Health Outcomes Following Enrollment in Medicare Among Older People with HIV - Effective antiretroviral therapy (ART ) has transformed HIV into a manageable chronic condition, resulting in a rapidly aging population of people with HIV (PWH). Adults aged 65 are now the fastest growing group of PWH in the U.S. and face complex health needs, including high rates of comorbid chronic conditions and lifelong reliance on ART. Age 65 represents a critical transition point when many PWH become newly eligible for Medicare. For PWH, successful navigation of Medicare enrollment and continuity of coverage is essential to maintaining uninterrupted access to ART and HIV care. Yet Medicare coverage is complex, often incomplete, and highly variable across plans, creating risk for coverage gaps, high out-of-pocket costs, and disruptions to HIV care. PWH frequently must navigate multiple payers and assistance programs, including Medicare, Medicaid, and Ryan White-funded services. Guidance is typically provided by advisors with either HIV-specific expertise or Medicare expertise, but rarely both. Challenges are particularly acute in the Southern U.S., which bears a disproportionate HIV burden and includes several states with poorly performing Medicare systems. Despite the size and vulnerability of this population, little research has examined how PWH experience the Medicare transition and ongoing coverage, how insurance-related challenges affect HIV care and ART adherence, or how advisors support PWH. To address this critical gap, we propose an exploratory mixedmethods study across five Southern states to characterize Medicare navigation experiences among PWH and the advisors who assist them, and to examine associations between insurance-related challenges and health behaviors and outcomes. In Aim 1, we will conduct qualitative interviews with PWH aged 65 (N=35) and with health benefit advisors, including Ryan White non-medical case managers (N=15) and State Health Insurance Assistance Program advisors (N=15). Interviews will examine barriers to enrollment or continuity, coverage stability, financial burden, sources of assistance, and perceived effects on HIV care and ART access. In Aim 2, we will administer a survey to PWH aged 65 (N=300) to assess patterns of insurance-related challenges during and after the Medicare transition and their associations with ART adherence, care engagement, viral suppression, self-rated health, acute care use, and quality of life. Findings will inform improved benefit navigation for older PWH and guide development of targeted interventions to strengthen continuity of HIV care in an aging population.
