PS19-003 Antiretroviral Improvement among Medicaid EnrolleeS (AIMS): An Insurance-based Data-to-Care Intervention for Medicaid enrollees in Virginia

项目概要（仅B类） 抗逆转录病毒疗法（ART）极大地改变了艾滋病毒临床护理的格局。感染者 艾滋病毒感染者（PLWH），抗逆转录病毒疗法可以延长寿命，降低发病率，并防止艾滋病毒的进一步传播。 病毒由于对艾滋病毒携带者和公共卫生的好处，现在建议所有艾滋病毒携带者使用抗逆转录病毒疗法。然而 近五分之一的被诊断为艾滋病毒感染者和接受医疗护理的人没有接受抗逆转录病毒治疗。 导致美国远未达到80%病毒抑制的国家目标，种族/民族 病毒抑制方面的城乡差距依然存在。确定最需要这些服务的艾滋病毒携带者 尽管Data to Care干预措施具有挑战性，但实时干预措施的影响可能是即时的 最近成功地实施了使用监测数据的方法。然而，没有数据护理干预措施 据我们所知，已经使用医疗索赔数据来实现，这是一个丰富的，实时的 医疗参与和护理质量。AIMS项目（医疗补助中的抗逆转录病毒改善） 登记者）将独特地实时整合行政索赔和艾滋病毒监测数据， 一项新的基于保险的数据护理研究，将改善抗逆转录病毒药物的处方和依从性， 艾滋病病毒感染者的医疗补助登记者。我们的目标是：1）完善和评估一种新的算法，以识别生活在 艾滋病毒感染者及其提供者的实时行政索赔（目标1）; 2）实施和评估AIMS- 包括点对点提供者咨询，增强患者支持，以及对医疗补助计划注册者的常规护理 使用严格的实验设计（Aim 2）;和3）进行AIMS患者和提供者干预的成本效益（目标3）。通过利用 将提供实时、全面的行政索赔和艾滋病毒监测数据， 在艾滋病毒感染者脱离艾滋病毒护理之前的关键阶段。因此，大西洋、印度洋、地中海和南海干预措施有可能 提高艾滋病毒感染者的关键护理质量和健康成果，包括抗逆转录病毒疗法的启动， 启动、依从和病毒抑制。大西洋、印度洋、地中海和南海区域研究的基础是成功实施了一项 弗吉尼亚州的Data2Care倡议，该倡议利用艾滋病毒监测数据成功地将PLWH与护理重新联系起来， 利用弗吉尼亚州最近扩大的医疗补助，提供了一个独特的样本PLWH谁可能是 首次接受艾滋病治疗。该项目的结果有可能改善几个关键的 弗吉尼亚州PLWH的健康指标，这对改善公共卫生和促进健康至关重要 股权这项工作还将开发和严格测试一个实时干预模式，以支持艾滋病毒的传播。 其他司法管辖区可能采用的护理连续体。

PROJECT SUMMARY (CATEGORY B ONLY) Antiretroviral therapy (ART) has dramatically changed the landscape of clinical care for HIV. For people living with HIV (PLWH), ART can extend the lifespan, decrease morbidity, and prevent onward transmission of the virus. Because of the benefits for PLWH and for public health, ART is now recommended for all PLWH. Yet nearly 1 in 5 people who are diagnosed with HIV and who receive medical care do not receive ART. This has contributed to the United States falling far short of its national goal of 80% viral suppression, with racial/ethnic and urban-rural disparities in viral suppression remaining. Identifying the PLWH most in need of these interventions in real-time, where impact can be immediate, is challenging although Data to Care interventions using surveillance data have recently successfully been implemented. However, no Data to Care interventions have been implemented, to our knowledge, using medical claims data which is a rich, real-time source of medical engagement and quality of care. The AIMS project (Antiretroviral Improvement among Medicaid enrolleeS) will uniquely integrate administrative claims and HIV surveillance data in real-time to implement a novel insurance-based Data to Care study that will improve antiretroviral prescribing and adherence among Medicaid enrollees living with HIV. We aim to: 1) Refine and assess a novel algorithm to identify people living with HIV and their providers from real-time administrative claims (Aim 1); 2) Implement and evaluate AIMS— including peer-to-peer provider consultation, enhanced patient support, and usual care for Medicaid enrollees with HIV and no antiretroviral prescriptions for an extended period—using a rigorous experimental design (Aim 2); and 3) Conduct a cost-effectiveness of the AIMS patient and provider interventions (Aim 3). By leveraging real-time, comprehensive administrative claims and HIV surveillance data, AIMS interventions will be delivered at the critical stage before PLWH fall out of HIV care. The AIMS interventions thus have the potential to improve key quality of care and health outcomes for people living with HIV, including ART initiation, re- initiation, adherence, and viral suppression. The AIMS study builds on the successful implementation of a Data2Care initiative in Virginia, which has used HIV surveillance data to successfully re-link PLWH to care, and capitalizes on Virginia's recent expansion of Medicaid, providing a unique sample of PLWH who may be receiving HIV medical care for the first time. Results from this project have the potential to improve several key health indicators for PLWH in Virginia, which are critical for improving public health and promoting health equity. This work will also develop and rigorously test a model for real-time interventions to support the HIV care continuum, which other jurisdictions may adopt.