CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

999 Antiretroviral Treatment Among Commercially Insured Persons With HIV in the United States Kashif Iqbal ;Ya-Lin A. Huang; Philip Peters; Karen Hoover CDC, Atlanta, GA, USA Background: Antiretroviral treatment (ART) is now recommended for all HIV-infected persons in the United States. This analysis describes antiretroviral use among commercially insured HIV-infected adults from a large administrative claims database. Methods: We analyzed 2013 Truven Health MarketScan Commercial Claims and Encounters ® , a large database derived from administrative claims for healthcare services provided to commercial health plan enrollees. Among enrolled persons aged 18-64 years, we identified HIV-infected persons who had at least one inpatient or outpatient medical claimwith an ICD-9-CM diagnosis code for HIV infection. We linked and examined their outpatient pharmacy claims for antiretroviral use using National Drug Codes. We compared persons prescribed antiretrovirals with those who did not have prescribed antiretrovirals to identify differences by age, sex, geographic region, and type of insurance. Chi-square and t-test were done for statistical significance. Results: In 2013, there were a total of 43,737,217 persons in this commercial insurance database, including 62,185 (0.14%) HIV-infected adults. Overall, 38,939 (63%) HIV-infected adults were prescribed antiretrovirals and 23,246 (37%) were not prescribed any antiretrovirals. There were significant overall differences (p-value <0.05) in age, gender, residence, geography and health insurance plan among HIV-infected adults prescribed and not prescribed antiretrovirals (Table). Notably, higher proportion of persons who were not prescribed antiretrovirals were female (28.5% vs 15.8%) and at ages 18-34 (27.1% vs 16.5%) compared with those who were prescribed antiretrovirals. Conclusions: Despite having commercial insurance, a significant proportion of HIV-infected adults were not prescribed ART. Insurance-based strategies such as electronic reports to physicians regarding patients not receiving ART could be important novel methods to increase the percentage of HIV-infected adults who receive optimal care in the United States.

1000 Increases in Health Insurance Coverage Among MSM: 20 US Cities, 2008-2014 Laura A. Cooley; Brooke Hoots; CyprianWejnert; Rashunda Lewis; Gabriela Paz-Bailey ; for the NHBS Study Group CDC, Atlanta, GA, USA

Background: The Affordable Care Act (ACA), passed in 2010, is intended to improve access to health insurance coverage for all Americans, including those at risk for or living with HIV; the ACA includes provisions for prevention and treatment of HIV, which can result in improved health outcomes. CDC’s National HIV Behavioral Surveillance (NHBS) monitors health behaviors in populations at risk for HIV, including gay, bisexual, and other men who have sex with men (MSM). We assessed changes in reported health insurance coverage among MSM participating in NHBS in 2008, 2011, and 2014. Methods: We analyzed NHBS data from sexually active MSM aged 18 years or older who were recruited and interviewed at venues in 20 U.S. cities. We compared the percentages reporting health insurance coverage in 2008, 2011, and 2014, using chi-square tests. To determine if interview year was associated with health insurance status, we used a Poisson model with robust standard errors to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). The model was adjusted for demographic characteristics and self-reported HIV status; we included individual interaction terms for each covariate by interview year. Results: Among included MSM (2008: 8,903; 2011: 9,256; 2014: 9,640), the percentage with health insurance coverage increased from 68% in 2008 to 79% in 2014 (aPR 1.14 [2014 vs 2008], CI: 1.12, 1.16, P value for trend including all three years < 0.001). By age, the increase in health insurance coverage was significant for all groups but was higher among MSM aged 18-29 (aPR 1.17, CI: 1.14-1.21) and 30-39 years (aPR 1.16, CI: 1.12-1.20). By education, the increase was greatest for MSM with no more than a high school education (aPR 1.28, CI: 1.22, 1.35). By income, the increase was greatest for MSM reporting an annual income less than $20,000 (aPR 1.33, CI: 1.26, 1.39). Health insurance coverage increased regardless of self-reported HIV status (Table). Conclusions: Corresponding with the passage of the ACA, health insurance coverage increased among MSM participating in NHBS from 2008 to 2014. Increases were greatest in key demographic segments with historically lower health insurance coverage. While causality cannot be established using NHBS data, these findings are encouraging. As health insurance coverage increases among MSM, it will be important to also monitor progress in HIV prevention and treatment outcomes while assessing for any continued barriers to care.

Poster Abstracts

426

CROI 2016