Year of Publication

2016

College

Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Steven Browning, Ph.D.

Committee Member

Daniela Moga, M.D., Ph.D.

Committee Member

Lorie Chesnut, DrPH

Abstract

Background: Randomized clinical trials of combination antiretroviral therapy (cART) inform the use of specific antiretrovirals (ARV) and their combination for optimizing therapeutic efficacy. It is critical that patients have access to and receive the most appropriate first-line treatment.

Objective: To examine factors that impact receiving initial guideline-recommended cART within a cohort of commercially insured patients in the United States (US)

Research Design: A population based cohort study.

Data Sources: A secondary administrative insurance claims database.

Subjects: Employed, commercially insured individuals with HIV who were continuously eligible for insurance coverage from January 2007 through December 2009 and received a new ARV prescription.

Measures: The primary outcome was defined as an initial claim for a prescription containing recommended cART consisting of two nucleoside reverse transcriptase inhibitors and either a non-nucleoside reverse transcriptase inhibitor, protease inhibitor or an integrase strand transfer inhibitor. Modified Poisson adjusted multivariable models including patient demographic and provider characteristics evaluated predictors of receiving recommended cART.

Results: Of the 2,115 patients with a new ARV claim, 59% were white and 71% were male with a median age of 42 years (Interquartile Range: 35-49). Overall, 76% of the population received recommended cART. Receiving care from an infectious disease specialist was the strongest predictor of receiving recommended cART (Risk Ratio: 1.37, 95% Confidence Interval (CI): 4 1.30, 1.43). Men, those with less education, younger individuals, and no comorbidities were also more likely to receive recommended cART (p<0.01).

Conclusions: Many HIV-infected patients that are in clinical care are not prescribed recommended cART. Increased communication and training of healthcare providers is necessary to insure patients receive a durable first-line regimen.

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