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…

The National Institutes of Health Office of the Director awarded The Medical College of Wisconsin, Inc. $429,000 on September 2, 2026, under the Trans-NIH Research Support program (CFDA 93.310) to conduct an exploratory mixed-methods study examining health outcomes and Medicare navigation experiences among older people with HIV in five Southern states.

The research characterizes how people with HIV aged 65 and older experience Medicare enrollment and ongoing coverage, how insurance-related challenges affect HIV care and antiretroviral therapy adherence, and how health benefit advisors support this population. The study includes qualitative interviews with people with HIV aged 65 (n=35) and health benefit advisors, including Ryan White non-medical case managers (n=15) and state health insurance assistance program counselors, alongside quantitative examination of associations between insurance-related barriers and health behaviors and outcomes. The work addresses a gap in evidence on Medicare transitions for a rapidly aging cohort of people with HIV who face complex navigation of multiple payers—Medicare, Medicaid, and Ryan White-funded services—particularly in Southern states bearing disproportionate HIV disease burden and variable Medicare system performance.

Work is performed in Wauwatosa, Wisconsin with a period of performance from September 2, 2026 through August 31, 2028. The award is a project grant, the standard NIH assistance type for investigator-initiated research.

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.