Abara Winston E, Smith Lerissa, Zhang Shun, Fairchild Amanda J, Heiman Harry J, Rust George
Winston E. Abara is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Lerissa Smith and Harry J. Heiman are with the Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta. Shun Zhang and George Rust are with the National Center for Primary Care, Morehouse School of Medicine. Amanda J. Fairchild is with the Department of Psychology, University of South Carolina, Columbia.
Am J Public Health. 2014 Nov;104(11):e135-41. doi: 10.2105/AJPH.2014.302227. Epub 2014 Sep 11.
We examined whether the timely initiation of antiretroviral therapy (ART) differed by race and comorbidity among older (≥ 50 years) people living with HIV/AIDS (PLWHA).
We conducted frequency and descriptive statistics analysis to characterize our sample, which we drew from 2005-2007 Medicaid claims data from 14 states. We employed univariate and multivariable Cox regression analyses to evaluate the relationship between race, comorbidity, and timely ART initiation (≤ 90 days post-HIV/AIDS diagnosis).
Approximately half of the participants did not commence ART promptly. After we adjusted for covariates, we found that older PLWHA who reported a comorbidity were 40% (95% confidence interval = 0.26, 0.61) as likely to commence ART promptly. We found no racial differences in the timely initiation of ART among older PLWHA.
Comorbidities affect timely ART initiation in older PLWHA. Older PLWHA may benefit from integrating and coordinating HIV care with care for other comorbidities and the development of ART treatment guidelines specific to older PLWHA. Consistent Medicaid coverage helps ensure consistent access to HIV treatment and care and may eliminate racial disparities in timely ART initiation among older PLWHA.
我们研究了年龄较大（≥50岁）的艾滋病毒/艾滋病患者（PLWHA）中，抗逆转录病毒疗法（ART）的及时启动在种族和合并症方面是否存在差异。
我们进行了频率和描述性统计分析，以描述我们的样本特征，该样本取自2005 - 2007年14个州的医疗补助索赔数据。我们采用单变量和多变量Cox回归分析来评估种族、合并症与ART及时启动（艾滋病毒/艾滋病诊断后≤90天）之间的关系。
大约一半的参与者没有及时开始ART治疗。在对协变量进行调整后，我们发现报告有合并症的老年PLWHA及时开始ART治疗的可能性为40%（95%置信区间 = 0.26, 0.61）。我们发现老年PLWHA在ART及时启动方面不存在种族差异。
合并症影响老年PLWHA中ART的及时启动。老年PLWHA可能会从将艾滋病毒护理与其他合并症护理相结合和协调，以及制定针对老年PLWHA的ART治疗指南中受益。统一的医疗补助覆盖有助于确保持续获得艾滋病毒治疗和护理，并可能消除老年PLWHA在ART及时启动方面的种族差异。
