Initiation and continuation of newer antiretroviral treatments among medicaid recipients with AIDS
Initiation and continuation of newer antiretroviral treatments among medicaid recipients with AIDS
复制标题
DOI：
10.1046/j.1525-1497.2001.01025.x
复制
发表时间：
2001-12-01
影响因子：
5.7
通讯作者：
McSpiritt, E
中科院分区：
文献类型：
--
作者：
Crystal, S;Sambamoorthi, U;McSpiritt, E
目的：在引入这些治疗后的3年内，检查各社会人口亚组中新的抗逆转录病毒治疗的启动情况。设计：合并医疗补助支付索赔和艾滋病毒/艾滋病监测数据被用来分析使用蛋白酶抑制剂（PLA）和非核苷类逆转录酶抑制剂（NNRTIs）随着时间的推移。使用生存分析技术分析PI/NNRTI使用的开始。普通最小二乘法和逻辑回归被用来确定PI/NNRTI therapy.SETTING和参与者的持久性的预测因素：研究人群包括2,459新泽西非HMO成人医疗补助受益人艾滋病，确定通过艾滋病毒/艾滋病登记处和医疗补助文件之间的匹配。他们的PI/NNRTI的使用是从1996年3月，当第一个PI被许可，到1998年底。测量和主要结果：非裔美国人开始治疗平均8个月后，比非西班牙裔白人，开始治疗注射吸毒者和那些谁没有通过医疗补助豁免计划接受病例管理也较慢。使用比例风险回归进行的多变量治疗时间分析证实了这些双变量结果。在开始使用PI/NNRTI的患者中，35%在随访结束时已停用。治疗个体的双变量分析发现，非裔美国人和西班牙裔美国人的PI/NNRT 1使用占随访时间的比例较低，老年人和通过医疗补助豁免计划接受病例管理的人较高，而注射药物使用史与持久性无关。回归分析证实了这些结果，该分析发现，控制其他特征、非洲裔美国人种族和西班牙裔种族均与开始治疗后PI/NNRTI时间比例显著降低8%相关。替代方法建模持久性产生了类似的results.CONCLUSIONS：结果表明，一致的纵向使用是困难的许多患者。尽管通过医疗补助计划提供的药房和其他保健服务的覆盖率相当，但少数族裔受益人的持续使用率较低。我们的研究结果表明，有必要研究非经济障碍，以适当使用高效抗逆转录病毒治疗，并制定和测试方案的战略，以支持患者在这些方案保持一致。
OBJECTIVE: To examine initiation of newer antiretroviral treatments across sociodemographic subgroups during the 3 years following the introduction of these treatments. and explore persistence on treatment and its association with patient characteristics.DESIGN: Merged Medicaid paid claims and HIV/AIDS surveillance data were used to analyze use of protease inhibitors (Pla) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) over time. Survival analysis techniques were used to analyze initiation of PI/NNRTI use. Ordinary least squares and logistic regression were used to determine predictors of persistence on PI/NNRTI therapy.SETTING AND PARTICIPANTS: The study population consisted of 2,459 New Jersey non-HMO adult Medicaid beneficiaries with AIDS, identified through a match between HIV/AIDS Registry and Medicaid files. Their PI/NNRTI use was followed from March 1996, when the first PI was licensed, to the end of 1998.MEASUREMENTS AND MAIN RESULTS: African Americans initiated treatment on average 8 months later than non-Hispanic whites; initiation of treatment was also slower for injection drug users and for those who did not receive case management through a Medicaid waiver program. These bivariate findings were confirmed with a multivariate time-to-treatment analysis using proportional hazards regression. Among those initiating PI/NNRTI use, 35% had discontinued it by the end of follow-up. Bivariate analyses of treated individuals found that PI/NNRTl use as a proportion of follow-up time was lower for African Americans and Hispanics, and higher for older individuals and for those receiving case management through a Medicaid waiver program, while injection drug use history was not associated with persistence. These findings were confirmed by a regression analysis, which found that controlling for other characteristics, African-American race, and Hispanic ethnicity were each associated with a significant 8% reduction in the proportion of time on PI/NNRTIs following initiation of treatment. Alternative approaches for modeling persistence produced similar results.CONCLUSIONS: Results suggest that consistent longitudinal use is difficult for many patients. Persistence of use was lower for minority beneficiaries despite comparable coverage for pharmacy and other health services through Medicaid. Our findings suggest the need to examine nonfinancial barriers to appropriate use of highly active antiretroviral therapy, and to develop and test programmatic strategies for supporting patients in remaining on these regimens consistently.