Economic Barriers to Antiretroviral Therapy in Nursing Homes.
Medicare
access to antiretroviral therapy
aging with HIV
antiretrovirals
nursing home
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
received:
04
10
2019
revised:
18
11
2019
accepted:
20
11
2019
pubmed:
13
12
2019
medline:
30
1
2021
entrez:
13
12
2019
Statut:
ppublish
Résumé
Our aim was to clarify if persons living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) have adequate economic access to antiretroviral therapy (ART) when admitted to nursing homes (NHs). Medicare Part A pays NHs a bundled skilled nursing rate that includes prescription drugs for up to 100 days, after which individuals are responsible for the costs. A cross-sectional study. NHs. A total of 694 newly admitted long-stay (>100 d) NH residents with HIV. We used Minimum Dataset v.3.0, pharmacy dispensing data, NH provider surveys, and Medicare claims from 2011 to 2013. We assessed receipt of any HIV antiretrovirals or recommended combinations (ART), as defined by national care guidelines, and the source of payment. We identified predictors of antiretroviral use with risk-adjusted generalized estimating equation logistic models. All study persons living with HIV/AIDS in NHs had prescription drug coverage through Medicare's Part D program, and ART was 100% covered. However, only 63.9% received recommended ART, and 15.2% never received any antiretrovirals during their NH stay. The strongest predictor of not receiving antiretrovirals was the first 100 days of a long NH stay (odds ratio [OR] = .44; 95% confidence interval [CI] = .24-.80). The strongest predictor of receiving recommended ART was health acuity (OR = 1.51; 95% CI = 1.20-1.88). People living with HIV in NHs do not always receive lifesaving ART, but the reasons are unclear and appear unrelated to economic barriers. J Am Geriatr Soc 68:777-782, 2020.
Identifiants
pubmed: 31829445
doi: 10.1111/jgs.16288
pmc: PMC7578773
mid: NIHMS1637706
doi:
Substances chimiques
Anti-Retroviral Agents
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
777-782Subventions
Organisme : NIA NIH HHS
ID : R21 AG049269
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001064
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG046341
Pays : United States
Organisme : AHRQ HHS
ID : R36 HS025662
Pays : United States
Informations de copyright
© 2019 The American Geriatrics Society.
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