociology and Anthropology, Georgia Southern University. Robin Atwood, Jennifer B. Greenberg, Tara Ray, and Karol Kaye Harris are with the Department of Kinesiology and Health Education, The University of Texas at Austin
| | - Robin Atwood
- Matthew B. Flynn is with the Department of Sociology and Anthropology, Georgia Southern University. Robin Atwood, Jennifer B. Greenberg, Tara Ray, and Karol Kaye Harris are with the Department of Kinesiology and Health Education, The University of Texas at Austin
| | - Jennifer B Greenberg
- Matthew B. Flynn is with the Department of Sociology and Anthropology, Georgia Southern University. Robin Atwood, Jennifer B. Greenberg, Tara Ray, and Karol Kaye Harris are with the Department of Kinesiology and Health Education, The University of Texas at Austin
| | - Tara Ray
- Matthew B. Flynn is with the Department of Sociology and Anthropology, Georgia Southern University. Robin Atwood, Jennifer B. Greenberg, Tara Ray, and Karol Kaye Harris are with the Department of Kinesiology and Health Education, The University of Texas at Austin
| | - Karol Kaye Harris
- Matthew B. Flynn is with the Department of Sociology and Anthropology, Georgia Southern University. Robin Atwood, Jennifer B. Greenberg, Tara Ray, and Karol Kaye Harris are with the Department of Kinesiology and Health Education, The University of Texas at Austin
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18
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Bradley H, Viall AH, Wortley PM, Dempsey A, Hauck H, Skarbinski J. Ryan White HIV/AIDS Program Assistance and HIV Treatment Outcomes. Clin Infect Dis 2015; 62:90-98. [PMID: 26324390 DOI: 10.1093/cid/civ708] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/07/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Ryan White HIV/AIDS Program (RWHAP) provides persons infected with human immunodeficiency virus (HIV) with services not covered by other healthcare payer types. Limited data exist to inform policy decisions about the most appropriate role for RWHAP under the Patient Protection and Affordable Care Act (ACA). METHODS We assessed associations between RWHAP assistance and antiretroviral therapy (ART) prescription and viral suppression. We used data from the Medical Monitoring Project, a surveillance system assessing characteristics of HIV-infected adults receiving medical care in the United States. Interview and medical record data were collected in 2009-2013 from 18 095 patients. RESULTS Nearly 41% of patients had RWHAP assistance; 15% relied solely on RWHAP assistance for HIV care. Overall, 91% were prescribed ART, and 75% were virally suppressed. Uninsured patients receiving RWHAP assistance were significantly more likely to be prescribed ART (52% vs 94%; P < .01) and virally suppressed (39% vs 77%; P < .01) than uninsured patients without RWHAP assistance. Patients with private insurance and Medicaid were 6% and 7% less likely, respectively, to be prescribed ART than those with RWHAP only (P < .01). Those with private insurance and Medicaid were 5% and 12% less likely, respectively, to be virally suppressed (P ≤ .02) than those with RWHAP only. Patients whose private or Medicaid coverage was supplemented by RWHAP were more likely to be prescribed ART and virally suppressed than those without RWHAP supplementation (P ≤ .01). CONCLUSIONS Uninsured and underinsured HIV-infected persons receiving RWHAP assistance were more likely to be prescribed ART and virally suppressed than those with other types of healthcare coverage.
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Affiliation(s)
- Heather Bradley
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Abigail H Viall
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pascale M Wortley
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Antigone Dempsey
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland
| | - Heather Hauck
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland
| | - Jacek Skarbinski
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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