Adherence to highly active antiretroviral therapy impact on clinical and economic outcomes for Medicaid enrollees with human immunodeficiency virus and hepatitis C coinfection

Abstract

We examined the impact of antiretroviral treatment adherence among Hepatitis C co-infected HIV patients on survival and clinical outcomes. We analyzed Medicaid claims data from fourteen southern states from 2005-2007, comparing survival and clinical outcomes and cost of treatment for HIV and hepatitis-C co-infected patients (N=4,115) at different levels of adherence to antiretroviral therapy.More than one in five patients (20.5%) showed less than 50% adherence to antiretroviral treatment, but there were no racial-ethnic or gender disparities. Significant survival benefit was demonstrated at each incremental level of adherence to antiretroviral therapy (one-year mortality ranging from 3.5% in the highest adherence group to 26.0% in the lowest). Low adherence patients also had higher rates of hospitalization and emergency department visits. Relative to patients with high (>95%) ART-adherence, those with less than 25% treatment adherence had four-fold greater risk of death (adjusted odds ratio 4.22 [95% CI, 3.03,5.87]). Non-drug Medicaid expenditures were lower for high adherence patients, but cost of medications drove total Medicaid expenditures higher for high-adherence patients. Cost per quality-adjusted life year (QALY) saved (relative to the <25% low-adherence group) ranged from $21,874 for increasing adherence to 25-50% to $37,229 for increasing adherence to 75-95%. Adherence to antiretroviral therapy for patients with HIV and hepatitis C co-infection is associated with lower adverse clinical outcomes at a Medicaid cost per QALY commensurate with other well-accepted treatment and prevention strategies. Further research is needed to identify interventions which can best achieve optimal ART adherence at a population scale.

Health related quality of life of people receiving highly active antiretroviral therapy in Southwest Ethiopia

“…A study done in South Africa [ 36 ] and Ethiopia [ 23 ] also reported the same findings that adherence is known to contribute to the QoL of PLWHA, as persons with greater ability to adhere to their ART regimens have better QoL. Adherence is found to improve clinical conditions of patients and suppress viral load [ 37 – 39 ] which in turn influence QoL.…”

Adherence to antiretroviral therapy and factors affecting low medication adherence among incident HIV-infected individuals during 2009–2016: A nationwide study

“…Considering the social stigma associated with depression 27 , it is possible that HIV patients who had a better relationship with their physician were more likely to report their depressive symptoms than those with a poorer relationship. In addition, ART adherence study of HIV and viral hepatitis C (HCV) co-infected individuals also revealed that PDC >95% group had higher proportion of HCV treatment using the 2005–2007 Medicaid claims data 28 . Overall, improved patient-clinician relationships could enhance ART adherence 29 .…”

Coping strategies of people living with AIDS in face of the disease

“…Acquired Immune Deficiency Syndrome (AIDS) is an emerging disease and one of the major health problems today, due to its pandemic status and severe characteristics. A reduction of mortality rate associated with the success of antiretroviral therapy (ART) has been observed 1 . However, the disease still has a strong impact on the lives of people living with aids, mainly due to stigma and prejudice, psychiatric disorders such as depression, changes in marital relationships such as abandonment of the partner, and difficulties in keeping and reintegrating into the job market with consequent possible financial problems that may negatively influence ART adherence 2 .…”