Abstract
ObjectivesThe purpose of this study was to explore the racial and ethnic disparities in initiation of antiretroviral treatment (ARV treatment or ART) among HIV-infected Medicaid enrollees 18–64 years of age in 14 southern states which have high prevalence of HIV/AIDS and high racial disparities in HIV treatment access and mortality.MethodsWe used Medicaid claims data from 2005 to 2007 for a retrospective cohort study. We compared frequency variances of HIV treatment uptake among persons of different racial- ethnic groups using univariate and multivariate methods. The unadjusted odds ratio was estimated through multinomial logistic regression. The multinomial logistic regression model was repeated with adjustment for multiple covariates.ResultsOf the 23,801 Medicaid enrollees who met criteria for initiation of ARV treatment, only one third (34.6%) received ART consistent with national guideline treatment protocols, and 21.5% received some ARV medication, but with sub-optimal treatment profiles. There was no significant difference in the proportion of people who received ARV treatment between black (35.8%) and non-Hispanic whites (35.7%), but Hispanic/Latino persons (26%) were significantly less likely to receive ARV treatment.ConclusionsOverall ARV treatment levels for all segments of the population are less than optimal. Among the Medicaid population there are no racial HIV treatment disparities between Black and White persons living with HIV, which suggests the potential relevance of Medicaid to currently uninsured populations, and the potential to achieve similar levels of equality within Medicaid for Hispanic/Latino enrollees and other segments of the Medicaid population.
Highlights
There are nearly 50,000 new HIV infections each year and more than 1.1 million people living with HIV in the United States
Black and Hispanic/Latino individuals comprise the majority of new HIV infections, and of people living with the disease in the United States [2]
The purpose of this study is to explore the racial/ethnic disparities in the initiation of antiretroviral treatment among HIV-infected Medicaid enrollees in 14 southern states
Summary
There are nearly 50,000 new HIV infections each year and more than 1.1 million people living with HIV in the United States. Black and Hispanic/Latino individuals comprise the majority of new HIV infections, and of people living with the disease in the United States [2]. Black or African American persons represented 44% and Hispanic/Latino individuals represented 20% of new HIV infections in 2009. The Centers for Disease Control and Prevention (CDC) released data in July of 2012 documenting the percentage of people in five stages on the HIV Care Continuum: diagnosed, linked to care, retained in care, prescribed ARV, and virally suppressed. Minority ( Black and Hispanic/ Latino) individuals, are diagnosed, linked to care, retained in care, prescribed ARV, and virally suppressed less than Whites [5]
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