Ten-year trends in antiretroviral therapy persistence among US Medicaid beneficiaries

被引:0
|
作者
Youn, Bora [1 ]
Shireman, Theresa I. [1 ]
Lee, Yoojin [1 ]
Galarraga, Omar [1 ]
Rana, Aadia I. [2 ]
Justice, Amy C. [3 ,4 ]
Wilson, Ira B. [1 ]
机构
[1] Brown Univ, Dept Hlth Serv Policy & Practice, Sch Publ Hlth, 121 S Main St,Box G-S121-7, Providence, RI 02912 USA
[2] Brown Univ, Miriam Hosp, Alpert Med Sch, Dept Med, Providence, RI USA
[3] Yale Sch Med, Dept Internal Med, New Haven, CT USA
[4] Vet Affairs Connecticut Healthcare Syst, West Haven, CT USA
关键词
antiretroviral therapy; Medicaid; medication adherence; medication persistence; United States; UNITED-STATES; TEMPORAL TRENDS; HIV-INFECTION; ADHERENCE; DISCONTINUATION; CARE; MEDICATIONS; DISPARITIES; POPULATION; OUTCOMES;
D O I
10.1097/QAD.0000000000001541
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Objective: Whether the rate of HIV antiretroviral therapy (ART) persistence has improved over time in the United States is unknown. We examined ART persistence trends between 2001 and 2010, using non-HIV medications as a comparator. Methods: We conducted a retrospective cohort study using Medicaid claims. We defined persistence as the duration of treatment from the first to the last fill date before a 90-day permissible gap and used Kaplan-Meier curves and Cox proportional hazard models to assess crude and adjusted nonpersistence. The secular trends of ART persistence in 43 598 HIV patients were compared with the secular trends of persistence with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEI/ARB), statins, and metformin in non-HIV-infected patients and subgroups of HIV patients who started these control medications while using ART. Results: Median time to ART nonpersistence increased from 23.9 months in 20012003 to 35.4 months in 2004-2006 and was not reached for those starting ART in 2007-2010. In adjusted models, ART initiators in 2007-2010 had 11% decreased hazard of nonpersistence compared with those who initiated in 2001-2003 (P<0.001). For non-HIV patients initiating angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB), statins, and metformin, the hazard ratios for nonpersistence comparing 2007-2010 to 2001-2003 were 1.07, 0.94, and 1.02, respectively (all P<0.001). For HIV patients initiating the three control medications, the hazard ratios of nonpersistence comparing 2007-2010 to 2001-2003 were 0.71, 0.65, and 0.63, respectively (all P<0.001). Conclusion: Persistence with ART improved between 2001 and 2010. Persistence with control medications improved at a higher rate among HIV patients using ART than HIVnegative controls. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
引用
收藏
页码:1697 / 1707
页数:11
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