Evaluating patterns in retention, continuation, gaps, and re-engagement in HIV care in a Medicaid-insured population, 2006–2012, United States

ABSTRACT

We used the US-based MarketScan^® Medicaid Multi-state Databases to determine the un-weighted proportion of publically insured persons with HIV that were retained, continued, and re-engaged in care. Persons were followed for up to 84 months. Cox proportional hazards models were conducted to determine factors associated with gaps in care. Of the 6463 HIV cases identified in 2006, 61% were retained during the first 24 months, and 53% continued in care through 78 months. Between 8% and 30% experienced a gap in care, and 59% of persons who experienced a gap in care later re-engaged in care. Persons with one or more Charlson co-morbidities (HR 0.72, 95% CI 0.64–0.81), ages 40–59 (0.79, 0.71–0.88), mental illness diagnosis (0.79, 0.72–0.87), hepatitis C co-infection (0.83, 0.75–0.93), and female sex (0.86, 0.78–0.94) were less likely to experience a gap in care. Between 27% and 38% of those not retained in care continued to receive HIV-related laboratory services. This Medicaid claims database combines features of both clinic visits-based and surveillance lab-based surrogate measures to give a more complete picture of engagement in care than single-facility-based studies.

KEYWORDS:

• Retention in care
• engagement in care
• gap in care
• HIV
• Medicaid

Acknowledgements

This study was conducted as part of the authors' normal work activities at the Centers for Disease Control and Prevention, United States. The findings and conclusions in this study are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Disclosure statement

No potential conflict of interest was reported by the authors.