A Case-Control Study of Virologic Failure Among People Living with HIV Enrolled in a NYC-Based Medicaid Special Needs Plan

Engagement in HIV care is essential for viral suppression, and care coordination programs have shown improved retention and adherence. In New York Medicaid HIV Special Needs Plans (SNP), health-homes provide enhanced care coordination for people with HIV (PWH) at risk of non-adherence; however, evidence of their impact on virologic outcomes is limited. Using a matched case-control design and 2016-2018 data from a New York City Medicaid HIV SNP, this study examined associations between health-homes and virologic failure. Cases had virologic failure, defined as two consecutive viral loads > 200 copies/mL. Controls matched 1:1 on age (18+), race, and second viral load date, had no virologic failure. Conditional logistic regression examined virologic failure and health-home use duration, Social Deprivation Index (SDI), gender identity, HIV-infection stage, SNP enrollment, comorbidities, and polypharmacy. There were 2,566 PWH (62% male, mean age 42.9 years, mean SDI 92.3). Virologic failure was associated with HIV Stage III (OR = 2.01, 95% CI: 1.61-2.49), substance use disorder (OR = 2.09, 95% CI: 1.68-2.58), and < 6 months of health-home use (OR = 2.08, 95% CI: 1.27-3.42). The association attenuated with 6 + months of health-home use (reference=none; OR = 0.98, 95% CI: 0.77-1.25). Polypharmacy (OR = 0.72, 95% CI: 0.59-0.89) and mental health diagnoses (OR = 0.74, 95% CI: 0.59-0.94) had lower odds of virologic failure. Although further research is needed to clarify the roles of polypharmacy and mental health care, sustained health-home use may reduce disparities in virologic failure among PWH at high risk of falling out of care.