Proportions of Patients With HIV Retained in Care and Virally Suppressed in New York City and the United States

Xia, Qiang; Kersanske, Laura; Wiewel, Ellen W.; Braunstein, Sarah L.; Shepard, Colin W.; Torian, Lucia V.

doi:10.1097/qai.0000000000000464

Cited by 36 publications

(24 citation statements)

References 19 publications

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“…Although newer surveillance estimates suggest that the number of HIV-infected PWID in NYC may be overestimated [35], it is unclear what impact these results may have on the proportion of undiagnosed cases among PWID and others, even if levels of treatment engagement and viral suppression may be higher than previously estimated. Our analysis suggests that higher levels of virological suppression (i.e., 70% vs. 38%) substantially shifts estimates of transmission towards the undiagnosed population, but this assumes the size of the undiagnosed population remains as it was in the main analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, we conducted four series of one-way sensitivity analyses, where the following were adjusted: the reduction in PWID risk behavior following a positive HIV test (from a reduction of 25% to reductions of 0% and 50%); the change in agent risk behavior following ART initiation (from no change to a 50% increase and a 50% reduction); the level of viral suppression (from approximately 38% of those with an HIV diagnosis to 70%); and the proportion of undiagnosed HIV infection in the PWID population (from 39% for males and 22% for females, to 14% for each). Theses analyses were selected to challenge the sensitivity of our results to assumptions that are either difficult to confirm (see Agent Behavior in Additional file 1), or in the cases of diagnosis and viral suppression levels, due to competing methodologies [25, 35]. …”

Section: Methodsmentioning

confidence: 99%

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The risk of HIV transmission at each step of the HIV care continuum among people who inject drugs: a modeling study

et al. 2017

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BackgroundPeople who inject drugs (PWID) are at continued risk for HIV in the U.S., and experience disparities across the HIV care continuum compared to other high-risk groups. Estimates of the risk of HIV transmission at each stage of the care continuum may assist in identifying public health priorities for averting incident infections among PWID, in addition to transmissions to sexual partners of PWID.MethodsWe created an agent-based model simulating HIV transmission and the HIV care continuum for PWID in New York City (NYC) in 2012. To account for sexual transmission arising from PWID to non-PWID, the simulation included the entire adult NYC population. Using surveillance data and estimates from the National HIV Behavioral Surveillance system, we simulated a dynamic sexual and injecting network. We estimated the proportion of HIV transmission events attributable to PWID in the following categories, those: without an HIV diagnosis (‘Undiagnosed’); diagnosed but not on antiretroviral therapy (ART) (‘Diagnosed − not on ART’); those who initiated ART but were not virally suppressed (‘Unsuppressed’); and, those who achieved viral suppression (‘Suppressed’).ResultsWe estimated HIV incidence among PWID to be 113 per 100,000 person-years in 2012, with an overall incidence rate for the entire adult NYC population of 33 per 100,000 person-years. Despite accounting for only 33% of the HIV-infected PWID population, the Undiagnosed were associated with 52.6% (95% simulation interval [95% SI]: 47.1–57.0%) of total transmission events. The Diagnosed − not on ART population contributed the second-largest proportion of HIV transmissions, with 36.6% (95% SI: 32.2–41.5%). The Unsuppressed population contributed 8.7% (95% SI: 5.6–11.8%), and Suppressed 2.1% (95% SI: 1.1–3.9%), relatively little of overall transmission.ConclusionsAmong PWID in NYC, more than half (53%) of transmissions were from those who were unaware of their infection status and more than 36% were due to PWID who knew their status, but were not on treatment. Our results indicate the importance of early diagnosis and interventions to engage diagnosed PWID on treatment to further suppress population-level HIV transmission. Future HIV prevention research should focus on the elimination of identified and potential barriers to the testing, diagnosis, and retention of PWID on HIV treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4528-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The risk of HIV transmission at each step of the HIV care continuum among people who inject drugs: a modeling study

et al. 2017

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“…The “denominator” for all continuum steps is the number of cisgender MSM aged 18–40 years in NYC who are estimated to be HIV-infected (n = 15 000). Subsequent steps in the continuum are well described and defined when using population-based data: those who are diagnosed with HIV, followed by those retained in care, those prescribed antiretroviral therapy, and, finally, those achieving VLS [ 9 , 20 , 21 ]. The largest drop-off (33% relative decrease) is between those who are prescribed antiretrovirals and those who achieve VLS, highlighting the importance of medical and social interventions focused on maintenance of care and adherence.…”

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confidence: 99%

Redefining Prevention and Care: A Status-Neutral Approach to HIV

Myers

Braunstein

Xia

et al. 2018

Open Forum Infectious Diseases

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Recent biomedical advances inspire hope that an end to the epidemic of HIV is in sight. Adopting new approaches and paradigms for treatment and prevention in terms of both messaging and programming is a priority to accelerate progress. Defining the key sequential steps that comprise engagement in HIV care has provided a useful framework for clinical programs and motivated quality improvement initiatives. Recently, the same approach has been applied to use of pre-exposure prophylaxis for HIV prevention. Building on the various prevention and care continua previously proposed, we present a novel schematic that incorporates both people living with HIV and people at risk, making it effectively “status-neutral” in that it proposes the same approach for engagement, regardless of one’s HIV status. This multidirectional continuum begins with an HIV test and offers 2 divergent paths depending on the results; these paths end at a common final state. To illustrate how this continuum can be utilized for program planning as well as for monitoring, we provide an example using data for New York City men who have sex with men, a population with high HIV incidence and prevalence.

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“…Also in New York City, using methods to adjust for out-migration, 70%-71% (depending on the methodology) of persons living with HIV as of December 31, 2012 were suppressed in 2012. 33 In San Francisco, 78% of persons living with HIV in 2012 were suppressed. In Seattle-King County, 34 for persons living with HIV who had at least one viral load reported in 2009, 65% were suppressed in 2009 compared with 72% of persons living with HIV in San Francisco in 2009.…”

Section: Discussionmentioning

confidence: 99%

Disparities and Trends in Viral Suppression During a Transition to a “Test and Treat” Approach to the HIV Epidemic, San Francisco, 2008–2012

Schwarcz

Hsu²,

Scheer³

2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Proportions of Patients With HIV Retained in Care and Virally Suppressed in New York City and the United States

Cited by 36 publications

References 19 publications

The risk of HIV transmission at each step of the HIV care continuum among people who inject drugs: a modeling study

The risk of HIV transmission at each step of the HIV care continuum among people who inject drugs: a modeling study

Redefining Prevention and Care: A Status-Neutral Approach to HIV

Disparities and Trends in Viral Suppression During a Transition to a “Test and Treat” Approach to the HIV Epidemic, San Francisco, 2008–2012

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