PATTERNS AND CORRELATES OF LINKAGE TO APPROPRIATE HIV CARE FOLLOWING HIV DIAGNOSIS IN THE UNITED STATES MEDICAID POPULATION

Purpose:   Timely linkage to appropriate care after human immunodeficiency virus (HIV) diagnosis is critical for optimizing patient outcomes. A key goal of the U.S. National HIV/AIDS Strategy is to develop a “seamless system to immediately link people to continuous and coordinated quality care when they learn they are infected with HIV.” Information on the patterns and correlates of linkage is prerequisite to the development of optimal linkage policies. While several studies have investigated these issues, none have focused solely on Medicaid beneficiaries – the largest segment of the insured HIV population, which will grow even larger under the Affordable Care Act. This study examined patterns and correlates of linkage to appropriate HIV care following HIV diagnosis in the U.S. Medicaid population.

Method:   Retrospective study using claims data from 15 U.S. Medicaid Programs. Study sample comprised patients aged 18-64 years with ≥1 HIV test between 1/1/2003-5/1/2010, accompanied or followed by HIV diagnosis. “Test Index” corresponded to the HIV test that was temporally proximate to first HIV diagnosis. Study endpoint was linkage to appropriate HIV care, defined as receipt of CD4 and viral load tests as per U.S. treatment guidelines; a more restrictive definition – receipt of CD4, viral load, and drug resistance testing – was developed for use in sensitivity analyses. Time-to-event and multivariable logistic regression analyses characterized patterns and correlates of linkage to appropriate care.

Result:   Study included 6,684 patients: mean age 35 years, 70% female, 47% black race. In the main analysis, the 1-year Kaplan Meier-estimated probability of linkage to appropriate HIV care was 21.0%, increasing to 26.4% after 5 years; in sensitivity analyses using the more restrictive definition of appropriate care, these probabilities were 9.2% after 1 year and 11.5% after 5 years. In both analyses, the majority of patients who linked to appropriate HIV care did so within 3 months after Test Index. Multivariable logistic regression analyses indicated that the odds of linkage varied significantly by sex, race/ethnicity, and clinical factors.

Conclusion:   This study determined that, out of every 10 Medicaid patients diagnosed with HIV, only 1 to 2 linked to appropriate HIV care within 1 year of Test Index.  These findings underscore the need for more effective interventions in the Medicaid HIV+ population promoting timely linkage to appropriate post diagnosis care.