Association of medical insurance and other factors with receipt of antiretroviral therapy

Objectives, This study was designed to assess sociodemographic and medical insurer factors associated with receipt of highly active antiretroviral therapy (HAART). Methods, Patients included (n=959) were enrolled in the Johns Hopkins HIV Clinic after April 1, 1996, received ≥90 days of care, and had a CD4 count ≥500 cells/mm3 or HIV-1 RNA > 20 000 copies/mL. We assessed the associations of sociodemographic factors and medical insurance with receipt of HAART, stratified by 2 time periods (April 1996 through March 1997 versus April 1997 through March 1999). Results. HAART was more likely to be used in patients who were >39 years, White, had CD4 counts <350 cells/mm3, had fewer missed clinic visits, and did not have intravenous drug use as their risk factor for HIV transmission. In period 1 (April 1996 through March 1997), HAART was more likely to be used in patients who were commercially insured than in other payer groups; differences between payers narrowed in period 2 (April 1997 through March 1999), however, as did differences by race. Conclusions. Differences in use of HAART on the basis of payer have narrowed since 1996. This encouraging finding may demonstrate the importance of programs that lower economic barriers to medical care.