Service Delivery and Patient Outcomes in Ryan White HIV/AIDS Program–Funded and –Nonfunded Health Care Facilities in the United States

Weiser, John; Beer, Linda; Frazier, Emma L.; Patel, Roshni; Dempsey, Antigone; Hauck, Heather; Skarbinski, Jacek

doi:10.1001/jamainternmed.2015.4095

Cited by 110 publications

(83 citation statements)

References 17 publications

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“…2,12,21 Factors other than individual attributes related to sex, race and ethnicity, age, and care history may be contributing to these disparities. Social and structural factors such as income, employment, education, housing, health insurance coverage, and access to care have been shown to be associated with disparities in HIV infection 21 and engagement in HIV-related medical care, 7, 22 which may have affected viral burden and HIV transmission risk potential.…”

Section: Discussionmentioning

confidence: 99%

Durable Viral Suppression and Transmission Risk Potential Among Persons With Diagnosed HIV Infection: United States, 2012–2013

et al. 2016

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Background To examine durable viral suppression, cumulative viral load (VL) burden, and transmission risk potential among HIV-diagnosed persons in care. Methods Using data from the National HIV Surveillance System from 17 jurisdictions with complete reporting of VL test results, we determined the percentage of persons in HIV care who achieved durable viral suppression (all VL results <200 copies/mL) and examined viremia copy-years and time spent above VL levels that increase the risk of HIV transmission during 2012–2013. Results Of 265,264 persons in HIV care in 2011, 238,641 had at least two VLs in 2012–2013. The median number of VLs per individual during the 2-year period was five. Approximately 62% had durable viral suppression. The remaining 38% had high VL burden (geometric mean of viremia copy-years: 7,261) and spent an average of 438 days, 316 days, and 215 days (60%, 43.2%, and 29.5% of the 2-year time) above 200, 1,500, and 10,000 copies/mL. Women, blacks/African Americans, Hispanics/Latinos, persons with HIV infection attributed to transmission other than male-to-male sexual contact, younger age groups, and persons with gaps in care had higher viral burden and transmission risk potential. Conclusions Two-thirds of persons in HIV care had durable viral suppression during a 2-year period. One-third had high VL burden and spent substantial time above VL levels with increased risk of onward transmission. More intervention efforts are needed to improve retention in care and medication adherence so that more persons in HIV care achieve durable viral suppression.

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Section: Discussionmentioning

confidence: 99%

Durable Viral Suppression and Transmission Risk Potential Among Persons With Diagnosed HIV Infection: United States, 2012–2013

et al. 2016

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“…Finally, factors related to the influence of care setting on racial disparities in viral suppression could be explored. Weiser and colleagues found that poor HIV patients were more likely to achieve viral suppression if they received care at facilities funded by the Ryan White HIV/AIDS program, which have greater availability of ancillary services to address lack of resources [39]. …”

Section: Discussionmentioning

confidence: 99%

Trends in Racial and Ethnic Disparities in Antiretroviral Therapy Prescription and Viral Suppression in the United States, 2009–2013

Beer¹,

Bradley²,

Mattson³

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Objectives To examine trends in racial/ethnic disparities in antiretroviral therapy (ART) prescription and viral suppression among HIV-infected persons in care, overall and among MSM, from 2009 to 2013. Design The Medical Monitoring Project (MMP) is a complex sample survey of HIV-infected adults receiving medical care in the United States. Methods We used weighted interview and medical record data collected 06/2009–05/2014 to estimate the prevalence of ART prescription and viral suppression among racial/ethnic groups overall and among men who have sex with men (MSM). Results We found significant increases in ART prescription and viral suppression among all racial/ethnic groups from 2009 to 2013, both overall and among MSM. By 2013, overall and among MSM, the Hispanic-white disparity in ART prescription was non-existent, and the black-white disparity was not significant after accounting for differences between blacks and whites in age and length of HIV diagnosis. Despite reductions in racial/ethnic disparities in viral suppression over the time period, significant disparities remained among the total population, even after adjusting for differences in racial/ethnic group characteristics. Encouragingly, however, there was no significant Hispanic-white disparity in viral suppression among MSM by 2013. Conclusions Despite significant improvements in ART prescription and viral suppression in recent years, racial and ethnic disparities persist, particularly for black persons. If the United States is to achieve the National HIV/AIDS Strategy goal of reducing HIV-related health disparities, continued efforts to accelerate the rate of improvement in ART prescription and viral suppression among Hispanic and black persons may need to be prioritized.

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“…[27–29] Finally, as a measure of quality assurance, syphilis testing is a requirement of Ryan White funding and approximately 73% of MMP facilities received Ryan White funding in 2009–2011. [30]…”

Section: Discussionmentioning

confidence: 99%

Increased STD testing among sexually active persons receiving medical care for HIV infection in the United States, 2009 – 2013

Mattson

Bradley

Beer

et al. 2016

CLINID

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Background Current guidelines recommend that all sexually active HIV-infected persons be tested at least annually for syphilis, chlamydia, and gonorrhea. We examined temporal trends in syphilis, chlamydia, and gonorrhea testing among sexually active HIV-infected adults receiving medical care in the United States during 2009–2013. Methods Using medical record data from the Medical Monitoring Project, a population-based HIV surveillance system, we assessed the proportion of adults in HIV medical care who were tested for syphilis, chlamydia, and gonorrhea in the past 12 months by year and stratified by sex and sexual behavior, age, and race/ethnicity. Results During 2009–2013, the proportion of sexually active HIV-infected adults in medical care who were tested in the past year for all three examined STDs increased from 20% to 36% (PTREND < 0.01). Overall testing for syphilis increased from 55% to 65% (PTREND < 0.01), and significant increases were noted for the following subgroups: MSM (58% to 69%), non-Hispanic whites (48% to 64%), and all age groups with the exception of 18–29 year olds. Overall testing for chlamydia and gonorrhea increased from 22% to 42% (PTREND < 0.01) and significant increases were noted for most sub-groups. Conclusions STD testing significantly increased among sexually active HIV-infected adults receiving medical care; however, the majority of persons were not tested for all three STDs in 2013. While increased testing indicates progress, testing remained far below recommended guidelines. Our findings suggest enhanced efforts may be warranted to screen all sexually active HIV-infected adults for syphilis, chlamydia, and gonorrhea.

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Service Delivery and Patient Outcomes in Ryan White HIV/AIDS Program–Funded and –Nonfunded Health Care Facilities in the United States

Cited by 110 publications

References 17 publications

Durable Viral Suppression and Transmission Risk Potential Among Persons With Diagnosed HIV Infection: United States, 2012–2013

Durable Viral Suppression and Transmission Risk Potential Among Persons With Diagnosed HIV Infection: United States, 2012–2013

Trends in Racial and Ethnic Disparities in Antiretroviral Therapy Prescription and Viral Suppression in the United States, 2009–2013

Increased STD testing among sexually active persons receiving medical care for HIV infection in the United States, 2009 – 2013

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