Abstract
BackgroundPeople living with HIV are diagnosed with age-related chronic health conditions, including cardiovascular disease, at higher than expected rates. Medical management of these chronic health conditions frequently occur in HIV specialty clinics by providers trained in general internal medicine, family medicine, or infectious disease. In recent years, changes in the healthcare financing for people living with HIV in the U.S. has been dynamic due to changes in the Affordable Care Act. There is little evidence examining how healthcare financing characteristics shape primary and secondary cardiovascular disease prevention among people living with HIV. Our objective was to examine the perspectives of people living with HIV and their healthcare providers on how healthcare financing influences cardiovascular disease prevention.MethodsAs part of the EXTRA-CVD study, we conducted in-depth, semi-structured interviews with 51 people living with HIV and 34 multidisciplinary healthcare providers and at three U.S. HIV clinics in Ohio and North Carolina from October 2018 to March 2019. Thematic analysis using Template Analysis techniques was used to examine healthcare financing barriers and enablers of cardiovascular disease prevention in people living with HIV.ResultsThree themes emerged across sites and disciplines (1): healthcare payers substantially shape preventative cardiovascular care in HIV clinics (2); physician compensation tied to relative value units disincentivizes cardiovascular disease prevention efforts by HIV providers; and (3) grant-based services enable tailored cardiovascular disease prevention, but sustainability is limited by sponsor priorities.ConclusionsWith HIV now a chronic disease, there is a growing need for HIV-specific cardiovascular disease prevention; however, healthcare financing complicates effective delivery of this preventative care. It is important to understand the effects of evolving payer models on patient and healthcare provider behavior. Additional systematic investigation of these models will help HIV specialty clinics implement cardiovascular disease prevention within a dynamic reimbursement landscape.Trial registrationClinical Trial Registration Number: NCT03643705.
Highlights
People living with bHCP Healthcare Providers (HIV) are diagnosed with age-related chronic health conditions, including cardiovascular disease, at higher than expected rates
As HIV care has evolved into chronic disease management, HIV providers have increasingly taken on the role of primary care physicians and are managing the growing number of comorbidities
The EXTRA-cardiovascular disease (CVD) study is a randomized clinical effectiveness trial testing the efficacy of a multi-component, nurse-led intervention to reduce hypertension and high cholesterol in adults living with HIV [12]
Summary
People living with HIV are diagnosed with age-related chronic health conditions, including cardiovascular disease, at higher than expected rates. Medical management of these chronic health conditions frequently occur in HIV specialty clinics by providers trained in general internal medicine, family medicine, or infectious disease. As PLWH are living into their 8th and 9th decades, these individuals face increasing rates of other prevalent age-related chronic health conditions including cardiovascular disease (CVD). PLWH have a two-fold risk of developing CVD and experiencing an acute cardiac event compared to those without HIV [1] While some of this excess cardiovascular risk is due to HIV-related factors (e.g., inflammation, HIV medication), traditional risk factors including hypertension, hyperlipidemia, obesity, and smoking confer considerable risk [2]. In the United States, healthcare is financed by a fragmented patchwork of payers including private employer-sponsored insurers, publicallyfunded Medicare and Medicaid for retirees and those with low-income, charity care for those who lack sufficient insurance, and the federally-funded Ryan White HIV/AIDS Program
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