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—
Covariates | Total No. | HAART,a No. (%) | Suboptimal Treatment,b No. (%) | No ARV, No. (%) | P |
Total | 3259 | 1190 (36.5) | 855 (26.2) | 1214 (37.3) | |
Race/ethnicity | |||||
Non-Hispanic White | 457 | 228 (49.9) | 95 (20.8) | 134 (29.3) | <.01 |
Non-Hispanic Black | 2367 | 888 (37.5) | 701 (29.6) | 778 (32.9) | |
Hispanic | 346 | 51 (14.7) | 41 (11.9) | 254 (73.4) | |
Other | 89 | 23 (25.8) | 18 (20.2) | 48 (53.9) | |
Metro indexc | |||||
Large metro | 1662 | 553 (33.3) | 437 (26.3) | 672 (40.4) | <.01 |
Small metro | 1008 | 406 (40.3) | 257 (25.5) | 345 (34.2) | |
Nonmetro | 589 | 231 (39.2) | 161 (27.3) | 197 (33.5) | |
AIDS condition | |||||
Yes | 155 | 57 (36.8) | 46 (29.7) | 52 (33.6) | .51 |
No | 3104 | 1133 (36.5) | 809 (26.1) | 1162 (37.4) | |
Comorbidity | |||||
Yes | 1231 | 431 (35.0) | 356 (28.9) | 444 (36.1) | .02 |
No | 2028 | 759 (37.4) | 499 (24.6) | 770 (38.0) | |
Cesarean delivery | |||||
Yes | 1824 | 695 (38.1) | 506 (27.7) | 623 (34.2) | <.1 |
No | 1435 | 495 (34.5) | 349 (24.3) | 591 (41.2) | |
Months enrolled in Medicaidd | |||||
< 3 mo | 260 | 7 (2.7) | 6 (2.3) | 247 (95.0) | <.01 |
≥ 3 mo | 2999 | 1183 (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.
Full article at: http://goo.gl/pPfvjS
By: Shun Zhang, MD, MPH, 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
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.
More at: https://twitter.com/hiv_insight
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