Abstract

Purpose: Persistence data are lacking and outdated for US Medicaid beneficiaries prescribed Department of Health & Human Services (DHHS) guideline-recommended antiretroviral treatment (ART) regimens. The purpose of this study is to compare the persistence of newer DHHS guideline-recommended single- and multiple-tablet regimens (STRs and MTRs) for treatment-naïve patients.

Method: We included adult US Medicaid beneficiaries (aged =18 years) with =2 ART claims in the All-Payer Claims Database (1/1/2017–3/31/2020), continuous capture for 12-month pre- and post-index periods, and who newly initiated on ART. Index date was the first ART claim date for STRs and the last fill date of drugs used for MTRs within a 5-day window. Persistence was measured from the index date until treatment discontinuation (=90-day gap between fills of index regimen) or the end of the study period, whichever occurred first.

Results: We identified 44,764 (STR=34,787; MTR=9,977) Medicaid beneficiaries who newly initiated ART. The sample average age was 44±12 years, was predominantly male (65%) and resided in the southern US (37%). Unadjusted assessments showed a significantly higher proportion of STR initiators were persistent with their index regimens than MTR initiators (62% versus 41%, P<0.0001) over 6 months. STR initiators vs MTR initiators also had longer periods on therapy (mean: 239 versus 168 days, P<0.0001). Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) initiators had significantly higher unadjusted persistence than initiators of the MTRs emtricitabine/tenofovir disoproxil fumarate (F/TDF) + dolutegravir (DTG) and emtricitabine/tenofovir alafenamide (F/TAF) + DTG over 6 months (68% versus 23% and 52%, respectively). These findings were consistent over 12 months; however, overall persistence decreased after 6 months.

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