Background While the Ryan White HIV/AIDS Program (RWHAP) supports high-quality HIV care, Medicaid enrollment provides access to non-HIV care. People living with HIV (PLWH) with Medicaid historically have low viral suppression (VS) rates. In a state with previously high Qualified Health Plan coverage of PLWH, we examined HIV outcomes by insurance status during the first year of Medicaid expansion (ME). Methods Participants were PLWH ages 18-63 who attended ≥1 HIV medical visit/year in 2018 and 2019. We estimated associations of sociodemographic characteristics with ME enrollment prevalence and associations between insurance status and engagement in care and VS. Results Among 577 patients, 151 (33%) were newly eligible for Medicaid, and 77 (51%) enrolled. Medicaid enrollment was higher for those with incomes <100% Federal Poverty Level (adjusted prevalence ratio [aPR] 1.67; 95% confidence interval [CI] 1.00-1.86) compared to others. Controlling for age, income, and 2018 engagement, those with employment-based private insurance (adjusted risk difference [aRD] -8.5%, 95% CI -16.9-0.1) and Medicare (aRD -12.5%, 95% CI -21.2- -3.0) had lower 2019 engagement than others. For those with VS data (n=548), after controlling for age and baseline VS, those with Medicaid (aRD -4.0%, 95% CI -10.3-0.3) and with Medicaid due to ME (aRD -6.2%, 95% CI -14.1- -0.8) were less likely to achieve VS compared with others. Conclusions Given that PLWH who newly enrolled in Medicaid had high engagement in care, the finding of lower VS is notable. The discordance may be due to medication access gaps associated with changes in medication procurement logistics.
BACKGROUND Neonatal hypothermia is increasingly recognized as a major cause of neonatal morbidity and mortality. Warmth care is an essential component of newborn interventions to reduce neonatal mortality. The present study deals with the knowledge, attitude and neonatal warmth care practices among postnatal mothers/care givers in the postnatal ward and aims to assess the level of understanding, acceptance and implementation of warmth care practices among mothers/care givers. As ThermoSpot is proven to be useful in detecting hypothermia in newborn babies, mothers were taught to detect hypothermia and take necessary steps by observing the colour changes of ThermoSpot. We wanted to assess the knowledge, attitude and neonatal warmth care practices among postnatal mothers/care givers in the postnatal ward. We also wanted to educate the mothers to detect hypothermia in the newborn with a simple tool like ThermoSpot and to educate them regarding correct neonatal warmth care practices. METHODS This is a hospital based interventional study, conducted among 108 post-natal mothers for a period of 6 months. Sociodemographic details of mothers were collected in a proforma. Neonatal warmth care practices followed by mothers were noted. ThermoSpot was applied to all 108 babies and any change in the colour of ThermoSpot was recorded on day 1, at 48 hours and at 72 hours. All mothers were educated about interpretation of change in colour of the ThermoSpot in detecting hypothermia or fever in the newborn baby. Data was analysed using Microsoft Excel and SPSS (Version 20) software. RESULTS Out of 108 mothers, majority were in 20-24 years age group. Literacy and multiparity of the mothers were found to have statistical significance (p<0.05) regarding the knowledge of drying the baby and wrapping with warm clothes. Mothers of nuclear family, higher socioeconomic status, higher parity, and who had normal vaginal delivery, had shown higher knowledge about skin to skin contact which was statistically significant (p<0.05). Knowledge about rooming in had shown statistical significance among educated mothers, mothers belonging to higher socioeconomic status, higher parity and who had normal vaginal delivery (p <0.05). There was no statistical significance between knowledge of mothers about timing of new-born's first bath and demographic profile of mothers. Out of 108 mothers, 86 (79.6%) had knowledge to initiate breast feeds immediately after delivery where as 20.4% of mothers thought that breast feeds can be fed only when baby cries. Out of 648 ThermoSpot readings, 4 mothers reported PALE GREEN once, and one mother reported RED colour once. Data was analysed using Microsoft Excel and SPSS (Version 20) software. CONCLUSIONS In the present study, lack of maternal education on essential newborn care during antenatal (5%) and postnatal periods (13%) by health personnel was found to be one of the important factors contributing to poor knowledge and implementation of essential newborn warmth care practices. As ThermoSpot is not costly (Rs. 7 p...
Background People living with HIV (PLWH) with Medicaid historically have lower viral suppression (VS) rates than those with other insurance. VS rates with Medicaid expansion (ME) are unknown. We examined HIV outcomes (engagement in care, VS) by insurance status for a non-urban Southeastern Ryan White HIV/AIDS Program (RWHAP) Clinic cohort for year after ME. Methods Participants were PLWH ages 18-63 who attended > 1 HIV medical visit/year in 2018 and 2019. Log-binomial models were used to estimate the association of characteristics with Medicaid enrollment prevalence and one-year risks of engagement in care and VS in 2019. Results Among 577 patients, 241 (42%) were newly eligible for Medicaid due to ME and 79 (33%) enrolled (Figure 1a). For those without Medicare, Medicaid enrollment was higher for those with incomes < 100% FPL (adjusted prevalence ratio [aPR] 1.67; 95% confidence interval [CI] 1.00-1.86) compared to those with incomes > 101% FPL. Those enrolled in Medicaid due to ME had 87% engagement in care compared to 80-92% for other insurance plans (Figure 1b). Controlling for 2018 engagement, older age (adjusted risk ratio [aRR] for 10 years 1.03, 95% CI 1.00-1.05; Table 1) was associated with being engaged in 2019. Engagement was lower for those with employment-based insurance (aRR 0.91, 95% CI 0.83-0.99) and Medicare (aRR 0.87, 95% CI 0.78-0.96). Of those with viral loads in 2018 and 2019 (n=549), those who newly enrolled in Medicaid due to ME had 85% VS compared to 87-99% for other insurance plans (Figure 1c). In univariate analysis, age, income, and baseline viral load status were associated with viral suppression (Table 2), and those with Medicaid due to ME (aRR 0.90, 95% CI 0.81-1.00) were less likely to achieve VS compared with others. Figure 1 Table 1 Table 2 Conclusion The low uptake of ME was likely influenced by many PLWH already having Medicare. While the RWHAP supports high quality HIV care, Medicaid enrollment improves access to non-HIV care and should be supported by RWHAP. Given that engagement in care was high for PLWH who newly enrolled in Medicaid, the finding of lower VS is surprising. The discordance may be due to medication access gaps associated with changes in pharmacy logistics. Future studies with larger cohorts will need to examine how ME contributes to PLWH’s overall health and to ending the HIV epidemic. Disclosures Kathleen A. McManus, MD, MSCR, Gilead Sciences, Inc (Research Grant or Support, Shareholder) Rebecca Dillingham, MD, MPH, Gilead Sciences, Inc (Research Grant or Support)Warm Health Technologies, Inc (Consultant)
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