HIV / STI
Changes in ART Adherence From the Community to the Nursing Home for Adults with HIV Brianne Olivieri-Mui* Brianne Olivieri-Mui Ellen McCarthy Ira Wilson Mark Brennan-Ing Laura Senier Dae Hyun Kim
Background: Antiretroviral therapy (ART) adherence in nursing homes is lower than adherence in the community for adults with HIV (AWH). ART is necessary for people with HIV to achieve near normal life expectancy and viral suppression. Thus, it is critical to understand changes in ART adherence as people transition from the community to long-term NH residents.
Methods: Descriptive observational study of changes in ART adherence in the transition from the community to long NH stays for AWH in a 5% traditional Medicare 2014-2019 sample. Change in ART adherence was measured as the difference between the proportion of days covered (PDC) by a 3-drug antiretroviral regimen for 90 days before admission and up to 90 days after achieving long stay status. Change was grouped as never had, always had, lost, or gained ART. We describe person- and facility-level factors associated with ART adherence change.
Results: There were 713 long NH stays for 657 AWH across 598 NHs. The mean age of stays for AWH was 61 years (SD 11); 38% were age 65+. Stays of AWH were more often male (n=513, 72%), of Black race (n=393, 55%), for Medicaid dually eligible (n=419, 59%) with frailty (n=517, 73%), and located in the South (n=323, 45%). The average change in adherence from the community to NH long-stay was positive, gaining on average 13.8 days (SD 38) covered by ART. One in four (n=185, 26%) never had ART before or after admission to the NH, 3% (n=23) lost ART in the transition.
Conclusions and relevance: One of four nursing home stays lack ART because most individuals are not on ART at admission and do not initiate it during their stay. This highlights a critical need for prescription continuity and engaging PWH in treatment at the pivotal time of admission to a NH.