Retetio i HIV care amog a commercially isured populatio, 2006-2012 Kathy Byrd, MD, MPH 10th Iteratioal Coferece o HIV Treatmet ad Prevetio Adherece Jue 28 30, 2015 Natioal Ceter for HIV/AIDS, Viral Hepatitis, STD, ad TB Prevetio Divisio of HIV/AIDS Prevetio
Itroductio The HIV Care Cotiuum describes the ecessary steps to reach HIV viral suppressio Retetio i care is a critical compoet of the Care Cotiuum Retaied persos have earlier ART iitiatio, improved viral suppressio ad decreased morbidity ad mortality Retetio estimates rage from 51% - 89% depedig o data source
Objectives To estimate the proportio of commercially isured persos with HIV who were retaied i care, cotiued i care, had a gap i care ad re-egaged i care To determie factors associated with a gap i care To estimate the proportio of commercially isured persos with HIV, who were ot i care, who cotiued to receive HIV-related laboratory services
Study database: MarketSca Commercial Claims ad Ecouters Database, 2006-2012 Cotais paid, de-idetified, patiet-level healthcare claims from ipatiet, outpatiet, ad pharmaceutical services Icludes iformatio o coditios diagosed ad services performed Claims are for active employees, early retirees ad COBRA cotiuers isured by employer-sposored plas Every erollee is assiged a uique idetifier that allows trackig of idividual patiets across differet types of claims ad over multiple years
Idetificatio of persos with HIV Idetified from ipatiet ad outpatiet service claims i caledar year 2006 Oe or more ICD-9-CM diagostic billig codes for HIV 042; HIV disease V08; asymptomatic HIV ifectio status 079.53; HIV type 2 795.71; ospecific serologic evidece of HIV
Study iclusio criteria ICD-9-CM code for HIV/AIDS i 2006 ( = 15,187) 18 years of age i 2006 Cotiuously erolled i employer-sposored isurace for at least 10 moths out of each 12-moth period durig the iitial 24-moth retetio period ( = 14,952) 1 outpatiet claim with a physicia, urse practitioer or physicia s assistat i the first 6 moths of the retetio period ( = 7,913)
Case defiitios Retetio i care: 1 office visit claim durig each six-moth period of the retetio period w/ miimal of 60 days betwee visits Retetio period: the first 24-moth measuremet period (moths 0 24) from the date of the first service claim cotaiig a ICD-9-CM code for HIV/AIDS Cotiuatio i care: 1 office visit claim durig each subsequet six-moth iterval, after the retetio period, w/ miimal of 60 days betwee visits
Case defiitios cotiued Gap i care: o office visit claim for >6 moths Re-egagemet i care: 1 office visit claim after a gap i care Out of care: does ot meet defiitio for retaied or cotiued i care
Methods Calculated uweighted proportios Persos retaied i care durig the 24 moth retetio period Persos cotiued i care after the retetio period Persos with a gap i care Persos re-egaged i care after experiecig a gap i care Persos followed for up to 84 moths (years 2006 2012) Persos who were o loger erolled i isurace were cesored at the time of diserollmet
Aalysis Multivariable Cox proportioal hazards models were coducted to determie factors associated with gaps i care. Proportio of persos ot i care who received HIV-related laboratory tests was also determied 2 CD4 ad/or viral load tests at least 90 days apart
Cohort characteristics % % Total 7,913 100 Age group (media age: 45 years ) Sex 18 39 2,247 28 Male 6,139 78 40 59 5,276 67 Female 1,739 22 60 355 5 Regio Hepatitis B co-ifectio 117 2 Northeast 916 12 Hepatitis C co-ifectio 269 3 North Cetral 1,083 14 Metal illess diagosis 851 11 South 4,062 52 Alcohol/substace abuse diagosis 118 2 West 1,817 23 Charlso co-morbidities* 0 6,045 77 1 1,833 23 *Icludes 16 co-morbidities (7) ad excludes HIV, hepatitis B, hepatitis C, metal illess ad alcohol/substace abuse. There are a total of 17 Charlso co-morbidities, icludig HIV ad mild liver disease (which icludes viral hepatitis). Sice the etire sample was HIVifected ad because we wated to evaluate hepatitis B ad hepatitis C co-ifectio separately, we removed HIV, hepatitis B, ad hepatitis C from the list of Charlso co-morbidities evaluated.
Proportio of persos with HIV who were retaied ad cotiued i care, MarketSca Commercial Claims ad Ecouters Database, 2006-2012 Retetio period ( 0 24 ) 30 36 42 48 54 60 66 72 78 84 = 7,913 Still erolled^ ---- (100) 5,142 (84) 5,142 (84) 4,317 (71) 4,317 (71) 3,667 (60) 3,667 (60) 3,150 (51) 3,150 (51) 1,950 (32) 1,950 (32) Retaied/ cotiued i care 6,121 (77) 4,874 (95) 4,593 (89) 3,728 (86) 3,529 (82) 2,884 (79) 2,756 (75) 2,271 (72) 2,178 (69) 1,374 (70) 1,258 (65) ^Still erolled icludes those who met cotiuous erollmet criteria (i.e. had 10 moths of cotiuous erollmet i the MarketSca Commercial claims dataset durig each 12 moth measuremet period). *The deomiator for those cotiued i care, is persos still erolled i the MarketSca Commercial claims dataset durig the specified time period
Proportio of persos with HIV who were retaied ad cotiued i care, MarketSca Commercial Claims ad Ecouters Database, 2006-2012 Retetio period ( 0 24 ) 30 36 42 48 54 60 66 72 78 84 = 7,913 Still erolled^ ---- (100) 5,142 (84) 5,142 (84) 4,317 (71) 4,317 (71) 3,667 (60) 3,667 (60) 3,150 (51) 3,150 (51) 1,950 (32) 1,950 (32) Retaied/ cotiued i care 6,121 (77) 4,874 (95) 4,593 (89) 3,728 (86) 3,529 (82) 2,884 (79) 2,756 (75) 2,271 (72) 2,178 (69) 1,374 (70) 1,258 (65) ^Still erolled icludes those who met cotiuous erollmet criteria (i.e. had 10 moths of cotiuous erollmet i the MarketSca Commercial claims dataset durig each 12 moth measuremet period). *The deomiator for those cotiued i care, is persos still erolled i the MarketSca Commercial claims dataset durig the specified time period
Proportio of persos with HIV who experieced a gap i care ad those who re-egaged i care, MarketSca Commercial Claims ad Ecouters Database, 2006-2012 Retetio period ( 0 24 ) 30 36 42 48 54 60 66 72 78 84 N = 6,121 Gap i care* ---- 268 (5) 392 (8) 309 (7) 358 (8) 336 (9) 352 (10) 314 (10) 270 (9) 163 (8) 281 (14) Reegaged i care* ---- ---- 157 (3) 178 (4) 189 (4) 154 (4) 190 (5) 143 (5) 171 (5) 101 (5) 79 (4) *The deomiator for gap i care ad re-egaged i care is persos still erolled i the MarketSca Commercial claims dataset durig the specified time period.
Gaps ad re-egagemet i care Media time to first gap i care: 15 moths (IQR: 6 30) Media legth of gap i care: 3.2 moths (IQR: 1.3 7.1) Of the 1,551 persos who experieced a gap i care 70% (=1,086) re-egaged i care at least oce 22% (=241) re-egaged more tha oce Media time cotiued i care after re-egagemet: 17.4 moths (IQR: 6.9 31.0)
Factors associated with a gap i care Characteristic Hazard ratio (95% CI) P-value 1 Charlso co-morbidity 0.84 (0.77, 0.92) <0.001 Age 40 59 years 0.86 (1.79, 0.94) <0.001 Diagosed with metal illess 0.78 (0.69, 0.88) <0.001 Diagosed with alcohol/substace abuse 1.57 (1.13, 2.17) 0.007 North Cetral regio 1.34 (1.20, 1.50) <0.001
Laboratory tests for persos ot i care Moth % who received 2 CD4/VL tests 24 417 23% 36 190 35% 48 200 37% 60 217 40% 72 208 43% icludes persos who were cotiuously erolled but who did ot have 1 visit claim for each of the six moth periods of the specified 12 moth iterval
Limitatios Commercially isured, stably employed populatio which is ot geeralizable to etire populatio with HIV Office visits claims were ot ecessarily associated with a claim listig a HIV ICD-9-CM code o the date of the visit; office visits, therefore, may have bee for o-hiv related issues No data available for race/ethicity
Discussio High level of retetio ad cotiuatio i care amog this commercially isured populatio with HIV Retetio estimate was higher tha atioal estimates. Higher estimates may be due to stable employmet ad better access to care Gaps i care were commo ad moderately short ad the majority re-egaged i care
Discussio cotiued Most factors associated with a gap i care were similar to other studies with the exceptio of metal illess Sigificat proportio of those ot i care cotiued to receive HIV-related laboratory testig idicatig some egagemet i care. May reflect legtheig of time betwee cliic appoitmets for stable patiets * Citatios, refereces, ad credits
Thak you! For more iformatio please cotact Ceters for Disease Cotrol ad Prevetio 1600 Clifto Road NE, Atlata, GA 30333 Telephoe: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 Visit: www.cdc.gov Cotact CDC at: 1-800-CDC-INFO or www.cdc.gov/ifo The fidigs ad coclusios i this report are those of the authors ad do ot ecessarily represet the official positio of the Ceters for Disease Cotrol ad Prevetio. Natioal Ceter for HIV/AIDS, Viral Hepatitis, STD, ad TB Prevetio Divisio of HIV/AIDS Prevetio