Disparities in achieving and sustaining viral suppression among a large cohort of HIV-infected persons in care – Washington, DC^*

Abstract

One goal of the HIV care continuum is achieving viral suppression (VS), yet disparities in suppression exist among subpopulations of HIV-infected persons. We sought to identify disparities in both the ability to achieve and sustain VS among an urban cohort of HIV-infected persons in care. Data from HIV-infected persons enrolled at the 13 DC Cohort study clinical sites between January 2011 and June 2014 were analyzed. Univariate and multivariate logistic regression were conducted to identify factors associated with achieving VS (viral load <200 copies/ml) at least once, and Kaplan–Meier (KM) curves and Cox proportional hazards models were used to identify factors associated with sustaining VS and time to virologic failure (VL≥200 copies/ml after achievement of VS). Among the 4,311 participants 95.4% were either virally suppressed at study enrollment or able to achieve VS during the follow-up period. In multivariate analyses, achieving VS was significantly associated with age (aOR: 1.04; 95%CI: 1.03–1.06 per 5-year increase) and having a higher CD4 (aOR: 1.05, 95% CI 1.04–1.06 per 100 cells/mm3). Patients infected through perinatal transmission were less likely to achieve VS compared to MSM patients (aOR: 0.63, 95% CI 0.51–0.79). Once achieved, most participants (74.4%) sustained VS during follow-up. Blacks and perinatally-infected persons were less likely to have sustained VS in KM survival analysis (log rank chi-square p≤0.001 for both) compared to other races and risk groups. Earlier time to failure was observed among females, Blacks, publically insured, perinatally infected, those with longer-standing HIV infection, and those with diagnoses of mental health issues or depression. Among this HIV-infected cohort, most people achieved and maintained VS; however, disparities exist with regard to patient age, race, HIV transmission risk, and co-morbid conditions. Identifying populations with disparate outcomes allows for appropriate targeting of resources to improve outcomes along the care continuum.

HealthCall delivered via smartphone to reduce co-occurring drug and alcohol use in HIV-infected adults: A randomized pilot trial

“…However, substantial disparities remain (Hall et al, 2013) since African-Americans and Hispanics are at greater risk for HIV infection (Giordano et al, 2010; Harrison, Song, & Zhang, 2010; Siddiqi et al, 2015), and for failure to achieve viral suppression once infected (Castel et al, 2016; Xia, Sun, Wiewel, & Torian, 2017). HIV-infected individuals with alcohol and drug problems are also more likely than others to have poor health behaviors (Crane et al, 2017; Metrik, Caswell, Magill, Monti, & Kahler, 2016; Young, Wood, Dong, Kerr, & Hayashi, 2015), lower engagement in and utilization of HIV care, and lower ART adherence (Gwadz et al, 2016; Lake et al, 2017; Lucas, 2011).…”

Despite Early Medicaid Expansion, Decreased Durable Virologic Suppression Among Publicly Insured People with HIV in Washington, DC

“…Among Cohort participants, 84% were in continuous HIV care and 78% and 80% underwent regular CD4 and VL monitoring, respectively (11). From 2011-2014, publicly-insured PWH were less likely to achieve VS; privately-insured PWH had an earlier time to VS; and public insurance was associated with earlier time to virologic failure (9). Further, PWH concurrently receiving care at three or more clinics were more likely to have public insurance and detectable VL, as well as hypertension, cardiovascular disease, and mental health issues (12).…”

Patterns of comorbidity and sociodemographic and psychosocial correlates among people living with HIV in South Carolina, USA

“…For example, depression was very prevalent among PLWH, with rates ranging from 8% to 40%, which may be about two times higher than that in the general population . Consequently, mental health problems can complicate HIV treatment and care and lead to poorer health outcomes such as suboptimal ART adherence , substance use and unprotected sexual behaviors , and have been associated with faster disease progression . Although not particularly targeting PLWH, the US Department of Health and Human Services’ 2010 strategic framework also identified the psychological issues that are associated with multiple chronic conditions and acknowledged the challenges of emotion management, including depression .…”