Medicaid data as a complement to cohort studies for investigating cancers among older people with HIV

Johns Hopkins University, Baltimore MD

Investigators

Linked publications, trials & patents

Abstract

ABSTRACT Cancer is a significant comorbidity for people living with HIV (PLWH). An estimated 135,000 years of life were lost due to cancer among PLWH in the US between 2006-2015; the majority of this loss was among PLWH 40- 59 years old and those with non-AIDS defining cancers. In 2022, the International Agency for Research on Cancer and the National Cancer Institute (NCI) highlighted the need for investigations into the mechanisms underlying cancer survival differences among PLWH including the role of access to care. Though clearly important, healthy survivorship is about more than mortality. The NCI, in collaboration with leading cancer survivorship researchers, outlined a framework to define the key components of survivorship, which includes care beyond cancer treatment, like management of chronic conditions, psychosocial effects, and health promotion. This renewal application, directly informed by our progress under R01CA250851, will explore multiple domains of cancer survivorship to inform the underlying causes of high mortality among PLWH with cancer. Since 2018, our team has been investigating the impact of cancer on more than 290,000 PLWH enrolled in Medicaid across 14 states between 2001-2015. Approximately 40% of PLWH in the US are covered by Medicaid. Medicaid beneficiaries are a diverse, low-income population and include a comparison group for PLWH with similar risk factor burden and access to care. Our work has demonstrated that Medicaid is an important complement to existing resources for cancer research among PLWH in which we can conduct nuanced race-, sex, and/or site-specific cancer investigations across HIV and cancer care continuums. We have reported a substantially increased risk of mortality and adverse HIV-specific and age-related outcomes among PLWH with cancer enrolled in Medicaid. With additional funding (R01AI170240), we now have data for our initial 14 states plus 13 additional states and Washington, DC for 2016-2021. We propose to assess claims for more than 400,000 PLWH between 2001-2029 to: (1) Assess the age-, race/ethnicity-, sex-, and cancer- specific mortality disparities among beneficiaries with and without HIV, (2) Evaluate the association between HIV-infection and receipt of standard cancer treatment, post-treatment surveillance, adverse healthcare utilization, death, and total cost among beneficiaries with cancer, (3) Evaluate the near- and long- term impact of cancer and cancer treatment on the HIV care continuum including annual HIV care visits, viral load tests, antiretroviral medication possession ratio, and other HIV-related outcomes among beneficiaries with HIV, and (4) Evaluate the association between HIV-infection and provision of preventive care, comorbid health condition management, and psychosocial care among beneficiaries with cancer. Importantly, our study population is large enough to conduct analyses by cancer type, sex, and race. Findings from this work will inform strategies to improve clinical guidelines, public health interventions, and policy development for better survivorship care among PLWH.