Use of national standards to monitor HIV care and treatment in a high prevalence city—Washington, DC

Castel, Amanda D.; Terzian, Arpi; Hart, Rachel; Rayeed, Nabil; Kalmin, Mariah M; Young, Heather A.; Greenberg, Alan E.

doi:10.1371/journal.pone.0186036

Cited by 7 publications

(7 citation statements)

References 30 publications

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“…Overall, person-level RIC (73%) was slightly higher than national estimates (69%) and similar to estimates from other local and nationally representative studies (54-78%) 37-48 Higher estimates of RIC and VS were not surprising as DC Cohort participants represented persons at least minimally engaged in HIV care. 49 …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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Distance to HIV care may be associated with retention in care (RIC) and viral suppression (VS). RIC (≥ 2 HIV visits or labs ≥ 90 days apart in 12 months), prescribed antiretroviral therapy (ART), VS (< 200 copies/mL at last visit) and distance to care were estimated among 3623 DC Cohort participants receiving HIV care in 13 outpatient clinics in Washington, DC in 2015. Logistic regression models and geospatial statistics were computed. RIC was 73%; 97% were on ART, among whom 77% had VS. ZIP code-level clusters of low RIC and high VS were found in Northwest DC, and low VS in Southeast DC. Those traveling ≥ 5 miles had 30% lower RIC (adjusted odds ratio (aOR) 0.71, 95% CI 0.58, 0.86) and lower VS (OR 0.70, 95% CI 0.52, 0.94). Geospatial clustering of RIC and VS was observed, and distance may be a barrier to optimal HIV care outcomes.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“…Although the individual effects of site and insurance did not persist in adjusted analyses, the site-insurance interaction effect persisted, with privately-insured PWH receiving care in hospital clinics significantly more likely than publicly-insured PWH to achieve durable VS. This is significant in light of a previous Cohort study showing PWH at hospital clinics were less likely to be retained in care than those at community clinics [11]. Frequent lab monitoring alone is not sufficient to produce VS among vulnerable PWH, as many factors that determine successful medication adherence occur outside of the clinic context.…”

Section: Discussionmentioning

confidence: 94%

“…The DC Cohort, a district-wide, prospective, observational clinical cohort of PWH at 14 healthcare centers, has examined laboratory monitoring, insurance, clinic type, and HIV outcomes. Among Cohort participants, 84% were in continuous HIV care and 78 and 80% underwent regular CD4 and VL monitoring, respectively [11]. From 2011 to 2014, publicly-insured PWH were less likely to achieve VS; privately-insured PWH had an earlier time to VS; and public insurance was associated with earlier time to virologic failure [9].…”

Section: Introductionmentioning

confidence: 99%

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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“…The DC Cohort, a district-wide, prospective, observational clinical cohort of PWH at 14 healthcare centers, has examined laboratory monitoring, insurance, clinic type, and HIV outcomes. Among Cohort participants, 84% were in continuous HIV care and 78% and 80% underwent regular CD4 and VL monitoring, respectively (11). From 2011-2014, publicly-insured PWH were less likely to achieve VS; privately-insured PWH had an earlier time to VS; and public insurance was associated with earlier time to virologic failure (9).…”

Section: Introductionmentioning

confidence: 99%

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

Goldstein¹,

Hardy

Monroe

et al. 2020

Preprint

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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 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, privatelyinsured 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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Use of national standards to monitor HIV care and treatment in a high prevalence city—Washington, DC

Cited by 7 publications

References 30 publications

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

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

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

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