461. Payer Status Is Not a Predictor For Early HIV Care Entry
Session: Poster Abstract Session: HIV Primary Care
Friday, October 21, 2011
Room: Poster Hall B1
Background: Countless studies have demonstrated the positive impact of early entry into care of HIV infected patients on long term health status.  A significant portion of patients still continue to enter care at late disease stages.  The lack of health coverage is thought to be a primary barrier, which limits patient’s access to disease management in its early stages. The objective of this study was to determine the impact of payer status on the entry into care of HIV infected patients by comparing the disease stage at care entry of populations of two outpatient facilities, one serving primarily uninsured patients and the other serving the publicly insured.

Methods: This was a retrospective observational analysis of HIV infected patients treated at the University of Louisville Wings Clinic (Wings) and Robley Rex Veterans Affairs Medical Center (RRVAMC).  Patients entering care at Wings are primarily uninsured.RRVAMC patients receive care in a public payer system.  Disease progression at care entry was measured by initial CD4 cell counts, CD4 to CD8 ratios, and HIV viral load.  CD4 cell count was categorized into less than 200 vs greater or equal to 200 and the HIV RNA level (viral load) was categorized into less than 1000 versus greater or equal to 1000.  The chi-squared test was used to determine statistical differences in CD4 cell count and HIV RNA level between the two locations.

Results: A total of 546 patients were analyzed, 361 from the Wings clinic and 185 from RRVAMC.  Data was available on 269 patients from Wings clinic, 51 patients from RRVAMC. A total of 107 (40%) of patients at the Wings Clinic and 15 (30%) of patients at the RRVAMC had a CD4 cell count less than 200 (P=0.162).  A total of 222 (62%) of patients at the Wings Clinic and 25 (89%) of patients at the RRVAMC had a HIV RNA level greater than 1000 (P=0.004). 

Conclusion: 

Payer status does not significantly impact the early entry into care of HIV infected patients.  Instead, social and behavioral barriers might explain why patients continue to enter care at late disease stages despite having access to healthcare.  In order to achieve better long term clinical outcomes for patients infected with HIV, these barriers to care entry need to be identified and addressed so that the proven benefits of early HIV treatment can be realized.


Subject Category: H. HIV/AIDS and other retroviruses

Praveen Seshabhattar, MD1, Preethi Ananthakrishnan, MD1, Paula Peyrani, MD2, Timothy Wiemken, PhD2, Forest Arnold, DO2, Raul Nakamatsu, MD2, Rama Kapoor, MD1 and Julio Ramirez, MD2, (1)Infectious Diseases, University of Louisville, Louisville, KY, (2)Division of Infectious Diseases, University of Louisville, Louisville, KY

Disclosures:

P. Seshabhattar, None

P. Ananthakrishnan, None

P. Peyrani, None

T. Wiemken, None

F. Arnold, None

R. Nakamatsu, None

R. Kapoor, None

J. Ramirez, None

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