Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, New Haven, CT, USA.
J Gen Intern Med. 2011 Dec;26(12):1426-33. doi: 10.1007/s11606-011-1807-5. Epub 2011 Aug 12.
In the United States, mortality from cardiovascular disease has become increasingly common among HIV-infected persons. One-third of HIV-infected persons in care may rely on state-run AIDS Drug Assistance Programs (ADAPs) for cardiovascular disease-related prescription drugs. There is no federal mandate regarding ADAP coverage for non-HIV medications.
To assess the consistency of ADAP coverage for type 2 diabetes, hypertension, hyperlipidemia, and smoking cessation using clinical guidelines as the standard of care.
Cross-sectional survey of 53 state and territorial ADAP formularies.
ADAPs covering all first-line drugs for a cardiovascular risk factor were categorized as "consistent" with guidelines, while ADAPs covering at least one first-line drug, but not all, for a cardiovascular risk factor, were categorized as "partially consistent". ADAPs without coverage were categorized as "no coverage".
Of 53 ADAPs, four (7.5%) provided coverage consistent with guidelines (coverage for all first-line drugs) for all four cardiovascular risk factors. Thirteen (24.5%) provided no coverage for all four risk factors. Thirty-six (68%) provided at least partially consistent coverage for at least one surveyed risk factor. State ADAPs provided coverage consistent with guidelines most frequently for type 2 diabetes (28%), followed by hypertension (25%), hyperlipidemia (15%) and smoking cessation (8%). Statins (66%) were most commonly covered and nicotine replacement therapies (9%) least often. Many ADAPs provided no first-line treatment coverage for hypertension (60%), type 2 diabetes (51%), smoking cessation (45%), and hyperlipidemia (32%).
Consistency of ADAP coverage with guidelines for the surveyed cardiovascular risk factors varies widely. Given the increasing lifespan of HIV-infected persons and restricted ADAP budgets, we recommend ADAP coverage be consistent with guidelines for cardiovascular risk factors.
在美国，心血管疾病导致的死亡率在感染艾滋病毒的人群中越来越常见。在接受治疗的艾滋病毒感染者中，有三分之一可能依靠州立艾滋病药物援助计划（ADAP）获得与心血管疾病相关的处方药。对于非艾滋病毒药物，ADAP 的覆盖范围没有联邦授权。
根据临床指南作为护理标准，评估 ADAP 对 2 型糖尿病、高血压、高血脂和戒烟的覆盖范围的一致性。
对 53 个州和地区 ADAP 处方集的横断面调查。
将涵盖心血管风险因素所有一线药物的 ADAP 归类为与指南一致，而涵盖心血管风险因素至少一种一线药物但并非全部的 ADAP 归类为部分一致。没有覆盖的 ADAP 归类为没有覆盖。
在 53 个 ADAP 中，有 4 个（7.5%）为所有四个心血管风险因素提供了与指南一致的覆盖（涵盖所有一线药物）。有 13 个（24.5%）对所有四个风险因素均未提供覆盖。有 36 个（68%）为至少一个调查风险因素提供了至少部分一致的覆盖。州 ADAP 最常为 2 型糖尿病（28%）、高血压（25%）、高血脂（15%）和戒烟（8%）提供与指南一致的覆盖。他汀类药物（66%）最常被覆盖，尼古丁替代疗法（9%）最不常被覆盖。许多 ADAP 对高血压（60%）、2 型糖尿病（51%）、戒烟（45%）和高血脂（32%）没有提供一线治疗覆盖。
ADAP 对所调查心血管风险因素的覆盖范围与指南的一致性差异很大。鉴于艾滋病毒感染者的预期寿命延长和 ADAP 预算有限，我们建议 ADAP 对心血管风险因素的覆盖范围应与指南一致。
