Racial/Ethnic Disparities in Antiretroviral Treatment Among HIV-Infected Pregnant Medicaid Enrollees, 2005–2007

Zhang, Shun; Senteio, Charles; Felizzola, Jesus; Rust, George

doi:10.2105/ajph.2013.301328

Cited by 11 publications

(9 citation statements)

References 42 publications

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“…As argued previously, this strategy can include many individuals without HIV disease, who did not seek (and did not need) HIV treatment. 12 Similarly, Zhang and coauthors 21 reported that 37.3% of HIV-positive Medicaid-enrolled pregnant women received no ARV treatment in pregnancy. As screening pregnant women for HIV is the standard of care, 22 this method may include many who were only screened for HIV, but did not have HIV disease.…”

Section: Discussionmentioning

confidence: 99%

Identifying a Sample of HIV-Positive Beneficiaries From Medicaid Claims Data and Estimating Their Treatment Costs

Leibowitz

Desmond

2015

Am J Public Health

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Objectives We sought to identify people living with HIV/AIDS (PLWHA) from Medicare and Medicaid claims data to estimate Medicaid costs for treating HIV/AIDS in California. We examined how alternate methods of identifying the relevant sample affect estimates of per capita costs. Methods We analyzed data on Californians enrolled in Medicaid with an HIV/AIDS diagnosis reported in 2007 Medicare or Medicaid claims data. We compared alternative selection criteria by examining use of antiretroviral drugs, HIV-specific monitoring tests, and medical costs. We compared the final sample and average costs with other estimates of the size of California’s HIV/AIDS population covered by Medicaid in 2007 and their average treatment costs. Results Eighty-seven percent (18|290) of potentially identifiable HIV-positive individuals satisfied at least 1 confirmation criterion. Nearly 80% of confirmed observations had claims for HIV-specific tests, compared with only 3% of excluded cases. Female Medicaid recipients were particularly likely to be miscoded as having HIV. Medicaid treatment spending for Californians with HIV averaged $33|720 in 2007. Conclusions The proposed algorithm displays good internal and external validity. Accurately identifying HIV cases in claims data is important to avoid drawing biased conclusions and is necessary in setting appropriate HIV managed-care capitation rates.

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Section: Discussionmentioning

confidence: 99%

Identifying a Sample of HIV-Positive Beneficiaries From Medicaid Claims Data and Estimating Their Treatment Costs

Leibowitz

Desmond

2015

Am J Public Health

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“…Persons from these states account for approximately one third of all US Medicaid enrollees and about half of all African American Medicaid enrollees in the United States. 39 These states, mostly in the southern United States, also account for the greatest burden of HIV among older people. 1 Medicaid is also the largest source of health coverage for PLWHA.…”

Section: Methodsmentioning

confidence: 99%

The Influence of Race and Comorbidity on the Timely Initiation of Antiretroviral Therapy Among Older Persons Living With HIV/AIDS

et al. 2014

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Objectives We examined whether the timely initiation of antiretroviral therapy (ART) differed by race and comorbidity among older (≥ 50 years) people living with HIV/AIDS (PLWHA). Methods We conducted frequency and descriptive statistics analysis to characterize our sample, which we drew from 2005–2007 Medicaid claims data from 14 states. We employed univariate and multivariable Cox regression analyses to evaluate the relationship between race, comorbidity, and timely ART initiation (≤ 90 days post-HIV/AIDS diagnosis). Results Approximately half of the participants did not commence ART promptly. After we adjusted for covariates, we found that older PLWHA who reported a comorbidity were 40% (95% confidence interval = 0.26, 0.61) as likely to commence ART promptly. We found no racial differences in the timely initiation of ART among older PLWHA. Conclusions Comorbidities affect timely ART initiation in older PLWHA. Older PLWHA may benefit from integrating and coordinating HIV care with care for other comorbidities and the development of ART treatment guidelines specific to older PLWHA. Consistent Medicaid coverage helps ensure consistent access to HIV treatment and care and may eliminate racial disparities in timely ART initiation among older PLWHA.

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“…(1) Unfortunately, health disparities in access to ART as well as the demands of long-term medication adherence have meant that the full benefits of HIV treatment are often not realized. (2 3) Adverse social conditions of poverty are among the most consistent predictors of disease progression and morbidity in people living with HIV. (4) Food insecurity, defined as limited access to nutritious food to meet dietary needs for an active and healthy life, is prevalent in US urban centers among people living with HIV.…”

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confidence: 99%

Food Insecurity and Other Poverty Indicators Among People Living with HIV/AIDS: Effects on Treatment and Health Outcomes

et al. 2014

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Health disparities in access to antiretroviral therapy (ART) as well as the demands of long-term medication adherence have meant the full benefits of HIV treatment are often not realized. In particular, food insecurity has emerged as a robust predictor of ART non-adherence. However, research is limited in determining whether food insecurity uniquely impedes HIV treatment or if food insecurity is merely a marker for poverty that interferes more broadly with treatment. This study examined indicators of poverty at multiple levels in a sample of 364 men and 157 women living with HIV recruited through an offering of a free holiday food basket. Results showed that 61% (N = 321) of participants had experienced at least one indicator of food insecurity in the previous month. Multivariate analyses showed that food insecurity was closely tied to lack of transportation. In addition, food insecurity was associated with lacking access to ART and poor ART adherence after adjusting for neighbourhood poverty, living in an area without a supermarket (food desert), education, stable housing, and reliable transportation. Results therefore affirm previous research that has suggested food insecurity is uniquely associated with poor ART adherence and calls for structural interventions that address basic survival needs among people living with HIV, especially food security.

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Racial/Ethnic Disparities in Antiretroviral Treatment Among HIV-Infected Pregnant Medicaid Enrollees, 2005–2007

Cited by 11 publications

References 42 publications

Identifying a Sample of HIV-Positive Beneficiaries From Medicaid Claims Data and Estimating Their Treatment Costs

Identifying a Sample of HIV-Positive Beneficiaries From Medicaid Claims Data and Estimating Their Treatment Costs

The Influence of Race and Comorbidity on the Timely Initiation of Antiretroviral Therapy Among Older Persons Living With HIV/AIDS

Food Insecurity and Other Poverty Indicators Among People Living with HIV/AIDS: Effects on Treatment and Health Outcomes

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