Racial/ethnic disparities in antiretroviral treatment among HIV-infected pregnant Medicaid-enrollees, 2005-2007

Objectives. We examined racial/ethnic differences in rates of prenatal antiretroviral treatment among HIV-infected pregnant Medicaid-enrollees.

Methods. We analyzed Medicaid claims data from fourteen southern states from 2005-2007, comparing rates of not receiving any antiretroviral therapy (ARV) and rates of sub-optimal vs. optimal ARV therapy between racial-ethnic groups for 3,035 pregnant women diagnosed with HIV.

Results. Over a third (37.3%) of all HIV-infected pregnant women had zero claims for antiretroviral drugs. Three out of four (73.4%) of 346 Hispanic women received no prenatal antiretroviral treatment. After adjusting for covariates, Hispanic women had 3.89 (C.I., 2.58, 5.87) times the risk of not receiving any ARV medication compared with non-Hispanic Whites. Black or African American women were 1.58 times more likely to receive no treatment than white women. Hispanic women often had only one or two months of eligibility, perhaps associated with Medicaid eligibility barriers for immigrants. Having less than three months of eligibility was strongly associated with non-treatment (AOR = 29.0; C.I.13.4, 62.7)

Conclusions. Optimal treatment rates for HIV in pregnancy are an important public health priority, especially for preventing vertical transmission of HIV to the infant. Medicaid programs have both the surveillance capacity and drug coverage to assure that all HIV-infected pregnant women are at least offered treatment. States which offer emergency Medicaid coverage for only delivery services to pregnant immigrants are missing an opportunity to screen, diagnose, and treat pregnant women with HIV, and to prevent new cases of HIV in children.