Disparities in Engagement in Care and Viral Suppression Among Persons With HIV

Muthulingam, Dharushana; Chin, Jennie; Hsu, Ling; Scheer, Susan; Schwarcz, Sandra

doi:10.1097/qai.0b013e3182894555

Cited by 90 publications

(76 citation statements)

References 64 publications

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“…Past research has highlighted such disparities among the different racial/ethnic HIVinfected population. [34][35][36] The possible reasons for a slower decline in VL in men compared to women are less clear. Although some studies have shown that men are more likely to be late testers compared to women, 34 the body of research on healthcare utilization and adherence among women with HIV is mixed with many studies suggesting greater barriers, delayed care, and poor health outcomes for women.…”

Section: Discussionmentioning

confidence: 99%

Disparities in Viral Load and CD4 Count Trends Among HIV-Infected Adults in South Carolina

Chakraborty

Iyer

Duffus

et al. 2015

AIDS Patient Care and STDs

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On a population level, trends in viral load (VL) and CD4 cell counts can provide a marker of infectivity and an indirect measure of retention in care. Thus, observing the trend of CD4/VL over time can provide useful information on disparities in populations across the HIV care continuum when stratified by demography. South Carolina (SC) maintains electronic records of all CD4 cell counts and HIV VL measurements reported to the state health department. We examined temporal trends in individual HIV VLs reported in SC between January 1, 2005 and December 31, 2012 by using mixed effects models adjusting for gender, race/ethnicity, age, baseline CD4 count, HIV risk category, and residence. Overall VL levels gradually decreased over the observation period. There were significant differences in the VL decline by gender, age groups, rural/urban residence, and HIV risk exposure group. There were significant differences in CD4 increases by race/ethnicity, age groups, and HIV risk exposure group. However, the population VL declines were slower among individuals aged 13-19 years compared to older age groups ( p < 0.0001), among men compared to women ( p = 0.002), and among people living with HIV/AIDS (PLWHA) with CD4 count £ 200 cell/mm 3 compared to those with higher CD4 counts ( p < 0.0001). Significant disparities were observed in VL decline by gender, age, and CD4 counts among PLWHA in SC. Population based data such as these can help streamline and better target local resources to facilitate retention in care and adherence to medications among PLWHA.

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Section: Discussionmentioning

confidence: 99%

Disparities in Viral Load and CD4 Count Trends Among HIV-Infected Adults in South Carolina

Chakraborty

Iyer

Duffus

et al. 2015

AIDS Patient Care and STDs

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“…In other jurisdictions where such initiatives are not widespread, additional challenges to the uptake and adherence to antiretroviral therapy may be encountered, which may compromise the ability to satisfy this legal test for HIV nondisclosure. Indeed, studies in other North American settings have found that members of marginalized and vulnerable groups, including people who inject drugs, 18-21 ethnic minorities, 22 sex workers 23 and homeless individuals, 24 experience barriers to accessing antiretroviral therapy and achieving sustained viral suppression.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and predictors of facing a legal obligation to disclose HIV serostatus to sexual partners among people living with HIV who inject drugs in a Canadian setting:a cross-sectional analysis

et al. 2016

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“…Although health service provision and populations of PLWH vary from country to country, these studies suggest that PLWH are less likely to disengage from care if they are male, 8 older, 8,21,28,29 white 8,22 and men who have sex with men (MSM) 22,23 and have started ART. 8,21 Socioeconomic factors and education have been highlighted in relation to disparities in EIC 30,31 and complex patient groups, such as intravenous drug users, migrants and the newly diagnosed, are more likely to disengage from care. 23 Although recent diagnosis is associated with poor retention in care, 8 there is also an indication that EIC can diminish over time.…”

Section: Chapter 1 Backgroundmentioning

confidence: 99%

REACH: a mixed-methods study to investigate the measurement, prediction and improvement of retention and engagement in outpatient HIV care

Howarth

Apea

Michie

et al. 2017

Health Serv Deliv Res

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BackgroundAntiretroviral therapy (ART) benefits individuals living with human immunodeficiency virus (HIV) through reduced morbidity and mortality, and brings public health gains through a reduction in HIV transmission. People living with human immunodeficiency virus (PLWH) need to know their HIV status and engage in HIV care in order for these individual and public health benefits to be realised.ObjectiveTo explore, describe and understand HIV outpatient attendance in PLWH, in order to develop cost-effective interventions to optimise engagement in care.DesignA mixed-methods study incorporating secondary analysis of data from the UK Collaborative HIV Cohort (UK CHIC) study and primary data collection.MethodsPhase 1 – an engagement-in-care (EIC) algorithm was developed to categorise patients as in care or out of care for each month of follow-up. The algorithm was used in group-based trajectory analysis to examine patterns of attendance over time and of the association between the proportion of months in care before ART initiation and post-ART mortality and laboratory test costs. Phase 2 – a cross-sectional survey was conducted among patients attending seven London HIV clinics. Regular attenders (all appointments attended in past year), irregular attenders (one or more appointments missed in past year) and non-attenders (recent absence of ≥ 1 year) were recruited. A ‘retention risk tool’ was developed to identify those at risk of disengaging from care. Individual in-depth interviews and focus groups were conducted with PLWH. Phase 3 – key informant interviews were conducted with HIV service providers. Interventions were developed from the findings of phases 2 and 3.ResultsPlots from group-based trajectory analysis indicated that four trajectories best fitted the data. Higher EIC is associated with reduced mortality but the association between EIC before starting ART, and post-ART mortality [relative hazard (RH) per 10% increase in EIC 0.29, 95% confidence interval (CI) 0.18 to 0.47] was attenuated after adjustment for fixed covariates and post-ART cluster of differentiation 4 counts and viral loads (RH 0.74, 95% CI 0.42 to 1.30). Small differences were found in pre-ART EIC and the costs of post-ART lab tests. The final model for the retention risk tool included age at diagnosis, having children, recreational drug use, drug/alcohol dependency, insufficient money for basic needs and use of public transport to get to the clinic. Quantitative and qualitative data showed that a range of psychological, social and economic issues were associated with disengagement from care. The negative impact of stigma on attendance was highlighted. Interventions were proposed that support a holistic approach to care including peer support, address stigma by holding clinics in alternative locations and involve training staff to encourage attendance.ConclusionsThe study shows the adverse health impacts of disengaging from HIV care and demonstrates the importance of the wider health and social context in managing HIV effectively. Although phase 1 analysis was based on UK data, phases 2 and 3 were limited to London. The interventions proposed are supported by the data but their cost-effectiveness requires testing. Future research is needed to evaluate the interventions, to validate our retention risk tool across populations and settings, and to fully analyse the economic costs of disengaging from HIV care.FundingThe National Institute for Health Research Health Services and Delivery Research programme. The UK CHIC study is funded by the Medical Research Council UK (grant numbers G0000199, G0600337, G0900274 and M004236).

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Disparities in Engagement in Care and Viral Suppression Among Persons With HIV

Abstract: Socioeconomic resources and age, not race or gender, are associated with disparities in engagement in HIV care in San Francisco.

Cited by 90 publications

References 64 publications

Disparities in Viral Load and CD4 Count Trends Among HIV-Infected Adults in South Carolina

Disparities in Viral Load and CD4 Count Trends Among HIV-Infected Adults in South Carolina

Prevalence and predictors of facing a legal obligation to disclose HIV serostatus to sexual partners among people living with HIV who inject drugs in a Canadian setting:a cross-sectional analysis

REACH: a mixed-methods study to investigate the measurement, prediction and improvement of retention and engagement in outpatient HIV care

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