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Long-Acting Injectable Antiretroviral Therapy in Medicare-Enrolled Adults With HIV
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In adjusted analyses (Table 2), older PWH were less likely to receive LA-ART (aged, 55-64 years, aOR, 0.60 [95% CI, 0.56-0.65]; aged ≥65 years, aOR, 0.40 [95% CI, 0.37-0.43) than PWH younger than 55 years.
Notably, PWH with Alzheimer disease and related dementias, stroke disorders, heart failure, and chronic kidney disease or kidney failure were less likely to receive LA-ART, whereas people with mental health disorders were more likely to receive LA-ART.
Discussion
In this national cross-sectional study, uptake of LA-ART among Medicare PWH was low, reaching only 3.0% by 2023. Early diffusion appeared uneven, with lower use among American Indian or Alaska Native beneficiaries and people living in rural areas or the South—patterns that mirror longstanding disparities in HIV care delivery and access to specialty services.4-7 In addition, despite potentially greater benefit from reduced daily adherence burden and lower risk of potential adverse effects of oral tenofovir-based regimens, older beneficiaries and people with complex chronic conditions, including Alzheimer disease and related dementias and chronic kidney disease or kidney failure, were less likely to receive LA-ART, possibly reflecting clinician concerns about drug-drug interactions.7,8 Conversely, dual-eligible beneficiaries, who automatically qualify for subsidized drug coverage under the Part D Low-Income Subsidy,9 and people enrolled in Medicare Advantage, who receive financial protections through out-of-pocket maximum caps and reduced cost-sharing, were more likely to receive LA-ART, suggesting that differences in structural access, system-level factors, and affordability may be barriers to LA-ART. Finally, higher use among beneficiaries with mental health disorders is encouraging, given LA-ART’s potential to mitigate adherence challenges in this population,7and additional consideration for those with substance use disorders remains critical.
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