Minority Medicaid recipients least likely to be on most effective AIDS drugs

December 05, 2001

Among Medicaid recipients with AIDS, African Americans experience the longest delays in starting the most powerful anti-HIV drug regimens and are the least likely to use them consistently enough for maximum benefit, a new study reveals.

The research, published in the December issue of the Journal of General Internal Medicine, also indicates that Medicaid recipients enrolled in a special program of home- and community-based care tend to receive the more powerful therapies sooner and stay on them longer.

According to lead author Stephen Crystal, Ph.D., of Rutgers University, these state-of-the-art drugs - collectively known as highly active antiretroviral therapies - have been the standard of HIV care since 1996. However, their high cost and need for more intensive patient management can prevent their optimal use.

Crystal and his colleagues were particularly interested in identifying possible barriers to timely and consistent use of these drugs among Medicaid recipients because Medicaid is the largest underwriter of HIV/AIDS treatment in the United States. In addition, Crystal notes, "the poverty and complex care needs of [Medicaid] patients may make them vulnerable."

Crystal's team collected data on 1,739 adults diagnosed with AIDS in the New Jersey Medicaid program. The investigators examined several factors with the potential to influence when and how the newest AIDS drug regimens were administered.

The findings reveal significant disparities along ethnic lines. African Americans wait an average of eight months longer than whites to start receiving the more powerful anti-HIV drugs. Both African Americans and Hispanics are less likely than whites to remain on the drugs once therapy is started.

Crystal describes the findings about African Americans as "particularly troublesome, given the rates of HIV disease in this population. Although [they] made up 13 percent of the U.S. population, they represented 48 percent of all AIDS cases in 1998."

Although the study was not designed to reveal the exact reasons for these differences, Crystal suspects that differences in seeking care, nonfinancial barriers to medical access and differences in quality or continuity of care may be at play.

One study finding clearly suggests that differences in care may be a factor. Although all study participants received virtually identical coverage through Medicaid, 15 percent had access to case management and other community-based services through a special program. Program participants of all races, the authors found, tend to start on the newer drugs earlier and use them more consistently. Crystal suggests that the case managers, who make monthly home visits, may help these individuals overcome barriers that hamper other Medicaid recipients.

These and other findings, the researchers conclude, indicate the need to investigate new care strategies and supportive services that will help all subgroups of AIDS patients start using, and keep using, the most potent anti-HIV drug regimens.
The research was supported by grants from the National Institutes of Health.

The Journal of General Internal Medicine, a monthly peer-reviewed journal of the Society of General Internal Medicine, publishes original articles on research and education in primary care. For information about the journal, contact Renee F. Wilson at (410) 955-9868.

Posted by the Center for the Advancement of Health http://www.cfah.org. For more research news and information, go to our special section devoted to health and behavior in the "Peer-Reviewed Journals" area of Eurekalert!, http://www.eurekalert.org/jrnls/cfah/. For information about the Center, call Ira Allen, iallen@cfah.org (202) 387-2829.

Center for Advancing Health

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