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

项目总结(仅限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。对于活着的人来说 对于艾滋病毒(PLWH)，抗逆转录病毒治疗可以延长寿命，减少发病率，并防止进一步传播 病毒。由于抗逆转录病毒治疗对妇女健康和公共健康的好处，现在建议对所有妇女妇女都使用抗逆转录病毒治疗。还没有 近五分之一的艾滋病毒携带者和接受医疗护理的人没有接受抗逆转录病毒治疗。这有 导致美国远远达不到其80%病毒抑制的国家目标，种族/民族 在病毒抑制方面仍然存在城乡差距。找出最需要这些服务的公共福利院 影响可能立竿见影的实时干预具有挑战性，尽管数据需要护理干预 使用监测数据最近已成功实施。然而，没有数据可供护理干预 据我们所知，已使用医疗索赔数据实施，该数据是丰富的、实时的 医疗参与度和护理质量。AIMS项目(医疗补助中的抗逆转录病毒改进 注册人)将独特地实时集成管理索赔和艾滋病毒监测数据，以实施 基于保险的新数据护理研究将改善以下人群的抗逆转录病毒处方和依从性 携带艾滋病毒的医疗补助参与者。我们的目标是：1)改进和评估一种新的算法来识别生活在 与艾滋病毒及其提供者进行实时行政索赔(目标1)；2)执行和评价目标-- 包括点对点提供者咨询、增强的患者支持和对加入医疗补助的人的日常护理 使用严格的实验设计(AIM)，在较长时间内没有抗逆转录病毒处方 2)；以及3)实施AIMS患者和提供者干预措施的成本效益(AIMS 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，AIMS干预措施 在PLWH脱离艾滋病毒护理之前的关键阶段。因此，AIMS干预措施有可能 改善艾滋病毒携带者的关键护理质量和健康结果，包括开展抗逆转录病毒治疗，重新开展 启动、坚持和病毒抑制。AIMS研究建立在成功实施 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CARE重新联系起来，以及 利用弗吉尼亚州最近扩大的医疗补助，提供了一个独特的PLWH样本，他们可能是 第一次接受艾滋病毒医疗护理。这个项目的结果有可能改进几个关键的 弗吉尼亚州公共卫生保健中心的健康指标，这对改善公共卫生和促进健康至关重要 公平。这项工作还将开发和严格测试支持艾滋病毒的实时干预模型 关爱连续体，其他司法管辖区可以采用。

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.