HIV Infection and Linkage to HIV-Related Medical Care in Large Urban Areas in the United States, 2009

Laffoon, Benjamin T.; Hall, H. Irene; Babu, Aruna Surendera; Benbow, Nanette; Hsu, Ling; Hu, Yunyin W.; Workgroup, Urban Areas Hiv Surveillance

doi:10.1097/qai.0000000000000619

Cited by 10 publications

(7 citation statements)

References 6 publications

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“…Finally, the study sample was selected from one HIV clinic in Philadelphia and results may not be generalizable to other HIV-infected populations, particularly those living outside the United States. However, sociodemographic attributes of our study population are very similar to those of HIV-infected populations living in other economically disadvantaged urban areas in the United States including Baltimore, Newark, and New Orleans (Laffoon et al, 2015). Therefore, our findings may generalize to other urban HIV-infected populations in the United States.…”

Section: Discussionmentioning

confidence: 70%

Tuberculosis screening among HIV-infected patients: tuberculin skin test vs. interferon-gamma release assay

et al. 2017

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National guidelines recommend screening for latent tuberculosis infection (LTBI) in all HIV-infected patients. Thus, the objective of this study was to measure protocol adherence to national guidelines regarding LTBI screening for HIV-infected patients entering care at an urban primary care clinic specializing in HIV care, identify clinical and other characteristics associated with adherence, and determine whether transitioning from the tuberculin skin test (TST) to the interferon-gamma release assay (IGRA) improved adherence. We conducted a retrospective study using protocol adherence to LTBI screening guidelines within twelve months of entering care at an HIV clinic as the primary outcome. Successful protocol adherence was defined as the placement and reading of a TST, performance of an IGRA, or a note in study clinic records documenting prior testing or treatment for tuberculosis in an outside setting. Multivariable modified Poisson regression models were used in analyses. Overall, 32% (n = 118/372) of patients received LTBI screening within twelve months of entering care. Protocol adherence to LTBI screening guidelines increased from 28% to 37% following the transition from TST to IGRA screening. IGRA screening [adjusted prevalence ratio: 1.45, 95% confidence limits: (1.07, 1.96)], male sex [1.47 (1.05, 2.07)], transfer patient status [1.51 (1.05, 2.18)], and greater than one year of clinic attendance [1.62 (1.06, 2.48)] were independently associated with protocol adherence. Among patients without prior LTBI screening or treatment, patients entering the clinic in 2013 under the IGRA screening protocol were more likely to be screened for LTBI compared to patients entering under the TST screening protocol (34.3% vs. 9.7%, p < 0.001). In conclusion, transitioning from TST to IGRA-based screening improved adherence to screening guidelines. However, further work on improving adherence to LTBI screening guidelines among HIV-infected patients is needed.

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Section: Discussionmentioning

confidence: 70%

Tuberculosis screening among HIV-infected patients: tuberculin skin test vs. interferon-gamma release assay

et al. 2017

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“…Our model is also calibrated to currently available national estimates of engagement in the care continuum 19 . Data from large city and county programs have generally suggested more optimistic estimates of current HIV care engagement and viral suppression 29, 30 . To the extent that engagement in care and viral suppression in our base-case scenario are underestimated, the incremental impact of achieving NHAS targets may be more modest, and our model may be optimistically biased.…”

Section: Discussionmentioning

confidence: 99%

Effect of the US National HIV/AIDS Strategy targets for improved HIV care engagement: a modelling study

et al. 2016

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Structured Summary Background The recently updated White House National HIV/AIDS Strategy (NHAS) includes specific progress indicators for improving the HIV care continuum, but the economic and epidemiological impact of achieving those indicators remains unclear. Methods We constructed a dynamic transmission model of HIV progression and care engagement to project HIV incidence, prevalence, mortality, and costs among adults in the United States over ten years. We specifically considered achievement of the 2020 targets set forth in NHAS progress indicator 1 (90% awareness of serostatus), indicator 4 (85% linkage within one month), and indicator 5 (90% of diagnosed individuals in care). Finding At current rates of engagement in the HIV care continuum, we project 524,000 (95% Uncertainty Range 442,000 – 712,000) new HIV infections and 375,000 deaths (364,000 – 578,000) between 2016 and 2025. Achieving NHAS progress indicators 1 and 4 has modest epidemiologic impact (new infections reduced by 2·0% and 3·9%, respectively). By contrast, increasing the proportion of diagnosed individuals in care (indicator 5) averts 52% (47-56%) of new infections. Achieving all NHAS targets resulted in a 58% reduction (52%-61%) in new infections and 128,000 lives saved (106,000-223,000) at an incremental health system cost of $105 billion dollars. Interpretation Achievement of NHAS progress indicators for screening, linkage, and particularly improving retention in care, can substantially reduce the burden of HIV in the United States.

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“…These projections depend on data about rates of linkage and retention in AYA after routine screening, which vary by setting. Linkage to care rates for AYA, for example, range from 30% in Miami, FL to 92% in an emergency department in Bronx, NY (base case 76%) [13, 33, 34]. The current practice scenario projected more optimistic virologic outcomes than were reported in a recent review or in the CDC Medical Monitoring Project (80% versus 55% and 68% virologic suppression among those retained, respectively) [35, 36].…”

Section: Discussionmentioning

confidence: 99%

“…The peak HIV incidences (3.6/100PY and 7.2/100PY) examined in our sensitivity analyses mirrored that of higher risk populations (for example, Adolescent Trials Network study 110: 3.1/100PY; PROUD study 9.0/100PY), but we lacked data to derive age-specific incidence rates for these groups [39, 40]. Age-based, sexual identity- and orientation-based, racial/ethnic, and regional disparities have been described in both HIV screening and incidence [2, 4, 13, 33]. Risk factor assessment should be performed by health care practitioners and optimal screening strategies for known high-risk subgroups of AYA will be different than those presented in this analysis [41].…”

Section: Discussionmentioning

confidence: 99%

The Optimal Age for Screening Adolescents and Young Adults Without Identified Risk Factors for HIV

Neilan

Dunville

Ocfemia

et al. 2018

Journal of Adolescent Health

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HIV Infection and Linkage to HIV-Related Medical Care in Large Urban Areas in the United States, 2009

Cited by 10 publications

References 6 publications

Tuberculosis screening among HIV-infected patients: tuberculin skin test vs. interferon-gamma release assay

Tuberculosis screening among HIV-infected patients: tuberculin skin test vs. interferon-gamma release assay

Effect of the US National HIV/AIDS Strategy targets for improved HIV care engagement: a modelling study

The Optimal Age for Screening Adolescents and Young Adults Without Identified Risk Factors for HIV

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