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APHA Scientific Session and Event Listing

Stephen Crystal, PhD, Scott M. Bilder, MS, James Walkup, PhD, and Ayse Akincigil, PhD. Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, 30 College Avenue, New Brunswick, NJ 08901, 732-932-8579, scrystal@rci.rutgers.edu

Background: Several studies have documented racial/ethnic disparities in HIV/AIDS outcomes. Suboptimal and disparate outcomes may arise if patients do not consistently remain on regimens over time. Therefore, it is important to examine treatment consistency over time, within broad, generalizable populations.

Methods: We used 2000 data on Medicaid beneficiaries in four states accounting for more than 40% of U.S. AIDS cases, measuring proportion of observation time covered by a filled prescription for PI/NNRTI antiviral medications, from first-observed prescription to end of observation period. The study population included 12,219 African American, 6,094 Hispanic/Latino and 8,625 non-Hispanic white beneficiaries with HIV/AIDS diagnoses.

Results: Logistic regressions controlling for age, eligibility category, rural versus urban residence, psychiatric comorbidity and other factors identified substantial racial/ethnic differences in persistence. Relative to white males, odds ratios for achieving 80% or better medication coverage were .76 for white females, .77 for Hispanic males, .60 for Hispanic females, .63 for African American males, and .56 for African American females. Effects of gender and race/ethnicity combined to generate particularly low persistence rates for minority women. Persistence was lower at ages 18-44 than older ages. We also report on sensitivity to alternative persistence measures and other methodological choices.

Conclusions: We previously reported disparities in persistence in one state in the mid-1990s among Medicaid beneficiaries, despite similar financial eligibility for treatments. Current findings show substantial disparities in a larger and more recent population in multiple states and regions. Results suggest a need for renewed efforts to identify and address reasons for differential persistence.

Learning Objectives: At the conclusion of the session, the participant (learner) will be able to

• Understand patterns of Racial/Ethnic, Sex, Age, and other differences in consistency of PI/NNRTI medication use in persons with HIV/AIDS.
• Identify groups at particular risk of inconsistent medication use and its consequences.

Keywords: HIV Interventions, Medicaid

Presenting author's disclosure statement:

Any relevant financial relationships? No