Antiretroviral Therapy Changes for Medicare Beneficiaries With HIV Transitioning to Long-Term Care.

Abstract

Studies of nursing home (NH) residents show lower than expected antiretroviral therapy (ART) use, but it is unclear whether ART use changes across the transition from the community to long-term NH stay. To examine changes in ART use across the transition from the community to long-term NH stay. This retrospective cohort study examined long stays in US NHs for people with HIV in a sample of 5% of Medicare claims from 2014 to 2019. Stays were at least 30 days long, had at least 3 months between multiple stays, and were for those continuously enrolled in Medicare for the stay and 6 months before. Analysis was completed in May 2025. Admission year demographics included age, race and ethnicity (non-Hispanic Black, non-Hispanic White, and other [American Indian or Alaska Native, Asian or Pacific Islander, other, and unknown]), binary sex, Medicaid eligibility, whether the stay was preceded by a skilled nursing stay, and whether disability was Medicare original eligibility. NH characteristics included for-profit status, census region, and facility quality rating. Linear regression estimated changes in the proportion of days covered by 3-drug ART, and hierarchical multinomial logistic regression estimated the risk of never having, losing, or gaining ART vs always having it, across the transition from the community to long-term NH stay. There were 713 long NH stays for 657 people with HIV (mean [SD] age, 61.0 [11.4] years) across 598 facilities; 271 stays (38%) were for people aged 65 years and older. Only 23 individuals lost ART (3%), 97 individuals (14%) gained ART, 185 individuals (26%) never had ART, and 408 individuals (57%) always had ART across the transition. Excluding those who lost ART, all other groups were mostly men (never, 132 men [71%]; always, 289 men [71%]; gained, 72 men [74%]) and Black (never, 85 individuals [46%]; always, 237 individuals [58%]; gained, 58 individuals [60%]). There was an increase in the proportion of days covered (mean intercept α = 13.92; 95% CI, 9.57-18.29). Compared with always having ART, Black race (relative risk [RR], 0.52; 95% CI, 0.35-0.77), polypharmacy (RR, 0.41; 95% CI, 0.23-0.74), and disability as original Medicare eligibility (RR, 0.47; 95% CI, 0.29-0.77) were associated with lower risk of never having ART. For-profit facilities were associated with higher risk (RR, 1.63; 95% CI, 1.03-2.59) of never having ART. Polypharmacy was associated with lower risk of gaining ART (RR, 0.15; 95% CI, 0.05-0.49). These findings suggest that long-term NH stays may be associated with improved ART use among people with HIV because most stays without ART never had ART before admission.