From the Journals

Some children with HIV may not get enough medical care



Some children with HIV infection may not be receiving medical care frequently enough, according to researchers at the Centers for Disease Control and Prevention

The investigators examined claims cohorts of children aged 13 years and younger who had been diagnosed with HIV to track their retention of medical care over a 36-month period, starting in 2010. They found that rates of retention in care – defined as at least one visit in every 6-month period – were lower than expected.

However, because rates of AIDS diagnoses and deaths among children are low nationally – an estimated 2,477 children younger than 13 years had HIV in 2014 – it may be that “failure to meet the retention in care definition ... does not necessarily mean loss to follow-up,” cautioned Mary R. Tanner, MD, of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, and her coinvestigators (MMWR. 2017 Oct 6:66[39];1033-8).

In addition, in the Medicaid claims cohort, 59% of the children who were not retained in care during the first 24 months (but who remained in the study) were in care during months 25-36.

The researchers used the 2010-2014 MarketScan Multi-State Medicaid and MarketScan Commercial Claims and Encounters databases to make cohorts of Medicaid and commercial claims of 163 and 129 children, respectively. They tracked retention of care for these children starting from the first reported ICD-9-CM code for HIV or AIDS. One reason for the current study is that the National HIV Surveillance System, which has a goal of increasing retention in care, does not track children with HIV infection in its progress indicators.

In the first 24 months, 60% of the Medicaid cohort and 69% of the commercial claims cohort were retained in care. For children who remained in the study after month 24, the investigators further divided the cohorts into subgroups of those who remained in care thus far and those who did not. A total of 93% of those in the Medicaid cohort who remained in care during the first 24 months stayed in care in months 25-36, while 59% of those who didn’t remain in care in the first 24 months did remain in care during months 25-36.

For the subgroups in the commercial claims cohort, the same numbers were 85% and 32%.

Noting many possible limitations to the current study, the investigators nevertheless remarked that “overall, the fact that greater than 25% of children with diagnosed HIV infection did not meet the retention in care definition suggests that portions of this medically vulnerable population are not receiving the recommended frequency of medical care.”

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