Gaps in Care Persist Among Children With HIV

The National HIV Surveillance System tracks retention in care for adults diagnosed with HIV, but does not include children in its assessment.

In a report published in the CDC’s Morbidity and Mortality Weekly Report, researchers analyzed insurance claims data to determine retention in medical care among children diagnosed with HIV, based on a clinic-based standard definition of retention care.

According to the report, current guidelines for treating children with HIV recommend medical visits every 3-4 months for the first 2 years after care initiation. The researchers used a 36-month study period that extended from the date of the first insurance claim that included the diagnostic billing code for HIV or AIDS.

Cohorts included 163 children from the Medicaid database and 129 children from the commercial claims database. Retention in care was defined as at least 1 medical visit in each 6-month period during months 0-24, with a minimum of 60 days from the first medical visit in the prior 6-month period to the last medical visit in the subsequent 6-month period.

Overall, the researchers estimated that among children diagnosed with HIV aged 13 years and older, 60% of children insured through Medicare and 69% of children who were insured through commercial insurance companies were retained in medical care. These proportions were similar to those demonstrated in analyses of insurance claims data for adults with HIV infection.

Sixty percent of the Medicaid cohort and 69% of the commercial claims cohort were retained in care during months 0-24. Seventy-nine percent of the children in the Medicare cohort were in care during months 25-36, including 59% of children who were not retained in care during months 0-24. The researchers noted that this finding may demonstrate gaps in consistency of medical care, rather than loss to follow-up.

Despite similar findings for retention in care between children and adults with HIV, the researchers noted that the proportions of children not meeting retention in care were unexpected, indicating that a substantial amount of medically vulnerable children with HIV may not be receiving the recommended frequency of medical care. Gaps in care can lead to missed or delayed opportunities for disease prevention and reduced antiretroviral therapy.

Reference

Tanner MR, Bush T, Nesheim SR, et al. Retention in medical care among insured children with diagnosed HIV infection — United States, 2010-2014. MMWR. Published October 6, 2017. 66(39);1033-1038. https://www.cdc.gov/mmwr/volumes/66/wr/mm6639a1.htm?s_cid=mm6639a1_w