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Disparities in CD4(+) T-Lymphocyte Monitoring Among Human Immunodeficiency Virus-Positive Medicaid Beneficiaries: Evidence of Differential Treatment at the Point of Care

BACKGROUND:  Monitoring of immune function, measured by CD4(+) T-lymphocyte (CD4) cell count, is an essential service for people with human immunodeficiency virus (HIV). Prescription of antiretroviral (ARV) medications is contingent on CD4 cell count; patients without regular CD4 monitoring are unli...

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Detalles Bibliográficos
Autores principales: Davis, Anna C., Watson, Greg, Pourat, Nadereh, Kominski, Gerald F., Roby, Dylan H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231484/
https://www.ncbi.nlm.nih.gov/pubmed/25401120
http://dx.doi.org/10.1093/ofid/ofu042
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author Davis, Anna C.
Watson, Greg
Pourat, Nadereh
Kominski, Gerald F.
Roby, Dylan H.
author_facet Davis, Anna C.
Watson, Greg
Pourat, Nadereh
Kominski, Gerald F.
Roby, Dylan H.
author_sort Davis, Anna C.
collection PubMed
description BACKGROUND:  Monitoring of immune function, measured by CD4(+) T-lymphocyte (CD4) cell count, is an essential service for people with human immunodeficiency virus (HIV). Prescription of antiretroviral (ARV) medications is contingent on CD4 cell count; patients without regular CD4 monitoring are unlikely to receive ARVs when indicated. This study assesses disparities in CD4 monitoring among HIV-positive Medicaid beneficiaries. METHODS:  In this retrospective observational study, we examined 24 months of administrative data on 2250 HIV-positive, continuously enrolled, fee-for-service, Medicaid beneficiaries with at least 2 outpatient healthcare encounters. We used logistic regression to evaluate the association of patient demographics (age, gender, race or ethnicity, and language) with receipt of at least 1 CD4 test per year, controlling for other potentially confounding variables. RESULTS:  Having a history of ARV therapy was positively associated with receipt of CD4 tests. We found racial or ethnic, gender, and age disparities in CD4 testing. Among individuals with a history of ARV use, all racial or ethnic groups were significantly less likely to have CD4 tests than White non-Latinos (African Americans, odds ratio [OR] = 0.35, P < .0001; Asian or Pacific Islanders, OR = 0.31, P = .0047; and Latinos, OR = 0.42, P < .0001). CONCLUSIONS:  We identified disparities in receipt of CD4 tests, a finding that may elucidate one potential pathway for previously reported disparities in ARV treatment. Further qualitative and quantitative research is needed to identify the specific factors that account for these disparities, so that appropriate interventions can be implemented.
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spelling pubmed-42314842014-11-14 Disparities in CD4(+) T-Lymphocyte Monitoring Among Human Immunodeficiency Virus-Positive Medicaid Beneficiaries: Evidence of Differential Treatment at the Point of Care Davis, Anna C. Watson, Greg Pourat, Nadereh Kominski, Gerald F. Roby, Dylan H. Open Forum Infect Dis Major Articles BACKGROUND:  Monitoring of immune function, measured by CD4(+) T-lymphocyte (CD4) cell count, is an essential service for people with human immunodeficiency virus (HIV). Prescription of antiretroviral (ARV) medications is contingent on CD4 cell count; patients without regular CD4 monitoring are unlikely to receive ARVs when indicated. This study assesses disparities in CD4 monitoring among HIV-positive Medicaid beneficiaries. METHODS:  In this retrospective observational study, we examined 24 months of administrative data on 2250 HIV-positive, continuously enrolled, fee-for-service, Medicaid beneficiaries with at least 2 outpatient healthcare encounters. We used logistic regression to evaluate the association of patient demographics (age, gender, race or ethnicity, and language) with receipt of at least 1 CD4 test per year, controlling for other potentially confounding variables. RESULTS:  Having a history of ARV therapy was positively associated with receipt of CD4 tests. We found racial or ethnic, gender, and age disparities in CD4 testing. Among individuals with a history of ARV use, all racial or ethnic groups were significantly less likely to have CD4 tests than White non-Latinos (African Americans, odds ratio [OR] = 0.35, P < .0001; Asian or Pacific Islanders, OR = 0.31, P = .0047; and Latinos, OR = 0.42, P < .0001). CONCLUSIONS:  We identified disparities in receipt of CD4 tests, a finding that may elucidate one potential pathway for previously reported disparities in ARV treatment. Further qualitative and quantitative research is needed to identify the specific factors that account for these disparities, so that appropriate interventions can be implemented. Oxford University Press 2014-07-05 /pmc/articles/PMC4231484/ /pubmed/25401120 http://dx.doi.org/10.1093/ofid/ofu042 Text en Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.
spellingShingle Major Articles
Davis, Anna C.
Watson, Greg
Pourat, Nadereh
Kominski, Gerald F.
Roby, Dylan H.
Disparities in CD4(+) T-Lymphocyte Monitoring Among Human Immunodeficiency Virus-Positive Medicaid Beneficiaries: Evidence of Differential Treatment at the Point of Care
title Disparities in CD4(+) T-Lymphocyte Monitoring Among Human Immunodeficiency Virus-Positive Medicaid Beneficiaries: Evidence of Differential Treatment at the Point of Care
title_full Disparities in CD4(+) T-Lymphocyte Monitoring Among Human Immunodeficiency Virus-Positive Medicaid Beneficiaries: Evidence of Differential Treatment at the Point of Care
title_fullStr Disparities in CD4(+) T-Lymphocyte Monitoring Among Human Immunodeficiency Virus-Positive Medicaid Beneficiaries: Evidence of Differential Treatment at the Point of Care
title_full_unstemmed Disparities in CD4(+) T-Lymphocyte Monitoring Among Human Immunodeficiency Virus-Positive Medicaid Beneficiaries: Evidence of Differential Treatment at the Point of Care
title_short Disparities in CD4(+) T-Lymphocyte Monitoring Among Human Immunodeficiency Virus-Positive Medicaid Beneficiaries: Evidence of Differential Treatment at the Point of Care
title_sort disparities in cd4(+) t-lymphocyte monitoring among human immunodeficiency virus-positive medicaid beneficiaries: evidence of differential treatment at the point of care
topic Major Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231484/
https://www.ncbi.nlm.nih.gov/pubmed/25401120
http://dx.doi.org/10.1093/ofid/ofu042
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