Use of Antiretroviral Therapy for a US Medicaid Enrolled Pediatric Cohort with HIV

Abstract

Appropriate antiretroviral therapy use in children with Human Immunodeficiency Virus (HIV) is essential for optimizing clinical outcomes and preventing HIV transmission. To describe and determine correlates of HIV antiretroviral therapy (ART) persistence and implementation for children and adolescents in the United States. We studied Medicaid enrollees (ages 2–19 years) with HIV in 14 states in 2011 and 2012. We defined non-persistence as a discontinuation of an ART regimen for at least 90 days, and calculated implementation as the proportion of days on ART while persistent. We used Cox proportional regression and logistic regression to determine characteristics associated with ART non-persistence and poor (< 90%) implementation, respectively. Among those with ≥ 1 year of observation (n = 8679), 55.7% never received ART. For ART recipients (n = 3849), 34.9% discontinued ART. Correlates of ART non-persistence included older age (e.g., 15–19 vs. 2–5 years [adjusted hazard ratio (aHR) 2.9, 95% CI 2.1–4.0]; females vs. males (aHR 1.2; 1.1–1.3); mental health conditions (aHR 1.3; 1.1–1.5), drug/alcohol abuse (aHR 1.2; 1.0–1.5) and HIV-related conditions (aHR 1.2; 1.0–1.4). Those with an outpatient visit were less likely to discontinue an ART (aHR 0.32; 0.28–0.36). During persistent episodes, 42.3% had poor ART implementation. Correlates of poor implementation included females vs. males (aOR 1.2; 95% CI 1.0–1.3), Black vs. White race (aOR 1.3; 95% CI 1.1–1.7) and Hispanic/Latino vs. White (aOR 1.3; 1.0–1.8). Among Medicaid youth with HIV, there were low rates of ART exposure, and ART discontinuation was common. Correlates of persistence and implementation differed, suggesting a need for varying clinical interventions to improve connection to care and ensuring ongoing engagement with ART use.