Comparison of Clinical Outcomes of Persons Living With HIV by Enrollment Status in Washington, DC: Evaluation of a Large Longitudinal HIV Cohort Study

Abstract

Background HIV cohort studies have been used to assess health outcomes and inform the care and treatment of people living with HIV disease. However, there may be similarities and differences between cohort participants and the general population from which they are drawn. Objective The objective of this analysis was to compare people living with HIV who have and have not been enrolled in the DC Cohort study and assess whether participants are a representative citywide sample of people living with HIV in the District of Columbia (DC). Methods Data from the DC Health (DCDOH) HIV surveillance system and the DC Cohort study were matched to identify people living with HIV who were DC residents and had consented for the study by the end of 2016. Analysis was performed to identify differences between DC Cohort and noncohort participants by demographics and comorbid conditions. HIV disease stage, receipt of care, and viral suppression were evaluated. Adjusted logistic regression assessed correlates of health outcomes between the two groups. Results There were 12,964 known people living with HIV in DC at the end of 2016, of which 40.1% were DC Cohort participants. Compared with nonparticipants, participants were less likely to be male (68.0% vs 74.9%, P<.001) but more likely to be black (82.3% vs 69.5%, P<.001) and have a heterosexual contact HIV transmission risk (30.3% vs 25.9%, P<.001). DC Cohort participants were also more likely to have ever been diagnosed with stage 3 HIV disease (59.6% vs 47.0%, P<.001), have a CD4 <200 cells/µL in 2017 (6.2% vs 4.6%, P<.001), be retained in any HIV care in 2017 (72.9% vs 59.4%, P<.001), and be virally suppressed in 2017. After adjusting for demographics, DC Cohort participants were significantly more likely to have received care in 2017 (adjusted odds ratio 1.8, 95% CI 1.70-2.00) and to have ever been virally suppressed (adjusted odds ratio 1.3, 95% CI 1.20-1.40). Conclusions These data have important implications when assessing the representativeness of patients enrolled in clinic-based cohorts compared with the DC-area general HIV population. As participants continue to enroll in the DC Cohort study, ongoing assessment of representativeness will be required.

HIV care continuum outcomes among recently diagnosed people with HIV (PWH) in Washington, DC

“…An analysis comparing demographic and clinical characteristics of DC Cohort participants, compared with Washington DC residents with HIV identified with surveillance data, was previously undertaken [ 23 ]. The DC Cohort includes individuals receiving HIV care in Washington, DC, who reside in DC and the surrounding metropolitan areas, which include parts of Maryland and Virginia.…”

“…Compared with nonparticipants, participants were less likely to be male (68.0% vs. 74.9%, P < 0.001) and more likely to be Black (82.3% vs. 69.5%, P < 0.001) and have a heterosexual contact HIV transmission risk (30.3% vs. 25.9%, P < 0.001). DC Cohort participants were also more likely to have ever been diagnosed with stage 3 HIV disease (59.6% vs. 47.0%, P < 0.001), have a CD4 <200 cells/μl in 2017 (6.2% vs. 4.6%, P < 0.001) and to be virally suppressed in 2017 (61.4% vs. 50.5%, P < 0.001) [ 23 ]. We do not have a recent comparison between recently diagnosed individuals within the DC Cohort vs. those living in DC identified through surveillance data.…”

“…The DC Cohort study has a consent rate of over 80% of those eligible patients approached and enrols patients seeking HIV care in 14 major clinics in the District. Although there are limitations in the representativeness of the DC Cohort population to all people with HIV in Washington, DC [23] it is a data source that is extremely useful for describing HIV outcomes within DC. Some of the limitations of this study are due to the nature of the DC Cohort study and DC Health surveillance data collection protocols.…”

Identifying Geographic Areas of Washington, DC, With Increased Potential for Sexual HIV Transmission Among People With HIV With STIs and Concurrent Elevated HIV RNA: Data From the DC Cohort

“…The true frequency and type of condomless sex exposure among persons with unsuppressed HIV and partners without PrEP was unknown, and the distribution of very high viral loads that may be associated with an elevated risk of potential sexual transmission was not addressed [ 24 ]. Our analysis only includes participants engaged in care to some degree, and it is possible that those PWH not engaged in care may be at higher risk for transmission of HIV and STI [ 25 ]. While ZIP codes were available for participant residence location, these areas are not necessarily equated to where sexual risk behaviors occur.…”

Evaluation of the Implementation and Effectiveness of a Mobile Health Intervention to Improve Outcomes for People With HIV in the Washington, DC Cohort: Study Protocol for a Cluster Randomized Controlled Trial

“…Through a network of research assistants (RAs) located at these partner clinics, approximately 450 people with HIV enroll in the DC Cohort annually. DC Cohort participants represent about 75% of people with HIV cared for at these clinics and are demographically similar to the broader HIV population in DC; in 1 interim assessment, 4258 (82%) of 5193 participants were black, 3531 (68%) male, and 1973 (38%) men who have sex with men (MSM) [ 14 ].…”