25 January 2013
Fewer than one quarter of US Medicaid patients diagnosed with HIV infection began care within 1 year, according to results of a 15-state study. Blacks began HIV care two times faster than whites.
Medicaid—government health support for low-income people—is the largest single source of health care for HIV-positive people in the United States. This retrospective analysis of Medicaid claims data from 15 states sought to determine linkage to care among Medicaid recipients diagnosed with HIV infection.
The study involved 18- to 64-year-olds who had one or more HIV tests yielding an HIV diagnosis between 1 January 2003 and 1 May 2010. The researchers defined linkage to care as receiving CD4 and viral load tests according to US treatment guidelines.
This analysis involved 6684 people with an average age of 35 years. While 70% of participants were women, 47% were black.
Within 1 year of testing positive for HIV, only 21% of study participants had entered care for HIV infection. Within 5 years of testing positive, that proportion had risen only to 26.4%.
Compared with whites, blacks had a twice faster time to entering HIV care (hazard ratio 2.034, P < 0.001). The researchers note that this finding contrasts with earlier research showing “disparities in access to HIV care favoring whites.”
They stress that “the proportion of patients who linked to appropriate HIV care was very low given the availability of effective treatment, suggesting a need for more effective interventions promoting timely linkage to appropriate care after diagnosis.”
Source: Stephen S. Johnston, Timothy Juday, Daniel Seekins, Tony Hebden, Nicole Fulcher, Amanda M. Farr, Bong-Chul Chu, C. Daniel Mullins. Patterns and correlates of linkage to appropriate hiv care after HIV diagnosis in the US Medicaid population. Sexually Transmitted Diseases. 2013; 40: 18-25.
For the study abstract
(Downloading the complete article requires a subscription to Sexually Transmitted Diseases or an online payment; the abstract is free.)