OBJECTIVES : This study aims to assess real-world time to ART initiation and describe outcomes in Medicaid patients based on timeliness of ART initiation.

METHODS : A retrospective longitudinal analysis was conducted using multi-state Medicaid data (01/1997-03/2017). Adults with HIV-1 and ≥6 months of continuous eligibility pre-HIV-1 diagnosis, no ART pre-HIV-1 diagnosis, no HIV-2 diagnosis at any time, and initiating an ART (including one protease inhibitor [PI], or one integrase strand transfer inhibitor [INSTI], or one non-nucleoside reverse transcriptase inhibitor [NNRTI], with ≥2 nucleoside reverse transcriptase inhibitors) in 2012 or later were included. Patients initiating ART >360 days post-HIV-1 diagnosis were excluded. Patients were classified into mutually exclusive groups based on timeliness of receipt of ART post-HIV-1 diagnosis. Healthcare costs were evaluated over the first 36 months post-HIV-1 diagnosis.

RESULTS : Among 974 patients, 347 (35.6%) were excluded (initiated ART >360 days post-diagnosis) and 627 eligible patients were analyzed; mean age was 40.1 years (SD=12.3), 42.7% were females, and 53.9% were black. ART was initiated within 14 days of diagnosis in 20.4% of patients, between 15-60 days in 36.4%, between 61-180 days in 26.0%, and between 181-360 days in 17.2%. In total, 24.1%, 34.1%, and 41.8% patients initiated a PI-, INSTI-, or NNRTI-based regimen, respectively. Darunavir (9.6%), elvitegravir (16.9%), and efavirenz (26.5%) were the most commonly used ART across classes, and most patients (58.5%) initiated a single-tablet regimen. Over 36 months following HIV-1 diagnosis, total healthcare costs (i.e., sum of medical and pharmacy costs) increased with delayed ART initiation from $74,092 for patients treated within 14 days to $83,157 for patients treated between 181-360 days post-diagnosis.

CONCLUSIONS : This study revealed that only 20% of Medicaid patients initiated ART within 14 days post-diagnosis and that patients with delayed initiation accumulated more healthcare costs than those with rapid initiation, highlighting the long-term benefits of rapid ART initiation.