Antiretroviral Therapy Use Improves after Transition to Long-Term Nursing Home Care

A retrospective cohort study analyzing Medicare claims from 2014 to 2019 examined antiretroviral therapy (ART) usage among people with HIV transitioning from community settings into long-term nursing home (NH) care in the United States. The study focused on 713 long NH stays of at least 30 days across 598 facilities, with a sample representing 5% of Medicare claims. Participants were predominantly men and Black individuals, with a significant portion aged 65 or older. The research investigated changes in ART coverage during the transition from community to NH care, considering patient demographics, Medicaid eligibility, disability status, and facility characteristics such as for-profit status and quality ratings. Findings revealed that 57% of residents consistently received ART before and during NH stays, while 26% never had ART, 14% gained ART during their NH stay, and 3% lost ART coverage. The analysis showed an increase in the proportion of days covered by ART after NH admission, highlighting that long-term NH stays may support improved ART adherence, especially since most residents who lacked ART in the NH also did not have it prior to admission. Factors linked to a lower risk of never having ART included Black race, polypharmacy, and qualifying for Medicare due to disability. Conversely, residing in for-profit NHs was associated with a higher risk of never receiving ART. The study underscores the variability of ART use across different patient subgroups and nursing home settings, emphasizing the influence of facility ownership and resident clinical characteristics on ART adherence. Given these results, there may be implications for regulatory oversight and quality improvement initiatives targeting ART delivery in long-term care facilities. The findings add valuable data to the healthcare management of aging HIV-positive populations within the NH environment. The research methodology included linear regression models to quantify ART coverage days and multinomial logistic regression to assess risks of ART status changes across care transitions. The study helps clarify ART utilization patterns amid an increasingly aging HIV population requiring long-term care, a critical aspect for payers, providers, and policymakers concerned with optimizing HIV treatment continuity and regulatory compliance in nursing homes.