HIV Viral Suppression Among Persons With Varying Levels of Engagement in HIV Medical Care, 19 US Jurisdictions

Cohen, Stacy M.; Hu, Xiaohong; Sweeney, Patricia; Johnson, Anna Satcher; Hall, H. Irene

doi:10.1097/qai.0000000000000349

Cited by 52 publications

(45 citation statements)

References 21 publications

(23 reference statements)

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“…Nearly all (89%) reported receiving HIV treatment during their recent incarceration and 86% reported being on ART at the time the baseline assessment was completed in the community after release; 62% had a suppressed viral load based on objective laboratory data. This proportion of participants with viral suppression is higher than the estimate that only 30% of HIV-infected persons in the U.S. have achieved viral suppression; and more similar to recent studies that estimated viral suppression among persons in HIV care [40–42]. Collectively, these data suggest that this population in Washington, DC has reliable access to HIV providers prior to, during, and after incarceration, yet ART adherence could be improved and this would lead to higher rates of viral suppression.…”

Section: Discussionsupporting

confidence: 74%

Gender Differences in HIV Care among Criminal Justice-Involved Persons: Baseline Data from the CARE+ Corrections Study

et al. 2017

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BackgroundHIV-infected individuals recently released from incarceration have suboptimal linkage and engagement in community HIV care. We conducted a study to evaluate an information and communication technology intervention to increase linkage to community care among HIV-infected persons recently involved in the criminal justice (CJ) system. Baseline characteristics including risk behaviors and HIV care indicators are reported and stratified by gender.MethodsWe recruited HIV-infected individuals in the District of Columbia jail and persons with a recent history of incarceration through community and street outreach. Participants completed a baseline computer-assisted personal interview regarding HIV care and antiretroviral treatment (ART) adherence, substance use, and sexual behaviors. CD4 and HIV plasma viral load testing were performed at baseline or obtained through medical records. Data were analyzed for the sample overall and stratified by gender.ResultsOf 110 individuals, 70% were community-enrolled, mean age was 40 (SD = 10.5), 85% were Black, and 58% were male, 24% female, and 18% transgender women. Nearly half (47%) had condomless sex in the three months prior to incarceration. Although drug dependence and hazardous alcohol use were highly prevalent overall, transgender women were more likely to have participated in drug treatment than men and women (90%, 61%, and 50% respectively; p = 0.01). Prior to their most recent incarceration, 80% had an HIV provider and 91% had ever taken ART. Among those, only 51% reported ≥90% ART adherence. Fewer women (67%) had received HIV medications during their last incarceration compared to men (96%) and transgender women (95%; p = 0.001). Although neither was statistically significant, transgender women and men had higher proportions of baseline HIV viral suppression compared to women (80%, 69%, and 48.0% respectively, p>0.05); a higher proportion of women had a CD4 count ≤200 compared to men and transgender women (17%, 8% and 5% respectively; p>0.05).ConclusionsIn this study, HIV-infected persons with recent incarceration in Washington, DC reported important risk factors and co-morbidities, yet the majority had access to HIV care and ART prior to, during, and after incarceration. Self-reported ART adherence was sub-optimal, and while there were not statistically significant differences, CJ-involved women appeared to be at greatest risk of poor HIV outcomes.Trial registrationRegistered on ClinicalTrials.gov on 10/16/2012. Reference number: NCT01721226.

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Section: Discussionsupporting

confidence: 74%

Gender Differences in HIV Care among Criminal Justice-Involved Persons: Baseline Data from the CARE+ Corrections Study

et al. 2017

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“…First, the inexistence of a longitudinal database of clinic visits forced us to use CD4 and HIV RNA-1 testing results as surrogate for clinic visits. Though this approach has been used in other studies (10,16,24), it is possible that, in the present study, retention was underestimated in periods when testing was less available for structural reasons, as cited above. Thus, it is particularly reassuring that despite these limitations, our estimates of retention in care were as high as those found in high-income settings.…”

Section: Discussionmentioning

confidence: 94%

“…Similar to previous studies (6,8,10,24,25), early HIV care was defined as the first two years after linkage. Retention in early HIV care was measured using visit constancy, and defined by the proportion of six-month intervals with ≥1 CD4 or HIV-1 RNA measurement in the outpatient setting.…”

Section: Methodsmentioning

confidence: 99%

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Retention in Early Care at an HIV Outpatient Clinic in Rio de Janeiro, Brazil, 2000–2013

et al. 2015

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Retention in early HIV care has been associated with virologic suppression and improved survival, but remains understudied in Brazil. We estimated retention in early HIV care for the period 2000–2013, and identified socio-demographic and clinical factors associated with good retention in an urban cohort from Rio de Janeiro, Brazil. Antiretroviral therapy-naïve, HIV-infected persons ≥18 years old linked to care between 2000–2011 were included. Retention in the first two years post-linkage (i.e. early care) was defined by the proportion of six-month intervals with ≥1 HIV laboratory result. “Good” retention was defined as ≥1 HIV laboratory result recorded in at least three intervals. Overall, 80% of participants met criteria for good retention and retention significantly improved over the study period. Older age, higher education level and early antiretroviral therapy initiation were associated with good retention. Efforts to improve retention in early care in this population should target younger and less-educated HIV-infected persons.

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“…15 Similarly, of 338,959 persons living with HIV in 19 U.S. jurisdictions in 2010, older age and retention in care were both significantly associated with viral suppression. 19 …”

Section: Introductionmentioning

confidence: 99%

Impact of Age on Retention in Care and Viral Suppression

Yehia

Rebeiro

Althoff

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Retention in care is important for all HIV-infected persons and is strongly associated with initiation of antiretroviral therapy and viral suppression. However, it is unclear how retention in care and age interact to effect viral suppression. We evaluated whether the association between retention and viral suppression differed by age at entry into care. Methods Cross-sectional analysis (2006-2010) involving 17,044 HIV-infected adults in 14 clinical cohorts across the U.S. and Canada. Patients contributed one year of data during their first full calendar year of clinical observation. Poisson regression examined associations between retention measures [U.S. National HIV/AIDS Strategy (NHAS), U.S. Department of Health and Human Services (DHHS), 6-month gap, and 3-month visit constancy] and viral suppression (HIV RNA ≤200 copies/mL) by age group: 18-29, 30-39, 40–49, 50–59, and ≥60 years old. Results Overall, 89% of patients were retained in care using the NHAS measure, 74% with the DHHS indicator, 85% did not have a 6-month gap, and 62% had visits in 3-4 quarters of the year; 54% achieved viral suppression. For each retention measure, the association with viral suppression was significant for only the younger age groups (18-29 and 30-39 years): 18-29 [adjusted prevalence ratio (APR)=1.33, 95% confidence interval (CI)=1.03-1.70]; 30-39 (APR=1.23, CI=1.01-1.49); 40-49 (APR=1.06, CI=0.90-1.22); 50-59 (APR=0.92, CI=0.75-1.13); ≥60 years (APR=0.99, CI=0.63-1.56) using the NHAS measure as a representative example. Conclusions These results have important implications for improving viral control among younger adults, emphasizing the crucial role retention in care plays in supporting viral suppression in this population.

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HIV Viral Suppression Among Persons With Varying Levels of Engagement in HIV Medical Care, 19 US Jurisdictions

Abstract: Higher levels of engagement in care, including more frequent monitoring of CD4 and viral load, were associated with viral suppression.

Cited by 52 publications

References 21 publications

Gender Differences in HIV Care among Criminal Justice-Involved Persons: Baseline Data from the CARE+ Corrections Study

Gender Differences in HIV Care among Criminal Justice-Involved Persons: Baseline Data from the CARE+ Corrections Study

Retention in Early Care at an HIV Outpatient Clinic in Rio de Janeiro, Brazil, 2000–2013

Impact of Age on Retention in Care and Viral Suppression

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