Schizophrenia and retention in HIV care among adults insured through Medicaid in the United States: a population-based retrospective cohort study

Background: People with schizophrenia spectrum disorders are at elevated risk of HIV, and people with both HIV and schizophrenia are at elevated risk of death compared to individuals with either diagnosis alone. Limited research has assessed the HIV care cascade, and in particular retention in care, among people with HIV (PWH) and schizophrenia in the U.S.

Methods: This population-based retrospective cohort used Medicaid claims data to compare retention in HIV care between PWH with schizophrenia (n=38,217) and matched controls without schizophrenia (n=29,455) from 2001-2012. The primary outcome of annual retention in HIV care was at least 2 tests for CD4+ T-cell count or HIV viral load at least 90 days apart per year. Unadjusted and covariate-adjusted differences in period prevalence of retention among cases and controls were estimated.

Findings: Annual retention in HIV care was 29·9% (95% CI: 29·4-30·4%) among people with schizophrenia and 38·5% (95% CI: 37·9-39·1%) among controls, representing 8·5% (95% CI 9·3-7·7) lower retention in unadjusted and 9·0% (95% CI 9·9-8·2) lower retention in adjusted estimates for people with HIV and schizophrenia. This disparity varied across states. Over time, retention increased and the disparity between people with and without schizophrenia diminished.

Interpretation: PWH in the U.S. insured through Medicaid and diagnosed with schizophrenia experience lower retention in HIV care than controls. Suboptimal retention likely drives disparities in HIV-related morbidity and mortality for PWH with schizophrenia, and targeted individual and structural interventions are merited to improve the health of this population.