Assessing Antiretroviral Use During Gaps in HIV Primary Care Using Multisite Medicaid Claims and Clinical Data

Area of Science:

• Public Health
• Infectious Diseases
• HIV/AIDS Research

Background:

• Clinic visit frequency may not accurately reflect retention in HIV care.
• Some patients with gaps in primary care are still on antiretroviral therapy (ART) and virally suppressed.

Purpose of the Study:

• To determine if individuals with gaps in HIV primary care obtain ART during these gaps.
• To evaluate factors associated with ART receipt during care gaps.

Main Methods:

• Combined HIV Research Network and Medicaid data from 5 sites.
• Used multinomial logistic regression to analyze factors associated with ART prescriptions during care gaps.
• Included patients with at least 180 days between HIV outpatient clinic visits.

Main Results:

• Over half (54%) of patients with HIV primary care gaps received a new ART prescription during the gap.
• Viral load suppression before the gap, duration of the gap, and Medicaid enrollment proportion were associated with ART receipt.
• Women, older individuals, and those with viral suppression were less likely to have a care gap.

Conclusions:

• Medicaid-insured individuals frequently receive ART during HIV care gaps.
• Retention measures ignoring ART use and viral suppression may misclassify patients.
• Current retention metrics may inaccurately label patients on ART as not retained.