Socioeconomic resources and age, not race or gender, are associated with disparities in engagement in HIV care in San Francisco.
Background Early virologic suppression after HIV infection improves individual health outcomes and decreases onward transmission. In San Francisco, immediate ART at HIV diagnosis was piloted in 2013-14 and expanded citywide in 2015 in a rapid start initiative to link all new diagnoses to care within five days and start ART at the first care visit. Methods HIV providers and linkage navigators were trained on a rapid start protocol with sites caring for vulnerable populations prioritized. Dates of HIV diagnosis, first care visit, ART initiation, and virologic suppression were abstracted from the SFDPH HIV surveillance registry. Results During 2013 to 2017, among 1354 new HIV diagnoses in San Francisco, median days from diagnosis to first virologic suppression decreased from 145 to 76 (48%, p<0.0001) and median days from first care visit to ART initiation decreased from 28 to 1 (96%, p<0.0001). By 2017, 28% of new diagnoses had a rapid start, which was independently associated with Latinx ethnicity (AOR 1.73, 95%CI 1.15-2.60) and recent years of diagnosis (2017 AOR 16.84, 95%CI 8.03-35.33). Persons with a rapid ART start were more likely to be virologically suppressed within 12 months of diagnosis than those with a non-rapid start (RR 1.17, 95% CI 1.10-1.24). Conclusions During a multisector initiative to optimize ART initiation, median time from diagnosis to virologic suppression decreased by nearly half. Immediate ART at care initiation was achieved across many, but not all, populations, and was associated with improved suppression rates.
Introduction:Ending the HIV epidemic in the U.S. holds rapid antiretroviral therapy as a key strategy to improve the health of those with HIV and to decrease transmission. In 2015, Getting to Zero San Francisco, a multisector consortium, expanded rapid antiretroviral therapy citywide.Methods: A Getting to Zero San Francisco Rapid ART Program Initiative for HIV Diagnoses Committee (academic, community, service delivery, health department partners) designed the program, protocol, dissemination plan, and monitoring strategy. Newly diagnosed patients were linked to an HIV medical home or Rapid ART Program Initiative for HIV Diagnoses initiation hub to best deliver rapid antiretroviral therapy across a diverse patient mix, with a goal of ≤5 working days from diagnosis to care and ≤1 day from care to antiretroviral therapy. Stakeholders were trained on rapid antiretroviral therapy via Getting to Zero San Francisco meetings, in-services, public health detailing, and peer-topeer recruiting, prioritizing HIV clinics serving patients of color, Latinx ethnicity, youth, and the uninsured or publicly insured. Rapid ART Program Initiative for HIV Diagnoses−specific metrics were derived from surveillance data; stratified by sex/gender, age, race/ethnicity, and housing status; and presented at public meetings. Data were analyzed between January and April 2021.Results: From 2014 to 2018, median time from diagnosis to care decreased 71% (7 to 2 days), care to antiretroviral therapy decreased from 19 to 0 days, and diagnosis to virologic suppression decreased 51% (94 to 46 days). Improvements occurred regardless of age, race/ethnicity, sex/gender, exposure, or housing status.Conclusions: During a citywide initiative to optimize antiretroviral therapy initiation, time from HIV diagnosis to care, antiretroviral therapy, and virologic suppression decreased across all affected groups to varying degrees. The Rapid ART Program Initiative for HIV Diagnoses Committee continues to address challenges to retention and expand implementation.
Women electing pregnancy termination can serve as a sentinel population to track trends in the HIV epidemic. However, barriers remain to wider implementation of the approach as a surveillance tool.
This program evaluation assessed utilization of blood products and hospital services in 1975. One hundred eight hemophiliacs, 10 (0-4 years), 37 (5-12 years), 21 (13-18 years), 24 (19-30 years), 16 (30 years and over); 73 (Factor VIII), 20 (Factor IX), 12 (Von Willebrand’s Disease), and 3 (Factor XI) were categorized as to their severity and their primary treatment mode: Home Care Prophylactic, Home Care Episodic, Hospital-based Prophylactic, and Hospital-based Episodic Care. The results showed that the major user of hospital services was the child, 5-12 years. Hospital-based patients used more hospital based services, i.e., emergency room, comprehensive clinic, and dental non-surgery than did home based patients. In terms of factor unit consumption per kilogram body weight, prophylactic patients used the greatest amount of blood product. Children on prophylaxis missed less school but adults on prophylaxis did not miss less work. Children on hospital modes of care utilized this medical service less in the summer than did their peers on home based care. These results provided direction for planning future programs and staffing. They suggest a need for increasing surveillance of Home Care patients to maximize their participation in certain hospital based services. The unexpected finding of decreased hospital based care during the summer warrants further study. The results suggest considering prophylactic modes of care in school aged children.
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