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In the United States (U.S.), to contain costs many state Medicaid programs offer specialty health insurance plans for costly conditions such as HIV/AIDS. This study compared service utilization between Florida Medicaid enrollees diagnosed with HIV/AIDS in standard Medicaid managed care plans to enrollees in HIV/AIDS specialty plans. We found lower mean utilization among HIV/AIDS enrollees in specialty plans compared to enrollees with HIV/AIDS in standard MMA plans for all services except inpatient which was approximately the same. While fewer emergency visits is a desired outcome, lower rates of other services may indicate suboptimal management of patients or lower engagement in care among enrollees in HIV/AIDS specialty plans. Continuous monitoring of experiences of patients in HIV/AIDS specialty plans is warranted to determine whether the observed utilization patterns represent better management through reductions in low value care or reduced engagement in care, and whether these utilization patterns persist. [ABSTRACT FROM AUTHOR]

Objective: To elucidate how and in what ways cumulative violence affects health-related quality of life (HRQoL) among a clinical cohort of virally stable people living with HIV., Design: We used data from the University of North Carolina Center for AIDS Research HIV clinical cohort. Our analysis was limited to participants with an undetectable viral load (<200) and those who completed the Clinical, Sociodemographic, and Behavioral Survey between 2008 and 2017 ( n = 284)., Methods: A path analysis was used to test our primary hypothesis that the effect of cumulative violence on HRQoL would be mediated through symptoms of post-traumatic stress disorder (PTSD), depressive symptoms, and HIV symptom distress., Results: The impact of cumulative violence on HRQoL was fully mediated by symptoms of PTSD, depressive symptoms, and HIV symptom distress. Greater exposure to violence was associated with higher odds of PTSD symptoms ( P <0.001), increased depressive symptoms ( P <0.001), and increased HIV symptom distress ( P < 0.01). HIV symptom distress displayed the largest association with HRQoL ( P < 0.001), followed by depressive symptoms ( P = 0.001) and PTSD symptoms ( P < 0.001). These factors explained approximately 51% of the variance in HRQoL ( R2 = 0.51, P < 0.001)., Conclusions: Our findings indicate that addressing physical and mental health symptoms rooted in violent victimization should be a point of focus in efforts to improve HRQoL among people living with HIV who are virally stable., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Data are limited on cumulative impacts of depression on engagement in care and HIV outcomes in women living with HIV (WLWH) during the era of universal antiretroviral therapy (ART). Understanding the relationship of accumulated depression with HIV disease management may help identify benefits of interventions to reduce severity and duration of depressive episodes., Setting: A cohort of WLWH (N = 1491) from the Women's Interagency HIV Study at 9 sites across the US., Methods: This longitudinal observational cohort study (2013-2017) followed WLWH for a maximum of 9 semiannual visits. Depression was quantified as a time-updated measure of percent of days depressed (PDD) created from repeated assessments using the Center for Epidemiologic Studies Depression scale. Marginal structural Poisson regression models were used to estimate the effects of PDD on the risks of missing an HIV care appointment, <95% ART adherence, and virological failure (≥200 copies/mL)., Results: The risk of missing an HIV care appointment [risk ratio (RR) = 1.16, 95% confidence interval = 0.93 to 1.45; risk difference (RD) = 0.01, -0.01 to 0.03], being <95% ART adherent (RR = 1.27, 1.06-1.52; RD = 0.04, -0.01 to 0.07), and virological failure (RR = 1.09, 1.01-1.18; RD = 0.01, -0.01 to 0.03) increased monotonically with increasing PDD (comparing those with 25 to those with 0 PDD). The total effect of PDD on virological failure was fully (%100) mediated by being <95% ART adherent., Conclusions: Time spent depressed increases the risk of virological failure through ART adherence, even in the era of universal ART regimes forgiving of imperfect adherence.