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Among 1942 persons with human immunodeficiency virus (HIV) without healthcare coverage in 2012-2015, transitioning to Medicaid (adjusted prevalence ratio, 0.95 [0.87, 1.04]) or to private health insurance (1.04 [0.95, 1.13]) was not associated with a change in consistent HIV viral suppression compared to continued reliance on the Ryan White HIV/AIDS Program.

Improvements in treatment have made HIV a manageable chronic condition, leading to increased life expectancy and a growing share of people with HIV who are older. Older people with HIV have higher rates of many chronic conditions, yet little is known about differences in health care utilization and spending. This study compared health care utilization and spending for Medicare beneficiaries with and without HIV, accounting for differential mortality. The data included demographic characteristics and claims-based information. Estimated cumulative spending for beneficiaries with HIV aged 67 to 77 years was 26% higher for Medicare Part A and 39% higher for Medicare Part B compared with beneficiaries without HIV; most of these differences would be larger if not for greater mortality risk among people with HIV (and therefore fewer years to receive care). Future research should disentangle underlying causes for this increased need and describe potential responses by policymakers and health care providers. [ABSTRACT FROM AUTHOR]

Posttraumatic stress disorder (PTSD) resulting from military service is a common, yet often chronic condition. Treatment outcome often is attenuated by programs that are (a) lengthy in nature and (b) constricted in their target outcomes. These limitations leave much of the emotional and behavioral impairment that accompanies PTSD unaddressed and/or unassessed. Typical PTSD treatment programs are 3-4 months in length, which is challenging for the pace of the nation's military. In this investigation, we will compare two treatments, Trauma Management Therapy (TMT) and Prolonged Exposure (PE), both redesigned to address the needs of active duty personnel (300 participants at 3 military installations). Specifically, we will compare the TMT Intensive Outpatient Program (IOP; 3 weeks) to PE's compressed (2 week) format. Both interventions will be compared to a standard course of PE (12 weeks). In addition to PTSD symptomatology, outcome measurement includes other aspects of psychopathology as well as changes in social, occupational, and familial impairment. Potential negative outcomes of massed treatment, such as increased suicidal ideation or increased alcohol use, will be assessed, as will genetic predictors of PTSD subtype and treatment outcome. This study will inform the delivery of care for military-related PTSD and particularly the use of intensive or compressed treatments for active duty personnel., (© 2019 The Authors.)

Background: Medicaid is the single largest source of health care coverage for people living with HIV (PLWH) in the United States. Therefore, high-quality HIV care and associated viral suppression among Medicaid beneficiaries have the potential to greatly impact the HIV epidemic. The HIV Health Improvement Affinity Group (HHIAG) supported state efforts to improve health outcomes for PLWH enrolled in Medicaid through new or enhanced collaborations between state public health departments and state Medicaid agencies., Methods: Supported by multiple federal health agencies for 1 year, state health department and Medicaid staff from 19 states participated in state-to-state learning and sharing of promising approaches. This evaluation assessed the HHIAG's processes, short-term outcomes, and lessons learned through review of state materials, a web survey, and telephone interviews., Results: Of the 19 states, 13 (68%) ultimately established new, or refined existing, data-sharing agreements between Medicaid and public health departments. Nearly all states with data-sharing agreements successfully matched the data or streamlined the data-matching process (n = 12/13). Two-thirds of states (67%, n = 8/12) with matched data generated an HIV care continuum for state Medicaid/Children's Health Insurance Program beneficiaries; 75% (n = 6/8) of these states also initiated quality improvement activities., Conclusions: The HHIAG created an unique opportunity for multiple federal agencies and states to collaborate and implement data-driven, state-specific solutions to improve care delivery and, ultimately, clinical outcomes for PLWH. The HHIAG model has the potential to be replicated to address other public health issues that cross agency and institutional boundaries, such as hepatitis C.

Background: Given high rates of HIV among Baltimore men who have sex with men (MSM), we examined characteristics associated with HIV prevalence and unrecognized HIV infection among Baltimore MSM at two time points., Methods: Cross-sectional behavioral surveys and HIV testing in 2004-2005 and 2008 using venue-based sampling among adult Baltimore men at MSM-identified locations. MSM was defined as sex with a male partner in the past year. Bivariate and backward stepwise regression identified characteristics associated with HIV and unrecognized infection., Results: HIV prevalence was 37.7% overall in 2004-2005 (n = 645) and 37.5% in 2008 (n = 448), 51.4% and 44.7% among black MSM and 12.9% and 18.3% among non-Hispanic white MSM. Compared with non-Hispanic white MSM, black MSM were 4.0 times (95% confidence interval, 2.3-7.0) more likely to be HIV-positive in 2004-2005 and 2.5 times (95% confidence interval, 1.5-4.0) more likely in 2008. Prevalence of unrecognized HIV infection was 58.4% overall in 2004-2005 and 74.4% in 2008, 63.8% and 76.9% among black MSM and 15.4% and 47.4% among non-Hispanic white MSM. In adjusted models, unrecognized infection was significantly associated with minority race/ethnicity, younger age, and no prior year doctor visits in 2004-2005 and with younger age and no prior year doctor visits in 2008., Conclusion: High rates of HIV infection and substantial rates of unrecognized HIV infection among Baltimore MSM, particularly men of color and young men, require urgent public and private sector attention and increased prevention response.

Data from the 2007 heterosexual wave at the Baltimore site of the National HIV Behavioral Surveillance System, a cross-sectional, venue-based sample survey targeting high-risk heterosexuals, are presented on risks associated with reporting unprotected sex with casual/exchange partners. Recruitment areas were 10 census tracts within Baltimore City categorized as being in the top 20% of tracts most affected by poverty and AIDS in the Baltimore-Towson metropolitan statistical area. Recruitment venues were not attended for the sole purpose of finding sexual partners. The study population was 301 men and women, aged 18-50, who reported sexual intercourse with a member of the opposite sex in the past 12 months. HIV prevalence was 3% overall. Factors independently associated with reporting sex with a casual or exchange partner in the past 12 months were homelessness, age, 4 or more sex partners during the past 12 months, concurrent sex partners in the past 12 months, binge drinking during the past 30 days, and history of sexually transmitted disease diagnoses. HIV testing results suggest that a generalized epidemic is occurring among the population having heterosexual sex in these areas. Furthermore, sexual risk behaviors were widespread in this population, suggesting that HIV prevention efforts in these geographic areas are needed.