Non-adherence has big impact on Medicaid beneficiaries with HIV

Despite advances in modern day HIV treatments, non-adherence to HIV medication remains a significant challenge among Medicaid patients living with HIV, according to new data presented at the 9^th International AIDS Society (IAS) Conference in Paris, France.

Dunn

Keith Dunn, PharmD, BCPS, AAHIVE, associate medical director, Janssen Infectious Diseases, and colleagues, studied patients’ administrative claims from Medicaid databases from six states. Conducting a retrospective longitudinal study, patients were observed over a period of greater than or equal to six months during which the researchers assessed the risk factors of poor adherence in Medicaid beneficiaries living with HIV and taking commonly used antiretroviral (ARV) regimens. They also compared healthcare resource utilization and associated costs between patients with suboptimal versus optimal adherence.

“Our study shows that adherence is a significant issue, identifying more than two-thirds of the Medicaid-insured patients observed had poor or suboptimal adherence to treatment, and, these patients have longer hospital stays, more long-term care admissions and significantly higher medical costs,” Dunn tells Managed Healthcare Executive.

As Dunn noted, 70% of patients in the study were non-adherent to HIV treatment (51% poor, 19% suboptimal). The study also found risk factors of poor adherence included younger age (one of the fastest growing populations of new HIV infections), non-capitated or dual Medicaid/Medicare insurance coverage, no prior use of ARVs and absence of HIV symptoms.

These findings are important because adherence to HIV treatment is critical for keeping the virus at an undetectable level, helping to minimize the risk of virologic failure and limiting a patient’s consumption of additional healthcare resources, according to Dunn.

“Non-adherence to HIV treatment is the leading cause of virologic failure, which could lead to the development of HIV drug resistance,” Dunn says.

Previous studies have documented adherence issues in commercially insured patients, but the demographics of those patients may differ significantly from the Medicaid population, according to Dunn. “As Medicaid represents the largest source of coverage for people living with HIV, we felt that it was important to examine the Medicaid population separately.”

It is important that healthcare providers, especially those providing care to Medicaid patients, understand this reality and prioritize the assessment of adherence-and resulting consequences of non-adherence like increased costs and possible development of drug resistance-when individualizing antiretroviral (ARV) regimens for patients, according to Dunn.

“Understanding the rates, reasons and consequences of non-adherence in this population will assist healthcare providers and formulary committees in selecting regimens that may help improve adherence such as fixed-dose combinations or single-tablet regimens, or those regimens that may help prevent the development of HIV drug resistance,” he says.   

Decision makers need to consider two things, according to Dunn.

• Consider providing access to ARV regimens. “First, in an effort to control economic consequences of non-adherence and as a possible strategy to improve adherence, decision makers should consider providing access to ARV regimens that help decrease pill burden such as fixed-dose combinations or single tablet regimens,” he says.
•  Recognize the need for ARVs. “Additionally, decision makers should recognize healthcare providers will have a significant need for ARVs that help prevent the development of HIV drug resistance should patients continue to have adherence issues and experience virologic failure,” Dunn says.