Identifying Spatial Variation Along the HIV Care Continuum: The Role of Distance to Care on Retention and Viral Suppression

Terzian, Arpi; Younes, Naji; Greenberg, Alan E.; Opoku, Jenevieve; Hubbard, Julie; Happ, Lindsey Powers; Kumar, Princy; Jones, Rena R.; Castel, Amanda D.

doi:10.1007/s10461-018-2103-8

Cited by 34 publications

(19 citation statements)

References 49 publications

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“…Our findings are consistent with another recent DC Cohort analysis showing that PWH who were retained in care were more likely to receive care at community clinics, while those with VS were less likely to receive care at community clinics [24]. Geographic clusters of DC Cohort participants within Washington, DC with low retention in care but high VS were located in more affluent areas of Washington, DC.…”

Section: Discussionsupporting

confidence: 91%

Despite early Medicaid expansion, decreased durable virologic suppression among publicly insured people with HIV in Washington, DC: a retrospective analysis

et al. 2020

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Background: Despite widely available access to HIV care in Washington, DC, inequities in HIV outcomes persist. We hypothesized that laboratory monitoring and virologic outcomes would not differ significantly based on insurance type. Methods: We compared HIV monitoring with outcomes among people with HIV (PWH) with private (commercial payer) versus public (Medicare, Medicaid) insurance receiving care at community and hospital clinics. The DC Cohort follows over 8000 PWH from 14 clinics. We included those ≥18 years old enrolled between 2011 and 2015 with stable insurance. Outcomes included frequency of CD4 count and HIV RNA monitoring (> 2 lab measures/year, > 30 days apart) and durable viral suppression (VS; HIV RNA < 50 copies/mL at last visit and receiving antiretroviral therapy (ART) for ≥12 months). Multivariable logistic regression models examined impact of demographic and clinical factors. Results: Among 3908 PWH, 67.9% were publicly-insured and 58.9% attended community clinics. Compared with privately insured participants, a higher proportion of publicly insured participants had the following characteristics: female sex, Black race, heterosexual, unemployed, and attending community clinics. Despite less lab monitoring, privately-insured PWH had greater durable VS than publicly-insured PWH (ART-naïve: private 70.0% vs public 53.1%, p = 0.03; ART-experienced: private 80.2% vs public 69.4%, p < 0.0001). Privately-insured PWH had greater durable VS than publicly-insured PWH at hospital clinics (AOR = 1.59, 95% CI: 1.20, 2.12; p = 0.001). Conclusions: Paradoxical differences between HIV monitoring and durable VS exist among publicly and privatelyinsured PWH in Washington, DC. Programs serving PWH must improve efforts to address barriers creating inequity in HIV outcomes.

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Section: Discussionsupporting

confidence: 91%

Despite early Medicaid expansion, decreased durable virologic suppression among publicly insured people with HIV in Washington, DC: a retrospective analysis

et al. 2020

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“…At hospital clinics in the DC Cohort, publicly-insured PWH were less likely than privately-insured PWH to achieve VS, despite increased lab monitoring. These results suggest that frequency of HIV Our findings are consistent with another recent DC Cohort analysis showing that PWH who were retained in care were more likely to receive care at community clinics, while those with VS were less likely to receive care at community clinics (24). Geographic clusters of DC Cohort participants within Washington, DC with low retention in care but high VS were located in more affluent areas of Washington, DC.…”

Section: Discussionsupporting

confidence: 90%

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

Goldstein¹,

Terzian

Monroe

et al. 2019

Preprint

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Background: Despite near-universal access to HIV care in Washington, DC, inequities in HIV outcomes persist. We hypothesized that laboratory monitoring and virologic outcomes would not differ significantly based on insurance type. Methods: We compared HIV monitoring with outcomes among people with HIV (PWH) with private (commercial payer) versus public (Medicare, Medicaid) insurance receiving care at community and hospital clinics. The DC Cohort follows over 8,000 PWH from 14 clinics. We included those ≥18 years old enrolled between 2011-2015 with stable insurance. Outcomes included frequency of CD4 count and HIV RNA monitoring (> 2 lab measures/year, >30 days apart) and durable viral suppression (VS; HIV RNA <50 copies/mL at last visit and receiving antiretroviral therapy (ART) for ≥12 months). Multivariable logistic regression models examined impact of demographic and clinical factors. Results: Among 3,908 PWH, 67.9% were publicly-insured and 58.9% attended community clinics. Compared with privately insured participants, a higher proportion of publicly insured participants had the following characteristics: female sex, Black race, heterosexual, unemployed, and attending community clinics. Despite less lab monitoring, privately-insured PWH had greater durable VS than publicly-insured PWH (ART-naïve: private 70.0% vs public 53.1%, p=0.03; ART-experienced: private 80.2% vs public 69.4%, p<0.0001). Privately-insured PWH had greater durable VS than publicly-insured PWH at hospital clinics (AOR=1.59, 95% CI: 1.20, 2.12; p=0.001). Conclusions: Paradoxical differences between HIV monitoring and durable VS exist among publicly and privately-insured PWH in Washington, DC. Programs serving PWH must improve efforts to address barriers creating inequity in HIV outcomes.

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“…In a meta-analysis of patient reported barriers to antiretroviral therapy adherence, distance to clinics was a significant factor [34]. Even in a high-income country HIV cohort, patients who traveled more than 5 miles vs. those who traveled less than 5 miles had 30% lower retention in care and lower viral suppression [35]. Given this established relationship between increased distance and decreased attendance, decentralizing care through community health workers or group medication pickups should be explored.…”

Section: Discussionmentioning

confidence: 99%

Does distance from a clinic and poverty impact visit adherence for noncommunicable diseases? A retrospective cohort study using electronic medical records in rural Haiti

Yan

Pierre-Louis²,

Isaac³

et al. 2020

BMC Public Health

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Background Adherence to regular outpatient visits is vital to managing noncommunicable diseases (NCDs), a growing burden in low and middle-income countries. We characterized visit adherence among patients with NCDs in rural Haiti, hypothesizing higher poverty and distance from the clinic were associated with lower adherence. Methods We analyzed electronic medical records from a cohort of adults in an NCD clinic in Mirebalais, Haiti (April 2013 to June 2016). Visit adherence was: 1) visit constancy (≥1 visit every 3 months), 2) no gaps in care (> 60 days between visits), 3) ≥1 visit in the last quarter, and 4) ≥6 visits per year. We incorporated an adapted measure of intensity of multidimensional poverty. We calculated distance from clinic as Euclidean distance or self-reported transit time. We used multivariable logistic regressions to assess the association between poverty, distance, and visit adherence. Results We included 463 adult patients, mean age 57.8 years (SE 2.2), and 72.4% women. Over half of patients had at least one visit per quarter (58.1%), but a minority (19.6%) had no gaps between visits. Seventy percent of patients had a visit in the last quarter, and 73.9% made at least 6 visits per year. Only 9.9% of patients met all adherence criteria. In regression models, poverty was not associated with any adherence measures, and distance was only associated with visit in the last quarter (OR 0.87, 95% CI [0.78 to 0.98], p = 0.03) after adjusting for age, sex, and hardship financing. Conclusions Visit adherence was low in this sample of adult patients presenting to a NCD Clinic in Haiti. Multidimensional poverty and distance from clinic were not associated with visit adherence measures among patients seen in the clinic, except for visit in the last quarter. Future research should focus on identifying and addressing barriers to visit adherence.

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Identifying Spatial Variation Along the HIV Care Continuum: The Role of Distance to Care on Retention and Viral Suppression

Cited by 34 publications

References 49 publications

Despite early Medicaid expansion, decreased durable virologic suppression among publicly insured people with HIV in Washington, DC: a retrospective analysis

Despite early Medicaid expansion, decreased durable virologic suppression among publicly insured people with HIV in Washington, DC: a retrospective analysis

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

Does distance from a clinic and poverty impact visit adherence for noncommunicable diseases? A retrospective cohort study using electronic medical records in rural Haiti

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