HIV / STI
A case-control study of virologic failure among people living with HIV enrolled in a NYC-based Medicaid special needs plan Emma Kohrt* Emma Kohrt Brianne Olivieri-Mui Rob Cavanaugh Brandon Dionne
Background: Viral suppression is essential for optimizing the health of people living with HIV (PLWH) and preventing HIV transmission. Therefore, there is a critical need to identify barriers to suppression. This study examined factors associated with virologic failure among PLWH enrolled in a Medicaid Special Needs Plan (SNP).
Methods: This matched case-control study used 2016-2018 claims data from Amida Care, a managed care organization administering a Medicaid SNP in New York City. Cases had at least one occurrence of virologic failure, defined as two consecutive viral load tests >200 copies/ml in a 4-month period. Controls had no instances of virologic failure. Both groups were enrolled in Amida Care for at least one year prior to the index date, or the date of the second viral load test in the 4-month period. Matching was performed using a 31-day window from the index date, age, and race. Conditional logistic regression models analyzed associations between exposures, (Social Deprivation Index (SDI) scores, gender, advanced care coordination, HIV stage, length of enrollment, and polypharmacy use) and virologic failure.
Results: The matched study sample included 2556 PLWH enrolled in Amida Care, with 62% male (n=1600), a mean age of 42.94 years (SD = 10.04), and a mean SDI score of 92.26 (SD = 13.91). Virologic failure was significantly associated with HIV Stage III diagnosis compared to Stages I/II (OR = 2.09, 95% CI: 1.69-2.58) and advanced care coordination for <6 months compared to never enrolled or enrolled for 6+ months (OR = 2.21, 95% CI: 1.36-3.58). Polypharmacy was associated with reduced odds of virologic failure (OR = 0.71, 95% CI: 0.54-0.92). While also significant, greater social deprivation (higher SDI scores) had little effect (OR = 1.01, 95% CI: 1.00-1.02).
Conclusion: By 6 months, advanced care coordination is no longer associated with virologic failure reflecting effective targeted efforts to increase engagement of high-risk PLWH in health care.