Do Persons Living with HIV Continue to Fill Prescriptions for Antiretroviral Drugs during a Gap in Care? Analysis of a Large Commercial Claims Database

Byrd, Kathy K.; Bush, Timothy J.; Gardner, Lytt I.

doi:10.1177/2325957417729750

Cited by 3 publications

(2 citation statements)

References 40 publications

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“…A recent analysis of a large billing claims database found that the proportion of persons who filled a prescription each month, throughout the entire length of gaps of more than 6 months, significantly decreased as the gap length increased. 22 This finding suggests that longer gaps do contribute more failures to refill medications than shorter gaps.…”

Section: Discussionmentioning

confidence: 99%

Gaps Up To 9 Months Between HIV Primary Care Visits Do Not Worsen Viral Load

Gardner

Marks²,

Patel

et al. 2018

AIDS Patient Care and STDs

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Current guidelines specify that visit intervals with viral monitoring should not exceed 6 months for HIV patients. Yet, gaps in care exceeding 6 months are common. In an observational cohort using US patients, we examined the association between gap length and changes in viral load status and sought to determine the length of the gap at which significant increases in viral load occur. We identified patients with gaps in care greater than 6 months from 6399 patients from six US HIV clinics. Gap strata were >6 to <7, 7 to <8, 8 to <9, 9 to <12, and ≥12 months, with viral load measurements matched to the opening and closing dates for the gaps. We examined visit gap lengths in association with two viral load measurements: continuous (log viral load at gap opening and closing) and dichotomous (whether patients initially suppressed but lost viral suppression by close of the care gap). Viral load increases were nonsignificant or modest when gap length was <9 months, corresponding to 10% or fewer patients who lost viral suppression. For gaps ≥12 months, there was a significant increase in viral load as well as a much larger loss of viral suppression (in 23% of patients). Detrimental effects on viral load after a care gap were greater in young patients, black patients, and those without private health insurance. On average, shorter gaps in care were not detrimental to patient viral load status. HIV primary care visit intervals of 6 to 9 months for select patients may be appropriate.

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Section: Discussionmentioning

confidence: 99%

Gaps Up To 9 Months Between HIV Primary Care Visits Do Not Worsen Viral Load

Gardner

Marks²,

Patel

et al. 2018

AIDS Patient Care and STDs

Self Cite

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“…Using a median value of 19%, we changed this to a monthly probability of each person taking a gap that month, 1e −0.19 * (1/12) = 0.016. Because 69% of those who experienced a gap never filled their prescriptions during the gap, 26 we assumed they were not virally suppressed and did not accrue costs (except for non-HIV medications). The duration of the gap was selected from a truncated normal distribution with a mean of 3 months, a standard deviation of 3 months, and lower and upper bounds of 1 and 12 months.…”

Section: Methodsmentioning

confidence: 99%

Estimated Lifetime HIV–Related Medical Costs in the United States

et al. 2021

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Background: Lifetime cost estimates are a useful tool in measuring the economic burden of HIV in the United States. Previous estimation methods need to be updated, given improving antiretroviral therapy regimens and updated costs. Methods:We used an updated version of the agent-based model progression and transmission of HIV (PATH) 3.0 to reflect current regimens and costs. We simulated a cohort of those infected in 2015 until the last person had died to track the lifetime costs for treatment of HIV, including HIV health care utilization costs (inpatient, outpatient, opportunistic infection prophylaxis, non-HIV medication, and emergency department), opportunistic infection treatment costs, and testing costs. We assumed a median per-person diagnosis delay of 3 years and a 3% base monthly probability of dropout from care for a base-case scenario. Additionally, we modeled a most favorable scenario (median diagnosis delay of 1 year and 1% base dropout rate) and a least favorable scenario (median diagnosis delay of 5 years and 5% base dropout rate).

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