BETHESDA, MD — Nearly a decade ago, in 2014, the U.S. Air Force reduced the frequency of mandated HIV medical evaluation visits from every 6 months to every 12 months. The goal was to improve military readiness.
A study team led by the Uniformed Services University of the Health Sciences decided to take advantage of the natural experiment using data for 2,676 active-duty Military Health System beneficiaries diagnosed with HIV. The difference-in-differences empirical strategy used the Army, Navy, and Marines as a control group to estimate the causal effect of reducing the frequency of mandated evaluation visits on the quality and cost of medical care for active-duty military members diagnosed with HIV.
The results published in the journal Health Economics indicated that reducing the frequency of mandated HIV medical evaluation visits reduced the likelihood of regular HIV visits by 23% but did not affect the likelihood of receiving other preventive care, adhering to HIV therapy or maintaining viral testing and suppression.1
“The study finds evidence that the recommended level of regular HIV visits may be higher than necessary,” write the researchers. “The reduction in regular HIV visits was not associated with a similar reduction in the studied quality of care measures, therefore, the effect of alleviating the mandate was overall positive in terms of reducing healthcare utilization without adversely affecting preventive care, HIV therapy, or viral testing and suppression.”
Background in the article from, in addition to USU, the Henry M. Jackson Foundation for the Advancement of Military Medicine, Walter Reed National Military Medical Center, the Navy Bloodborne Infection Management Center, all in Bethesda, MD, and Brooke Army Medical Center at Fort Sam Houston, TX, noted, “While treatable, HIV has remained costly to manage. Advancements in antiretroviral therapy (ART) have brought improvements in the health outcomes and life spans of persons living with HIV, reducing the gap between persons living with HIV and the general population. However, this has led to longer exposure to the HIV virus, longer exposure to toxicity associated with ART, and a higher incidence of other medical conditions associated with aging.”
The authors suggested that the new challenges have presented the need to develop an efficient HIV care plan for the costly long-term management of HIV.
The study also advised that HIV afflicts a disproportionately larger share of Black patients and men who have sex with men, “both of whom are groups who have historically faced discrimination, marginalization, and other challenges. Studying the management of HIV in the Military Health System (MHS), which consists of a large share of Black beneficiaries, allows us to ensure that patients in these groups receive adequate care. Examining care in the MHS, which provides universal healthcare coverage to all beneficiaries also sheds light on the care and cost in a universal coverage system.”
The authors explained that the Air Force, but not the other services, implemented the new policy in an effort to improve the military readiness and deployability of active-duty servicemembers living with HIV, noting, “Travel to an infectious disease specialty MTF for a mandatory HIV medical evaluation poses a potential interruption in duty or deployment, particularly for those stationed overseas, and limits the duration for which an active-duty member living with HIV can be deployed. To address this, the Air Force decreased the frequency with which an active-duty member living with HIV must travel for specialty evaluation from every 6 months to every 12 months.”
The study also noted that the number of new infections in recent years has declined, but the number of total HIV cases in the United States remains high—an estimated lifetime cost of $379,668.
“Due to this, HIV care remains a sizable burden on the U.S. healthcare system, which is further exacerbated by the increasing costs of healthcare,” the researchers pointed out. Preventive care in the form of checkups, screening, and immunizations is an integral part of HIV management policy aimed at maintaining quality of care and health outcomes while also potentially decreasing healthcare costs by preventing medical complications. Medical evaluation visits or checkups are one of the first steps in the path to providing such preventive care”.
They added, “We find no evidence that the policy change affected the likelihood of receiving antiretroviral therapy (ART) or that the policy change affected the likelihood of receiving CD4 measurements. We also find no evidence that the policy change affected the likelihood of viral load testing and suppression.”
- Topal S, Richard P, Young J, Ganesan A, et. al. Mandated checkups, knowledge of own health status, and chronic care utilization: The effect of HIV medical evaluation mandates on healthcare quality and expenditure in a US-single payer system. Health Econ. 2023 Sep 28. doi: 10.1002/hec.4761. Epub ahead of print. PMID: 37768123.
