Limited preventive care among Medicaid enrollees with HIV in the US South

Abstract

Abstract Routine preventive care (RPC) services are recommended for people with HIV, who have higher risk of certain preventable conditions. We used a pooled cross-section of patient-years to examine receipt of 5 annual RPC services among Medicaid enrollees in the US South. Data were person-level administrative claims (Medicaid Analytic eXtract, 2008–2012) and county-level characteristics for 16 Southern states plus District of Columbia. Generalized estimating equations estimated the probability of lipid, glucose, syphilis, and cervical cancer (women only) screenings and influenza vaccination. We also examined service receipt among subgroups including enrollees requiring more general or HIV-specific care, in managed care, < 45 years and, separately, Non-Hispanic Black and Non-Hispanic White enrollees. The sample included 57,695 adult Medicaid enrollees with HIV (187,275 enrollee-years) that were majority 45–54 years (38.0%), female (53.6%), Non-Hispanic Black (54.3%), and urban (90.2%). Enrollees received lipid, syphilis, and cervical cancer screenings and influenza vaccination in < 50% and glucose screening in 71.7% of total enrollment-years. The adjusted probability was low (< 50%) for all services except glucose screening (estimated probability 81%; 95% confidence interval 78%, 83%). Findings were similar across subgroups. There is consistent, suboptimal receipt of RPC services among people with HIV. Approaches are needed to increase uptake of RPC services.

Keywords

• HIV
• Preventive care
• Quality of care
• Screening
• Vaccination