Antiretroviral Utilization and Adherence Among Provincial Beneficiaries with HIV in Saskatchewan
Date
2024-09-17
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
ORCID
0009-0004-4166-7044
Type
Thesis
Degree Level
Masters
Abstract
Background:
HIV has been an alarming issue in the province of Saskatchewan. In 2018, the provincial drug insurance plan expanded their program to provide free antiretroviral medications to all beneficiaries living with HIV. The objective of this study was to examine antiretroviral therapy (ART) medication utilization and adherence before and after the implementation of the provincial coverage program.
Methods:
A retrospective study was conducted using administrative databases to examine beneficiaries of the provincial drug plan who were living with HIV. Aggregate ART drug claims and associated costs were measured in four-month intervals between 2015 and 2021. A linear regression model was developed to test the impact of the program using interrupted time series analysis. Also, the probability of achieving optimal adherence to ART medications was compared before and after the program's implementation. The effect of the provincial ART coverage program on achieving optimal adherence outcomes was measured using a random effects logistic regression model.
Results:
Among 4,994 Saskatchewan residents with at least one diagnosis of HIV, 1,828 were exclusive beneficiaries of the provincial drug plan and satisfied all other inclusion criteria. Almost two-thirds (57%) were male and one-third were aged between 40-59. A statistically significant increase in the number of active users (i.e., individuals with at least one ART claim) and the total number of ART prescription claims was observed immediately following program implementation. Total spending associated with increased utilization was attenuated due to a historical trend of declining ART costs. In contrast to the aggregate increase in drug utilization, no significant difference in the probability of optimal adherence was observed before versus after program implementation (53.6% vs 55.1%). However, certain subgroups of beneficiaries living with HIV may have been more likely to benefit than others. The two factors most strongly associated with optimal adherence were older age and no history of substance use.
Discussion:
In summary, our study showed a small increase in utilization following the implementation of an ART coverage program without a detectable effect on the frequency of optimal adherence among beneficiaries living with HIV. Although certain subgroups may have benefited, additional support measures are needed to help combat this important public health issue.
Description
Keywords
adherence, HIV, Antiretroviral utilization, Saskatchewan
Citation
Degree
Master of Science (M.Sc.)
Department
Pharmacy and Nutrition
Program
Pharmacy