Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA.
Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
J Gen Intern Med. 2024 Sep;39(12):2196-2205. doi: 10.1007/s11606-024-08847-y. Epub 2024 Jun 12.
BACKGROUND: Antiretroviral therapy (ART) is recommended for all people with HIV. Understanding ART use among Medicare beneficiaries with HIV is therefore critically important for improving quality and equity of care among the growing population of older adults with HIV. However, a comprehensive national evaluation of filled ART prescriptions among Medicare beneficiaries is lacking. OBJECTIVE: To examine trends in ART use among Medicare beneficiaries with HIV from 2013 to 2019 and to evaluate whether racial and ethnic disparities in ART use are narrowing over time. DESIGN: Retrospective observational study. SUBJECTS: Traditional Medicare beneficiaries with Part D living with HIV in 2013-2019. MAIN MEASURES: Months of filled ART prescriptions each year. KEY RESULTS: Compared with beneficiaries not on ART, beneficiaries on ART were younger, less likely to be Black (41.6% vs. 47.0%), and more likely to be Hispanic (13.1% vs. 9.7%). While the share of beneficiaries who filled ART prescriptions for 10 + months/year improved (+ 0.48 percentage points/year [p.p.y.], 95% CI 0.34-0.63, p < 0.001), 25.8% of beneficiaries did not fill ART for 10 + months in 2019. Between 2013 and 2019, the proportion of beneficiaries who filled ART for 10 + months improved for Black beneficiaries (65.8 to 70.3%, + 0.66 p.p.y., 95% CI 0.43-0.89, p < 0.001) and White beneficiaries (74.8 to 77.4%, + 0.38 p.p.y.; 95% CI 0.19-0.58, p < 0.001), while remaining stable for Hispanic beneficiaries (74.5 to 75.0%, + 0.12 p.p.y., 95% CI - 0.24-0.49, p = 0.51). Although Black-White disparities in ART use narrowed over time, the share of beneficiaries who filled ART prescriptions for 10 + months/year was significantly lower among Black beneficiaries relative to White beneficiaries each year. CONCLUSIONS: ART use improved from 2013 to 2019 among Medicare beneficiaries with HIV. However, about 25% of beneficiaries did not consistently fill ART prescriptions within a given year. Despite declining differences between Black and White beneficiaries, concerning disparities in ART use persist.
背景：抗逆转录病毒疗法（ART）被推荐用于所有 HIV 感染者。因此，了解医疗保险受益人中接受抗逆转录病毒治疗的情况对于改善越来越多的老年 HIV 感染者的护理质量和公平性至关重要。然而，目前缺乏对医疗保险受益人中接受抗逆转录病毒治疗的全面全国评估。
目的：评估 2013 年至 2019 年医疗保险受益人中接受抗逆转录病毒治疗的情况，并评估抗逆转录病毒治疗的使用是否随着时间的推移而逐渐缩小种族和民族差异。
设计：回顾性观察性研究。
受试者：2013-2019 年医疗保险受益人，参加了医疗保险部分 D，并且患有 HIV。
主要措施：每年接受抗逆转录病毒治疗的月份数。
主要结果：与未接受抗逆转录病毒治疗的患者相比，接受抗逆转录病毒治疗的患者年龄更小，黑人患者的比例较低（41.6%比 47.0%），而西班牙裔患者的比例较高（13.1%比 9.7%）。尽管每年接受抗逆转录病毒治疗 10 个月或以上的患者比例有所提高（每年增加 0.48 个百分点[pp.y.]，95%CI 0.34-0.63，p<0.001），但仍有 25.8%的患者在 2019 年未接受抗逆转录病毒治疗 10 个月或以上。2013 年至 2019 年期间，接受抗逆转录病毒治疗 10 个月或以上的黑人患者比例有所提高（从 65.8%到 70.3%，增加 0.66 个百分点，95%CI 0.43-0.89，p<0.001），白人患者比例也有所提高（从 74.8%到 77.4%，增加 0.38 个百分点；95%CI 0.19-0.58，p<0.001），而西班牙裔患者的比例保持稳定（从 74.5%到 75.0%，增加 0.12 个百分点，95%CI -0.24-0.49，p=0.51）。尽管抗逆转录病毒治疗的使用在黑人和白人之间的差异随着时间的推移而缩小，但每年接受抗逆转录病毒治疗的黑人患者比例仍明显低于白人患者。
结论：从 2013 年到 2019 年，医疗保险受益人中接受抗逆转录病毒治疗的情况有所改善。然而，约有 25%的患者在一年内未持续接受抗逆转录病毒治疗。尽管黑人和白人患者之间的差异在缩小，但抗逆转录病毒治疗的使用仍存在令人担忧的差异。
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