Trends of racial and ethnic disparities in virologic suppression among women in the HIV Outpatient Study, USA, 2010-2015

Abstract

In the United States, women accounted for 19% of new HIV diagnoses in 2015 and were less likely to reach virologic suppression when compared to men. We assessed trends and disparities in virologic suppression among HIV-positive women to inform HIV treatment strategies. Data were from a prospective cohort of the HIV Outpatient Study and collected at nine United States HIV clinics. We included women aged ≥18 years, with ≥1 visit, who were prescribed antiretroviral therapy, and had ≥1 viral load test performed between 2010 and 2015. We defined virologic suppression as viral load <50 copies/mL and calculated adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) for virologic suppression by race/ethnicity and year of measure. Generalized estimating equations were used for multivariable analyses to assess factors associated with virologic suppression. Among 809 women (median age = 44 years), 482 (60%) were black, 177 (22%) white, 150 (19%) Hispanic/Latina. Virologic suppression was less prevalent among black women (73%) compared with Hispanic/Latina women (83%) and white women (91%). In multivariable analyses, not achieving virologic suppression was more likely among black women (aPR = 2.13; CI = 1.50–3.02) or Hispanic/Latina women (aPR = 1.66; CI = 1.08–2.56) compared with white women, and among women who attended public clinics (aPR = 1.42; CI = 1.07–1.87) compared with those who attended a private clinic. Between 2010 and 2015, virologic suppression among HIV-positive women increased from 68% to 83%, but racial/ethnic disparities persisted. Black and Hispanic/Latina women had significantly lower rates of virologic suppression than white women. Interventions targeting virologic suppression improvement among HIV-positive women of color, especially those who attend public clinics, are warranted.

Exploring HIV-Related Stigma as a Determinant of Engagement in HIV Care by African American Women

“…health disparities persist across racial/ethnic and gender lines in the United States (Geter, Sutton, Armon, et al, 2018;Chapin-Bardales, Rosenberg, & Sullivan, 2017). In 2015, approximately 50% of new HIV diagnoses occurred in racial/ethnic minorities, yet they accounted for less than 30% of the the total U.S. population.…”

Quality of care for Black and Latina women living with HIV in the U.S.: a qualitative study

“…Evidence suggests that for every 100 U.S. women living with HIV, approximately 66 received some HIV medical care, 51 remained in continuous HIV care, and 53 were virally suppressedall critical indicators of well-being and population-based HIV treatment and prevention [3]. Black and Latina women in the U.S. in particular are less likely to use antiretroviral therapy (ART) [4], less likely to be virally suppressed [5], and more likely to die of causes related to HIV [6], as compared to white women. These inequities are in part attributed to compound systemic barriers to adequate HIV and non-HIV care faced by racial and ethnic minority women.…”

Examining adherence barriers among women with HIV to tailor outreach for long-acting injectable antiretroviral therapy

“…Race and ethnicity are also associated with lower ART adherence among Black and Latino PLHIV [ 24 – 27 ]. Black and Latina women are affected by racism and related structural factors as well as gender norms, contributing to complex and multi-level barriers to ART adherence for women in these sub-groups [ 28 – 30 ].…”