Sunday, December 13, 2015

Racial/Ethnic Disparities in Antiretroviral Treatment among HIV-Infected Pregnant Medicaid Enrollees, 2005–2007

Objectives. We examined racial/ethnic differences in prenatal antiretroviral (ARV) treatment among 3259 HIV-infected pregnant Medicaid enrollees.

Methods. We analyzed 2005–2007 Medicaid claims data from 14 southern states, comparing rates of not receiving ARVs and suboptimal versus optimal ARV therapy.

Results. More than one third (37.3%) had zero claims for ARV drugs. Three quarters (73.4%) of 346 Hispanic women received no prenatal ARVs. After we adjusted for covariates, Hispanic women had 3.89 (95% confidence interval = 2.58, 5.87) times the risk of not receiving ARVs compared with Whites. Hispanic women often had only 1 or 2 months of Medicaid eligibility, perhaps associated with barriers for immigrants. Less than 3 months of eligibility was strongly associated with nontreatment (adjusted odds ratio = 29.0; 95% confidence interval = 13.4, 62.7).

Conclusions. Optimal HIV treatment rates in pregnancy are a public health priority, especially for preventing transmission to infants. Medicaid has the surveillance and drug coverage to ensure that all HIV-infected pregnant women are offered treatment. States that offer emergency Medicaid coverage for only delivery services to pregnant immigrants are missing an opportunity to screen, diagnose, and treat pregnant women with HIV, and to prevent HIV in children.

TABLE 2—

Antiretroviral Drug Treatment Rates Among 3259 HIV-Infected Pregnant Women Enrolled in Medicaid: 14 Southern States, 2005–2007
CovariatesTotal No.HAART,a No. (%)Suboptimal Treatment,b No. (%)No ARV, No. (%)P
Total32591190 (36.5)855 (26.2)1214 (37.3)
Race/ethnicity
 Non-Hispanic White457228 (49.9)95 (20.8)134 (29.3)<.01
 Non-Hispanic Black2367888 (37.5)701 (29.6)778 (32.9)
 Hispanic34651 (14.7)41 (11.9)254 (73.4)
 Other8923 (25.8)18 (20.2)48 (53.9)
Metro indexc
 Large metro1662553 (33.3)437 (26.3)672 (40.4)<.01
 Small metro1008406 (40.3)257 (25.5)345 (34.2)
 Nonmetro589231 (39.2)161 (27.3)197 (33.5)
AIDS condition
 Yes15557 (36.8)46 (29.7)52 (33.6).51
 No31041133 (36.5)809 (26.1)1162 (37.4)
Comorbidity
 Yes1231431 (35.0)356 (28.9)444 (36.1).02
 No2028759 (37.4)499 (24.6)770 (38.0)
Cesarean delivery
 Yes1824695 (38.1)506 (27.7)623 (34.2)<.1
 No1435495 (34.5)349 (24.3)591 (41.2)
Months enrolled in Medicaidd
 < 3 mo2607 (2.7)6 (2.3)247 (95.0)<.01
 ≥ 3 mo29991183 (39.5)849 (28.3)967 (32.2)
Note. ARV = antiretroviral therapy; HAART = highly active antiretroviral therapy.
aHAART included at least 1 nucleoside reverse-transcriptase inhibitor and at least 2 other agents.
bSuboptimal treatment = some or any ARV treatment prescription other than HAART.
cLarge metro = metropolitan area with 1 million residents or more; small metro = metropolitan area with fewer than 1 million residents; nonmetro = rural area.
dEligible months over 3 years of Medicaid claim data.

Full article at:   http://goo.gl/pPfvjS

By:   Shun Zhang, MD, MPH,corresponding author Charles Senteio, MBA, Jesus Felizzola, MD, MHSA, MA, and George Rust, MD, MPH
Shun Zhang and George Rust are with the National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA. Charles Senteio is with the University of Michigan, School of Information, Ann Arbor. Jesus Felizzola is with the AIDS Education and Training Center, National Center for HIV Care in Minority Communities, HealthHIV, Washington, DC.
corresponding authorCorresponding author.
Correspondence should be sent to Shun Zhang, MD, MPH, CPH, Morehouse School of Medicine, 720 Westview, Atlanta, GA 30310 (e-mail:ude.msm@gnahzs). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link.
 

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