HIV Treatment Cascade by Housing Status at Enrollment: Results from a Retention in Care Cohort

Hawk, Mary; Maulsby, Cathy; Enobun, Blessing; Kinsky, Suzanne

doi:10.1007/s10461-018-2295-y

Cited by 6 publications

(5 citation statements)

References 53 publications

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“…Housing instability is a result of a complex interplay between individual vulnerabilities and broader structural factors. However, multiple randomized controlled trials have found providing housing assistance to independently improve outcomes among PLWH who experience housing instability [61,62], and thus it is a modifiable contextual factor [54,63]. To increase access to housing services for PLWH, the Health Resources and Services Administration recommends building new partnerships between public and private stakeholders, funding innovative strategies to address housing needs in PLWH, and involving PLWH with housing needs in this process [64].…”

Section: Discussionmentioning

confidence: 99%

Understanding disparities in viral suppression among Black MSM living with HIV in Atlanta Georgia

Sullivan

Knox

Jones

et al. 2021

J. Intern. AIDS Soc.

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Introduction Due to factors associated with structural racism, Black men who have sex with men (MSM) living with HIV are less likely to be virally suppressed compared to white MSM. Most of these data come from clinical cohorts and modifiable reasons for these racial disparities need to be defined in order to intervene on these inequities. Therefore, we examined factors associated with racial disparities in baseline viral suppression in a community‐based cohort of Black and white MSM living with HIV in Atlanta, GA. Methods We conducted an observational cohort of Black and white MSM living with HIV infection in Atlanta. Enrolment occurred from June 2016 to June 2017 and men were followed for 24 months; laboratory and behavioural survey data were collected at 12 and 24 months after enrolment. Explanatory factors for racial disparities in viral suppression included sociodemographics and psychosocial variables. Poisson regression models with robust error variance were used to estimate prevalence ratios (PR) for Black/white differences in viral suppression. Factors that diminished the PR for race by ≥5% were considered to meaningfully attenuate the racial disparity and were included in a multivariable model. Results Overall, 26% (104/398) of participants were not virally suppressed at baseline. Lack of viral suppression was significantly more prevalent among Black MSM (33%; 69/206) than white MSM (19%; 36/192) (crude Prevalence Ratio (PR) = 1.6; 95% CI: 1.1 to 2.5). The age‐adjusted Black/white PR was diminished by controlling for: ART coverage (12% decrease), housing stability (7%), higher income (6%) and marijuana use (6%). In a multivariable model, these factors cumulatively mitigated the PR for race by 21% (adjusted PR = 1.1 [95% CI: 0.8 to 1.6]). Conclusions Relative to white MSM, Black MSM living with HIV in Atlanta were less likely to be virally suppressed. This disparity was explained by several factors, many of which should be targeted for structural, policy and individual‐level interventions to reduce racial disparities.

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Section: Discussionmentioning

confidence: 99%

Understanding disparities in viral suppression among Black MSM living with HIV in Atlanta Georgia

Sullivan

Knox

Jones

et al. 2021

J. Intern. AIDS Soc.

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“…Other researchers modified the cascade for various reasons. First, data availability, which affects mostly stages included; for example, some studies started with PLHIV linked in care, [50][51][52] while others did not have viral load data. 53 In articles that used longitudinal design and multistate methods, the lack of transfer-out information 8 and failure to capture re-engagement in care after LTFU 46 affected the inclusion of these stages.…”

Section: Discussionmentioning

confidence: 99%

Statistical methods applied for the assessment of the HIV cascade and continuum of care: a systematic scoping review

Kalinjuma,

Glass,

Masanja

et al. 2023

BMJ Open

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ObjectivesThis scoping review aims to identify and synthesise existing statistical methods used to assess the progress of HIV treatment programmes in terms of the HIV cascade and continuum of care among people living with HIV (PLHIV).DesignSystematic scoping review.Data sourcesPublished articles were retrieved from PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete and Excerpta Medica dataBASE (EMBASE) databases between April and July 2022. We also strategically search using the Google Scholar search engine and reference lists of published articles.Eligibility criteriaThis scoping review included original English articles that estimated and described the HIV cascade and continuum of care progress in PLHIV. The review considered quantitative articles that evaluated either HIV care cascade progress in terms of the Joint United Nations Programme on HIV and AIDS targets or the dynamics of engagement in HIV care.Data extraction and synthesisThe first author and the librarian developed database search queries and screened the retrieved titles and abstracts. Two independent reviewers and the first author extracted data using a standardised data extraction tool. The data analysis was descriptive and the findings are presented in tables and visuals.ResultsThis review included 300 articles. Cross-sectional study design methods were the most commonly used to assess the HIV care cascade (n=279, 93%). In cross-sectional and longitudinal studies, the majority used proportions to describe individuals at each cascade stage (276/279 (99%) and 20/21 (95%), respectively). In longitudinal studies, the time spent in cascade stages, transition probabilities and cumulative incidence functions was estimated. The logistic regression model was common in both cross-sectional (101/279, 36%) and longitudinal studies (7/21, 33%). Of the 21 articles that used a longitudinal design, six articles used multistate models, which included non-parametric, parametric, continuous-time, time-homogeneous and discrete-time multistate Markov models.ConclusionsMost literature on the HIV cascade and continuum of care arises from cross-sectional studies. The use of longitudinal study design methods in the HIV cascade is growing because such methods can provide additional information about transition dynamics along the cascade. Therefore, a methodological guide for applying different types of longitudinal design methods to the HIV continuum of care assessments is warranted.

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“…The primary outcome of interest was progression through the HIV cascade of care. Using data from the confidential linkage to the Drug Treatment Program, we categorized participants into their stage of the HIV cascade of care using a priori definitions from previous studies [28,33,34]. At each semi-annual study visit, participants were assigned to one of five potential stages of the HIV cascade of care: unlinked to HIV care, included participants without HIV VL and CD4 þ cell count measurements conducted in the community and without any ART dispensations in the 6 months prior to the study visit; linked to HIV, care included participants with at least one community-based HIV VL or CD4 þ cell count measurement and 0 days of ART dispensation in the last 6 months; on ART, which included participants with at least one day of ART dispensation in the last 6 months; adherent to ART, included participants with at least 171 days of ART dispensation, corresponding to 95% adherence in the previous 6 months; and VL suppressed, which included participants with <50 copies/ml plasma at the most recent HIV VL analysis [33].…”

Section: Methodsmentioning

confidence: 99%

“…Homelessness has also been linked to increases in the intensity of alcohol and illicit drug use that can exacerbate HIV risk, interfere with ART adherence and hasten HIV disease progression [18,[24][25][26]. Previous systematic reviews have found strong evidence that exposure to marginal housing environments was associated with HIV risk behaviour, HIV acquisition, suboptimal HIV care and increased risk of mortality [22,[27][28][29].…”

Section: Introductionmentioning

confidence: 99%

Experiencing homelessness and progression through the HIV cascade of care among people who use drugs

Reddon

Fairbairn

Grant

et al. 2023

Aids

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Objective: To investigate the longitudinal association between periods of homelessness and progression through the HIV cascade of care among people who use drugs (PWUD) with universal access to no-cost HIV treatment and care. Design: Prospective cohort study. Methods: Data were analysed from the ACCESS study, including systematic HIV clinical monitoring and a confidential linkage to comprehensive antiretroviral therapy (ART) dispensation records. We used cumulative link mixed-effects models to estimate the longitudinal relationship between periods of homelessness and progression though the HIV cascade of care. Results: Between 2005 and 2019, 947 people living with HIV were enrolled in the ACCESS study and 304 (32.1%) reported being homeless at baseline. Homelessness was negatively associated with overall progression through the HIV cascade of care [adjusted partial proportional odds ratio (APPO) = 0.56, 95% confidence interval (CI): 0.49–0.63]. Homelessness was significantly associated with lower odds of progressing to each subsequent stage of the HIV care cascade, with the exception of initial linkage to care. Conclusions: Homelessness was associated with a 44% decrease in the odds of overall progression through the HIV cascade of care, and a 41–54% decrease in the odds of receiving ART, being adherent to ART and achieving viral load suppression. These findings support calls for the integration of services to address intersecting challenges of HIV, substance use and homelessness among marginalized populations such as PWUD.

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HIV Treatment Cascade by Housing Status at Enrollment: Results from a Retention in Care Cohort

Cited by 6 publications

References 53 publications

Understanding disparities in viral suppression among Black MSM living with HIV in Atlanta Georgia

Understanding disparities in viral suppression among Black MSM living with HIV in Atlanta Georgia

Statistical methods applied for the assessment of the HIV cascade and continuum of care: a systematic scoping review

Experiencing homelessness and progression through the HIV cascade of care among people who use drugs

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