title: Patterns and correlates of linkage to appropriate HIV care after HIV diagnosis in the US Medicaid population.
abstract: BACKGROUND
  Timely linkage to appropriate care after human immunodeficiency virus (HIV) diagnosis is critical to optimizing patient outcomes. Medicaid is the largest source of health care coverage for patients with HIV in the United States, yet no studies of linkage to appropriate HIV care have focused solely on the Medicaid population.
  
  
  METHODS
  This is a retrospective study using Medicaid claims data from 15 states. Study sample comprised patients aged 18 to 64 years with 1 or more HIV tests between January 1, 2003, to May 1, 2010, followed or accompanied by HIV diagnosis. The "Test Index" corresponded to the HIV test that was temporally proximate to first HIV diagnosis. Study end point was linkage to appropriate HIV care, defined as receipt of CD4 and viral load tests as per US treatment guidelines. Time-to-event analyses characterized patterns and correlates of linkage to appropriate care.
  
  
  RESULTS
  This study included 6684 patients, with a mean age of 35 years, 70% female, and 47% black race. Overall, 21.0% of patients linked to appropriate care within 1 year of the Test Index and 26.4% within 5 years. Compared with whites, blacks had a significantly shorter time to linkage to HIV appropriate care (hazard ratio, 2.034; P < 0.001).
  
  
  CONCLUSIONS
  These findings in Medicaid patients newly diagnosed with HIV contrast with prior research show disparities in access to HIV care favoring whites. Overall, 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.
authors.affiliation: Truven Health Analytics, Washington, DC, USA. stephen.johnston@truvenhealth.com
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Johnston
authors.forename: Timothy
authors.initials: T
authors.lastname: Juday
authors.forename: Daniel
authors.initials: D
authors.lastname: Seekins
authors.forename: Tony
authors.initials: T
authors.lastname: Hebden
authors.forename: Nicole
authors.initials: N
authors.lastname: Fulcher
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Farr
authors.forename: Bong-Chul
authors.initials: BC
authors.lastname: Chu
authors.forename: C Daniel
authors.initials: CD
authors.lastname: Mullins
mesh_terms: D000293:Adolescent; D000328:Adult; D044383:Black People; D016208:Databases, Factual; D003695:Delivery of Health Care; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000191:economics / Q000208:ethnology / Q000628:therapy*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities / Q000208:ethnology; D006801:Humans; D007344:Insurance Claim Reporting; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States; D044465:White People; D055815:Young Adult; D001741:Black or African American