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Despite early Medicaid expansion, decreased durable virologic suppression among publicly insured people with HIV in Washington, DC: a retrospective analysis

  • Goldstein, Deborah1, 2
  • Hardy, W. David3
  • Monroe, Anne4
  • Hou, Qingjiang5
  • Hart, Rachel5
  • Terzian, Arpi6
  • Subramanian, Thilakavathy
  • Binkley, Jeffery
  • Taylor, Rob
  • Rayeed, Nabil
  • Akridge, Cheryl
  • Purinton, Stacey
  • Naughton, Jeff
  • D’Angelo, Lawrence
  • Rahkmanina, Natella
  • Kharfen, Michael
  • Wood, Angela
  • Serlin, Michael
  • Kumar, Princy
  • Parenti, David
  • And 18 more
  • 1 Whitman-Walker Institute, 1525 14th Street, NW, Washington, DC, 20005, USA , Washington (United States)
  • 2 Georgetown University Medical Center, Washington, DC, USA , Washington (United States)
  • 3 Johns Hopkins University School of Medicine, Baltimore, MD, USA , Baltimore (United States)
  • 4 Milken Institute School of Public Health, George Washington University, Washington, DC, USA , Washington (United States)
  • 5 Cerner Corporation, Kansas City, MO, USA , Kansas City (United States)
  • 6 Patient-centered Outcomes Research Institute, Washington, DC, USA , Washington (United States)
Published Article
BMC Public Health
Springer (Biomed Central Ltd.)
Publication Date
Apr 16, 2020
DOI: 10.1186/s12889-020-08631-7
Springer Nature


BackgroundDespite widely available access to HIV care in Washington, DC, inequities in HIV outcomes persist. We hypothesized that laboratory monitoring and virologic outcomes would not differ significantly based on insurance type.MethodsWe compared HIV monitoring with outcomes among people with HIV (PWH) with private (commercial payer) versus public (Medicare, Medicaid) insurance receiving care at community and hospital clinics. The DC Cohort follows over 8000 PWH from 14 clinics. We included those ≥18 years old enrolled between 2011 and 2015 with stable insurance. Outcomes included frequency of CD4 count and HIV RNA monitoring (> 2 lab measures/year, > 30 days apart) and durable viral suppression (VS; HIV RNA < 50 copies/mL at last visit and receiving antiretroviral therapy (ART) for ≥12 months). Multivariable logistic regression models examined impact of demographic and clinical factors.ResultsAmong 3908 PWH, 67.9% were publicly-insured and 58.9% attended community clinics. Compared with privately insured participants, a higher proportion of publicly insured participants had the following characteristics: female sex, Black race, heterosexual, unemployed, and attending community clinics. Despite less lab monitoring, privately-insured PWH had greater durable VS than publicly-insured PWH (ART-naïve: private 70.0% vs public 53.1%, p = 0.03; ART-experienced: private 80.2% vs public 69.4%, p < 0.0001). Privately-insured PWH had greater durable VS than publicly-insured PWH at hospital clinics (AOR = 1.59, 95% CI: 1.20, 2.12; p = 0.001).ConclusionsParadoxical differences between HIV monitoring and durable VS exist among publicly and privately-insured PWH in Washington, DC. Programs serving PWH must improve efforts to address barriers creating inequity in HIV outcomes.

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