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Only 1 in 5 Medicaid Users Linked to Care Within a Year After HIV Diagnosis

Only about 20% of adult Medicaid recipients who tested positive for HIV during the past decade began receiving appropriate care -- including CDC T-cell count and viral load monitoring -- within a year of diagnosis, and the rate did not improve much within 5 years, according to an analysis described in the January 2013 issue of Sexually Transmitted Diseases.

Advances in antiretroviral therapy (ART) over the past 2 decades have dramatically reduced mortality related to HIV/AIDS, but new therapies can only benefit people who get tested, enter care, and start treatment in a timely manner. According to a CDC analysis of the care cascade," about 82% of people with HIV in the U.S. have been diagnosed, 66% have been linked to care, 37% remained in care, 33% were prescribed ART, and 25% achieved viral suppression.

A new analysis, however, suggests that even this low figure may be optimistic for some of the most heavily impacted groups of people with HIV.

Stephen Johnston of Truven Health Analytics and colleagues looked at patterns and factors associated with linkage to care among people receiving Medicaid, a program for low-income and disabled individuals that is the largest source of healthcare coverage for people with HIV in the U.S.

This retrospective study was based on Medicaid claims data from 15 states, focusing on individuals age 18 to 64 years who had at least 1 HIV test between January 2003 and May 2010 and were diagnosed as positive. The researchers looked at linkage to appropriate HIV care, defined as receiving CD4 count and viral load tests according to U.S. treatment guidelines.

The analysis included 6684 patients. A large majority -- 70% -- were women, 47% were black, and the average age was 35 years. This gender distribution differs from that of the overall population of people with HIV in the U.S., which is about 75% men (a majority of them men who have sex with men), and the mean age is a bit lower.

Results

• Overall, 21.0% of study participants were linked to appropriate care within 1 year after being diagnosed as HIV positive.
• 26.4% of participants were linked to care within 5 years of HIV diagnosis.
• Black patients had a significantly shorter time to linkage to care than white patients (hazard ratio 2.034, or about half the time).

Based on these results, the study authors concluded, "These findings in Medicaid patients newly diagnosed with HIV contrast with prior research show[ing] disparities in access to HIV care favoring whites."

The older research has generally looked at the HIV population as a whole, in which whites on average are more affluent than blacks and more likely to rely on private insurance rather than Medicaid.

"Overall, the proportion of patients who linked to appropriate HIV care was very low given the availability of effective treatment, suggesting a need for more effective interventions promoting timely linkage to appropriate care after diagnosis," the authors recommended.

2/5/13

Reference

SS Johnston, T Juday, D Seekins, et al. Patterns and correlated of linkage to approropriate HIV care after HIV diagnosis in the US Medicaid Population. Sexually Transmitted Diseases 40(1):18-25. January 2013.