Objective:

To compare the effectiveness of contemporary once-daily single-tablet regimens (STRs) and multi-tablet regimens (MTRs) in achieving viral suppression among people with HIV enrolled in Washington state Medicaid.

Approach:

• Study Design: The study linked 2023 Washington state Medicaid administrative data with statewide HIV RNA surveillance data for 2,874 adults with HIV.
• Viral Suppression Definition: Viral suppression was defined as an HIV RNA level below 200 copies/mL, with adjustments for various demographic and social factors.

Key Findings:

• 90.4% of Medicaid enrollees were virally suppressed.
• Viral suppression rates were 91.6% for the single-tablet regimen and 88.9% for first-line MTRs, with no statistically significant difference after adjustment.
• Among those experiencing unstable housing, suppression rates were nearly identical at 78.8% for the single-tablet regimen and 78.2% for first-line MTRs.
• Housing status was a significant factor; lower suppression rates were observed among those experiencing unstable housing.

Interpretation:

The study suggests that the difference in efficacy between single-tablet and multi-tablet regimens is minimal, and housing stability plays a crucial role in treatment adherence and viral suppression.

Limitations:

• The observational analysis could not account for factors influencing regimen selection, such as antiretroviral resistance and comorbidities.
• Findings may not be generalizable beyond Washington state due to unique Medicaid policies and support services.

Conclusion:

The small virologic advantage of single-tablet therapy does not justify its higher cost, indicating a need for a more holistic approach to HIV treatment that considers effectiveness, cost, and patient needs.

Sources:

• Open Forum Infectious Diseases