People living with HIV who are insured by Medicaid often have poor adherence to their antiretroviral (ARV) regimens, the National AIDS Treatment Advocacy Project (NATAP) reports. Not sticking to the daily HIV medication regimen is associated with increased health care costs among this population.
Researchers analyzed Medicaid claims made by 2,683 HIV-positive adults living in six states from 2012 through 2015, including Iowa, Kansas, New Jersey, Missouri, Mississippi and Wisconsin. The investigators looked for individuals’ first claim for coverage of one of five ARVs, including Prezista (darunavir), Reyataz (atazanavir), Isentress (raltegravir), Vitekta (elvitegravir) and Sustiva (efavirenz). In addition to analyzing records going forward from this point, the study authors looked at the previous six months of records—a period they referred to as the baseline.
Findings were presented at the 9th International AIDS Society Conference on HIV Science in Paris (IAS 2017).
The study population had a median age of 46.6. A total of 60.5 percent were men, 55.2 percent were Black and 64.9 percent lived in an urban era. About one in four did not receive ARVs during the baseline period.
The researchers analyzed the use of out- and inpatient care, emergency room care, long-term care, home care and other medical visits.
Pharmacy refill records helped the study authors estimate adherence to ARVs. They divided adherence into three levels based on the number of days covered by ARVs: optimal adherence, at least 95 percent of days; suboptimal adherence, 80 to 95 percent of days; and poor adherence, less than 80 percent of days.
After adjusting the data to account for various differences between the adherence groups, the researchers found that the increased likelihood of having poor adherence was as follows: those who were 18 to 29 years old compared with those age 50 and older were 1.58-fold more likely to have poor adherence; those with noncaptitated insurance (a managed care plan that does not establish a dollar amount to cover medical expenses during a defined period) compared with those without such insurance, 1.4-fold; those with both Medicaid and Medicare coverage compared with those with only Medicaid, 5.98-fold; those who did not take ARVs during the baseline period compared with those who did, 1.98-fold; and those who had no symptoms of HIV infection during the baseline period compared with those who did, 1.37-fold more likely.
Compared with those who had optimal adherence, those with suboptimal adherence spent 1.62 times more days in the hospital, had 3.11 times more long-term care admissions and had an average of $339 less in monthly costs, mainly because of differences in inpatient visit rates.
The study authors recommended that physicians support adherence by favoring prescribing single-tablet ARV regimens, especially those that include drugs that are much less likely to lead to drug resistance.
To read the NATAP article, click here.