Addressing the Challenges of the HIV Continuum of Care in High-Prevalence Cities in the United States

Greenberg, Alan E.; Purcell, David W.; Gordon, Christopher M.; Barasky, Rebecca J.; Rı́o, Carlos del

doi:10.1097/qai.0000000000000569

Cited by 37 publications

(39 citation statements)

References 33 publications

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“…Interventions included demonstration projects using innovative combinations of HIV prevention interventions, including large campaigns to educate health providers and patients about the benefits of HIV treatment [18]. In addition, best practices for increasing routine utilization of HIV care and medication adherence, including appointment reminders and accompaniment, case management, and other supportive services, were systematically evaluated and disseminated during this time [19].…”

Section: Discussionmentioning

confidence: 99%

Increased antiretroviral therapy prescription and HIV viral suppression among persons receiving clinical care for HIV infection

Bradley

Mattson

Beer

et al. 2016

Aids

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Objective To assess trends during 2009–2013 in antiretroviral therapy (ART) prescription and viral suppression among adults receiving HIV clinical care in the United States. Design We used data from the Medical Monitoring Project, a surveillance system producing national estimates of characteristics of HIV-infected adults receiving clinical care in the United States. Methods We estimated weighted proportions of persons receiving HIV medical care who were prescribed ART and achieved HIV viral suppression (<200 copies/ml) at both last test and at all tests in the previous 12 months during 2009–2013. We assessed trends overall and by gender, age, race/ethnicity, and sexual behavior/orientation. Results ART prescription and viral suppression increased significantly during 2009–2013, overall and in subgroups. ART prescription increased from 89 to 94% (P for trend <0.01). Viral suppression at last measurement increased from 72 to 80% (P for trend <0.01). The largest increases were among 18–29 year olds (56–68%), 30–39 year olds (62–75%), and non-Hispanic blacks (64–76%). Sustained viral suppression increased from 58 to 68% (P for trend <0.01). The largest increases were among 18–29 year olds (32–51%), 30–39 year olds (47–63%), and non-Hispanic blacks (49–61%). Conclusion Adults receiving HIV medical care are increasingly likely to be prescribed ART and achieve viral suppression. Recent efforts to promote early antiretroviral therapy use may have contributed to these increases, bringing us closer to realizing key goals of the National HIV/AIDS Strategy.

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Section: Discussionmentioning

confidence: 99%

Increased antiretroviral therapy prescription and HIV viral suppression among persons receiving clinical care for HIV infection

Bradley

Mattson

Beer

et al. 2016

Aids

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“…This interplay of effects may represent a rare example of the implementation of a technology policy – the LHIE intervention - having coincidental positive effect within the same clinical population on another policy goal: the National HIV/AIDS Strategy policy goals of improving outcomes along the care continuum, and reducing HIV care disparities. 12,37,38 …”

Section: Discussionmentioning

confidence: 99%

“…While the National HIV/AIDS Strategy emphasizes the need for innovative interventions to reduce HIV-related disparities, increase access to ART and improve outcomes along the continuum of care for PLWH, 12,13 few interventions or policies have been shown to reduce racial/ethnic gaps in HIV treatment and outcomes. Facilitating the delivery of ART and achieving VS are critical to achieving these goals.…”

Section: Introductionmentioning

confidence: 99%

Effects of a Laboratory Health Information Exchange Intervention on Antiretroviral Therapy Use, Viral Suppression, and Racial/Ethnic Disparities

Cunningham

Ford²,

Kinsler

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Although antiretroviral therapy (ART) is available to treat HIV+ persons and prevent transmission, ineffective delivery of care may delay ART use, impede viral suppression (VS) and contribute to racial/ethnic disparities along the continuum of care. This study tested the effects of a bi-directional laboratory health information exchange (LHIE) intervention on each of these outcomes. Methods We used a quasi-experimental, interrupted time series design to examine whether the LHIE intervention improved ART use and VS, and reduced racial/ethnic disparities in these outcomes among HIV+ patients (N=1,181) in a comprehensive HIV/AIDS clinic in Southern California. Main outcome measures included ART pharmacy fill and HIV VL lab data extracted from the medical records over three years. Race/ethnicity and an indicator for the intervention (after vs. before) were the main predictors. The analysis involved three-stage, multivariable logistic regression with generalized estimating equations (GEE). Results Overall, the intervention predicted greater odds of ART use (OR=2.50; 95% CI=2.29-2.73; P<0.001) and VS (OR=1.12; 95% CI=1.04-1.21; P<0.05) in the final models that included sociodemographic, behavioral, and clinical covariates. Prior to the intervention, there were significant Black/White disparities in ART use OR=0.75 (0.58-0.98; P=0.04) and VS OR=0.75 (0.61-0.92; P=0.001). After the intervention, the Black/White disparities decreased after adjusting for sociodemographics and the number of HIV care visits, and Latinos had greater odds than Whites of ART use and VS, adjusting for covariates. Conclusions The intervention improved overall ART treatment and VS, and reduced Black/White disparities. LHIE interventions may hold promise if implemented among similar patients.

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“…1 In the United States, an estimated 87% of the more than 1 million people living with HIV are aware of their diagnosis, 84% of whom are subsequently linked to care within 3 months, with 56% of those linked to care subsequently retained in care and 77% of those engaged in care ultimately achieving viral suppression. 2 However, among persons aged 13 to 24 years, care continuum outcomes are even worse.…”

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confidence: 99%

Implementation of an Integrated Approach to the National HIV/AIDS Strategy for Improving Human Immunodeficiency Virus Care for Youths

et al. 2017

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IMPORTANCEYouths aged 13 to 24 years old living with human immunodeficiency virus (HIV) are less likely than adults to receive the health and prevention benefits of HIV treatments, with only a small proportion having achieved sustained viral suppression. These age-related disparities in HIV continuum of care are owing in part to the unique developmental issues of adolescents and young adults as well as the complexity and fragmentation of HIV care and related services. This article summarizes a national, multiagency, and multilevel approach to HIV care for newly diagnosed youths designed to bridge some of these fragmentations by addressing National HIV/AIDS Strategy goals for people living with HIV.DESIGN, SETTING, AND PARTICIPANTS Three federal agencies developed memoranda of understanding to sequentially implement 3 protocols addressing key National HIV/AIDS Strategy goals. The goals were addressed in the Adolescent Trials Network, with protocols implemented in 12 to 15 sites across the United States. Outcome data were collected from recently diagnosed youth referred to the program.MAIN OUTCOMES AND MEASURES Cross-agency collaboration, youth-friendly linkage to care services, community mobilization to address structural barriers to care, cooperation among services, proportion of all men who have sex with men who tested, and rates of linkage to prevention services. RESULTSThe program addressed National HIV/AIDS Strategy goals 2 through 4 including steps within each goal. A total of 3986 HIV-positive youths were referred for care, with more than 75% linked to care within 6 weeks of referral, with almost 90% of those youths engaged in subsequent HIV care. Community mobilization efforts implemented and completed structural change objectives to address local barriers to care. Age and racial/ethnic group disparities were addressed through targeted training for culturally competent, youth-friendly care, and intensive motivational interviewing training. CONCLUSIONS AND RELEVANCEA national program to address the National HIV/AIDS Strategy specifically for youths can improve coordination of federal resources as well as implement best-practice models that are adapted to decrease service fragmentation and systemic barriers at local jurisdictions.

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Addressing the Challenges of the HIV Continuum of Care in High-Prevalence Cities in the United States

Cited by 37 publications

References 33 publications

Increased antiretroviral therapy prescription and HIV viral suppression among persons receiving clinical care for HIV infection

Increased antiretroviral therapy prescription and HIV viral suppression among persons receiving clinical care for HIV infection

Effects of a Laboratory Health Information Exchange Intervention on Antiretroviral Therapy Use, Viral Suppression, and Racial/Ethnic Disparities

Implementation of an Integrated Approach to the National HIV/AIDS Strategy for Improving Human Immunodeficiency Virus Care for Youths

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