New York City Achieves the UNAIDS 90-90-90 Targets for HIV-Infected Whites but Not Latinos/Hispanics and Blacks

Xia, Qiang; Lazar, Rachael; Bernard, Marie A.; McNamee, Paul; Daskalakis, Demetre; Torian, Lucia V.; Braunstein, Sarah L.

doi:10.1097/qai.0000000000001132

Cited by 28 publications

(16 citation statements)

References 20 publications

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“…By the final follow-up period, almost all had engaged in HIV care (>95%), but 13% had not initiated ART, and almost 40% had not achieved undetectable VL during this period. Yet leaders in the field have noted the objective of elimination of HIV transmission depends on the 90–90–90 goal; that is, 90% of PLWH being diagnosed, 90% of these being on ART, and 90% of these being virally suppressed (65, 66). …”

Section: Discussionmentioning

confidence: 99%

It’s a Process: Reactions to HIV Diagnosis and Engagement in HIV Care among High-Risk Heterosexuals

Kutnick

Gwadz

Cleland

et al. 2017

Front. Public Health

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After HIV diagnosis, heterosexuals in high-poverty urban areas evidence delays in linkage to care and antiretroviral therapy initiation compared to other groups. Yet barriers to/facilitators of HIV care among these high-risk heterosexuals are understudied. Under the theory of triadic influence, putative barriers to HIV care engagement include individual/attitudinal-level (e.g., fear, medical distrust), social-level (e.g., stigma), and structural-level influences (e.g., poor access). Participants were African-American/Black and Hispanic adults found newly diagnosed with HIV (N = 25) as part of a community-based HIV testing study with heterosexuals in a high-poverty, high-HIV-incidence urban area. A sequential explanatory mixed-methods design was used. We described linkage to HIV care and clinical outcomes [CD4 counts, viral load (VL) levels] over 1 year, and then addressed qualitative research questions about the experience of receiving a new HIV diagnosis, its effects on timely engagement in HIV care, and other barriers and facilitators. Participants were assessed five times, receiving a structured interview battery, laboratory tests, data extraction from the medical record, a post-test counseling session, and in-person/phone contacts to foster linkage to care. Participants were randomly selected for qualitative interviews (N = 15/25) that were recorded and transcribed, then analyzed using systematic content analysis. Participants were 50 years old, on average (SD = 7.2 years), mostly male (80%), primarily African-American/Black (88%), and low socioeconomic status. At the first follow-up, rates of engagement in care were high (78%), but viral suppression was modest (39%). Rates improved by the final follow-up (96% engaged, 62% virally suppressed). Two-thirds (69%) were adequately retained in care over 1 year. Qualitative results revealed multi-faceted responses to receiving an HIV diagnosis. Problems accepting and internalizing one’s HIV status were common. Reaching acceptance of one’s HIV-infected status was frequently a protracted and circuitous process, but acceptance is vital for engagement in HIV care. Fear of stigma and loss of important relationships were potent barriers to acceptance. Thus, partially as a result of difficulties accepting HIV status, delays in achieving an undetectable VL are common in this population, with serious potential negative consequences for individual and public health. Interventions to foster acceptance of HIV status are needed.

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Section: Discussionmentioning

confidence: 99%

It’s a Process: Reactions to HIV Diagnosis and Engagement in HIV Care among High-Risk Heterosexuals

Kutnick

Gwadz

Cleland

et al. 2017

Front. Public Health

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“…Population level disparities in retention, access to ART and virological suppression have also been found in other settings, including countries in South‐East and East Asia, where facilities face challenges in providing care for a growing number of PLHIV in resource‐limited settings . However, sex, race as well as other demographic and socioeconomic disparities in HIV care exist even in developed economies . It demonstrates the complexities of chronic care for vulnerable groups disproportionately affected by HIV, and resulting inequities at every step of the care cascade.…”

Section: Discussionmentioning

confidence: 93%

Using a HIV registry to develop accurate estimates for the HIV care cascade – the Singapore experience

Huang

Wong

et al. 2019

J Intern AIDS Soc

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Introduction Achieving UNAIDS 90‐90‐90 targets is a crucial step towards ending the AIDS epidemic. Many countries have published estimates of care cascades, although often with methodological limitations. We describe an approach that used the national HIV registry as a starting‐point to determine the HIV care cascade and resulting UNAIDS 90‐90‐90 estimates for Singapore in 2014. Methods HIV is a legally notifiable disease in Singapore. The anonymized HIV registry data provided for a back‐calculation model from the European Centre for Disease Prevention and Control to obtain 2014 estimates for the total number of persons living with HIV (PLHIV), and the count in the registry for proportions diagnosed with HIV and linked to care. Using additional data collected for a simple random sample from the registry, outcomes in 2015 and 2016 were ascertained retrospectively to derive proportions for those retained in care, on antiretroviral therapy, and achieved viral suppression. Findings were extrapolated to derive national estimates and UN90‐90‐90 estimates. Bootstrapped samples from the model and sample were used to derive 95% confidence intervals. Results An estimated 6900 (95% CI 6650, 7050) persons were living with HIV and AIDS in 2014. Of these, 4948 were diagnosed with HIV, and 4820 had been linked to care. The random sample of 500 persons was further analysed, and of these, 87.2% were retained in care, 84.6% on antiretroviral therapy, and 79.6% had suppressed viral loads. The proportions of HIV‐infected individuals on antiretroviral therapy and achieving viral suppression were 60.7% (95% CI 58.4, 63.6) and 57.1% (95% CI 55.0, 60.5) respectively. The corresponding UNAIDS 90‐90‐90 estimates were 71.7% (95% CI 70.0, 74.2) of all persons diagnosed; 84.6% (95% CI 81.6, 87.4) of diagnosed persons being on antiretroviral therapy, and 94.1% (95% CI 91.6, 96.2) of persons on therapy having achieved viral suppression. Conclusions A national HIV registry, alongside back‐calculation and additional data from a sample, can be used to estimate attainment of UNAIDS 90‐90‐90 targets and identify system gaps. The registry had advantages of providing a well‐established, comprehensive capture of diagnosed persons and easily accessible data. The same approach can be used elsewhere if similar data are available.

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“…Potential interventions to reduce the disparities—particularly the disparity in estimated HIV incidence—could include intensification of the New York City Condom distribution program (Des Jarlais et al, 2014), further expansion of ART treatment as prevention–achieving the 90–90-90 goals (Xia et al, 2016), couples HIV counseling (El-Bassel et al, 2011) for sexual partnerships that include one or both persons who inject, and pre-exposure prophylaxis. Utilizing multiple interventions would probably be most effective, but we need to acknowledge that with the present small numbers of newly diagnosed HIV infections among PWID (approximately 40 per year), successfully identifying PWID at highest risk could be difficult.…”

Section: Discussionmentioning

confidence: 99%

Heterosexual male and female disparities in HIV infection at the end of an epidemic: HIV infection among persons who inject drugs in New York City, 2001–2005 and 2011–2015

Jarlais

McKnight

Feelemyer

et al. 2018

Drug and Alcohol Dependence

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New York City Achieves the UNAIDS 90-90-90 Targets for HIV-Infected Whites but Not Latinos/Hispanics and Blacks

Cited by 28 publications

References 20 publications

It’s a Process: Reactions to HIV Diagnosis and Engagement in HIV Care among High-Risk Heterosexuals

It’s a Process: Reactions to HIV Diagnosis and Engagement in HIV Care among High-Risk Heterosexuals

Using a HIV registry to develop accurate estimates for the HIV care cascade – the Singapore experience

Heterosexual male and female disparities in HIV infection at the end of an epidemic: HIV infection among persons who inject drugs in New York City, 2001–2005 and 2011–2015

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