2001-2015 年,医疗补助计划(Medicaid)受益人中的艾滋病毒感染者继续接受护理和坚持抗逆转录病毒疗法的情况。

IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Aids Care-Psychological and Socio-Medical Aspects of Aids/hiv Pub Date : 2024-11-01 Epub Date: 2024-07-30 DOI:10.1080/09540121.2024.2383901
Jacqueline E Rudolph, Keri L Calkins, Xueer Zhang, Yiyi Zhou, Xiaoqiang Xu, Eryka L Wentz, Corinne E Joshu, Bryan Lau
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引用次数: 0

摘要

社会经济地位、居住地和种族/民族在 HIV 护理方面的差异阻碍了疫情控制的进展。在美国,医疗补助计划是低收入人群的保险来源,目前还没有任何研究全面描述了加入该计划的艾滋病病毒感染者的艾滋病护理流程。我们分析了美国 14 个州 2001-2015 年加入医疗补助计划的 246127 名 18-64 岁艾滋病病毒感染者的数据。我们估算了护理级联四个步骤的月流行率:保留护理/坚持抗逆转录病毒疗法;保留/不坚持;不保留/不坚持;不保留/不坚持。如果受益人每 6 个月接受一次门诊治疗,则视为继续接受治疗。依从性基于药物持有率。我们使用非参数多州方法估算了患病率,将死亡作为竞争事件,并使用反删减概率加权法估算了医疗补助的退出情况。在 2001-2015 年期间,无论是总体还是在所有分组中,感染艾滋病毒的受益人中坚持接受抗逆转录病毒治疗的比例都有所上升。到 2015 年,约有一半的受益人继续接受护理,42% 的受益人坚持抗逆转录病毒疗法。我们发现,不同种族/族裔和地区之间存在显著差异。我们的工作凸显了在此期间,不同保险状况的艾滋病护理级联中存在的重要差异。
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Retention in care and antiretroviral therapy adherence among Medicaid beneficiaries with HIV, 2001-2015.

Disparities in HIV care by socioeconomic status, place of residence, and race/ethnicity prevent progress toward epidemic control. No study has comprehensively characterized the HIV care cascade among people with HIV enrolled in Medicaid - an insurance source for low-income individuals in the US. We analyzed data from 246,127 people with HIV enrolled in Medicaid 2001-2015, aged 18-64, living in 14 US states. We estimated the monthly prevalence of four steps of the care cascade: retained in care/adherent to ART; retained/not adherent; not retained/adherent; not retained/not adherent. Beneficiaries were retained in care if they had an outpatient care encounter every six months. Adherence was based on medication possession ratio. We estimated prevalence using a non-parametric multi-state approach, accounting for death as a competing event and for Medicaid disenrollment using inverse probability of censoring weights. Across 2001-2015, the proportion of beneficiaries with HIV who were retained/ART adherent increased, overall and in all subgroups. By 2015, approximately half of beneficiaries were retained in care, and 42% of beneficiaries were ART adherent. We saw meaningful differences by race/ethnicity and region. Our work highlights an important disparity in the HIV care cascade by insurance status during this time period.

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