title: Evaluating patterns in retention, continuation, gaps, and re-engagement in HIV care in a Medicaid-insured population, 2006-2012, United States.
abstract: We used the US-based MarketScan(®) Medicaid Multi-state Databases to determine the un-weighted proportion of publically insured persons with HIV that were retained, continued, and re-engaged in care. Persons were followed for up to 84 months. Cox proportional hazards models were conducted to determine factors associated with gaps in care. Of the 6463 HIV cases identified in 2006, 61% were retained during the first 24 months, and 53% continued in care through 78 months. Between 8% and 30% experienced a gap in care, and 59% of persons who experienced a gap in care later re-engaged in care. Persons with one or more Charlson co-morbidities (HR 0.72, 95% CI 0.64-0.81), ages 40-59 (0.79, 0.71-0.88), mental illness diagnosis (0.79, 0.72-0.87), hepatitis C co-infection (0.83, 0.75-0.93), and female sex (0.86, 0.78-0.94) were less likely to experience a gap in care. Between 27% and 38% of those not retained in care continued to receive HIV-related laboratory services. This Medicaid claims database combines features of both clinic visits-based and surveillance lab-based surrogate measures to give a more complete picture of engagement in care than single-facility-based studies.
authors.affiliation: a Division of HIV/AIDS Prevention , Centers for Disease Control and Prevention , Atlanta , GA , USA.
authors.forename: Kathy K
authors.initials: KK
authors.lastname: Byrd
authors.affiliation: b Engility Corporation , Atlanta , GA , USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Furtado
authors.affiliation: a Division of HIV/AIDS Prevention , Centers for Disease Control and Prevention , Atlanta , GA , USA.
authors.forename: Tim
authors.initials: T
authors.lastname: Bush
authors.affiliation: a Division of HIV/AIDS Prevention , Centers for Disease Control and Prevention , Atlanta , GA , USA.
authors.forename: Lytt
authors.initials: L
authors.lastname: Gardner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D015897:Comorbidity; D003266:Continuity of Patient Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D015438:Health Behavior; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000458:organization & administration / Q000706:statistics & numerical data*; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D059012:Lost to Follow-Up; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D016016:Proportional Hazards Models; D014481:United States / Q000453:epidemiology; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV; Medicaid; Retention in care; engagement in care; gap in care