DOI
https://doi.org/10.25772/25KK-R029
Defense Date
2023
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Healthcare Policy & Research
First Advisor
April D Kimmel
Abstract
Ending the HIV epidemic is a global challenge. In United States, retention in care remains low with racial disparities. Physician reimbursement may be a barrier to improving retention in care. The first paper examines the association between physician reimbursement, measured by Medicaid-to-Medicare fee ratio, and retention in care in US South using generalized estimating equations with individual-level claims data. The study also assesses the associations by race. The results suggest that a small increase in fee ratio will increase retention in care for the overall population and non-Hispanic Black individuals but not for non-Hispanic White individuals. Increasing physician reimbursement may improve retention in care and promote health equity. Low-income countries, such as Cameroon, face the challenge of intimate partner violence, which may deter the achievement of reducing new HIV infections and improving HIV care continuum. The second and third paper develop and calibrate a population-level dynamic compartment model that simulates the impact of intimate partner violence on the HIV epidemic and HIV care continuum outcomes for total and sub-populations. The calibrated model demonstrates a very good fit to HIV prevalence and HIV incidence and an acceptable fit to HIV care continuum targets. Eliminating intimate partner violence is shown to improve HIV epidemic outcomes, particularly for female sex workers and low-risk adult women aged 25-64 years, but it has limited impact on HIV care continuum. Overall, these findings suggest that both increasing physician reimbursement and reducing intimate partner violence may help to tackle the challenge of ending the HIV epidemic globally.
Rights
© The Author
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
5-8-2023