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

2020 ◽  
Author(s):  
Deborah Goldstein ◽  
David Hardy ◽  
Anne Monroe ◽  
Qingjiang Hou ◽  
Rachel Hart ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Hiv Care ◽  
Virologic Suppression ◽  
Washington Dc ◽  
Community Clinics ◽  
Logistic Regression Models ◽  
Hiv Rna ◽  
Durable Viral Suppression ◽  
Publicly Insured ◽  
Privately Insured

Abstract 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, 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 privately-insured PWH in Washington, DC. Programs serving PWH must improve efforts to address barriers creating inequity in HIV outcomes.

scholarly journals Despite Early Medicaid Expansion, Decreased Durable Virologic Suppression Among Publicly Insured People with HIV in Washington, DC: a retrospective analysis

2020 ◽  
Author(s):  
Deborah Goldstein ◽  
David Hardy ◽  
Anne Monroe ◽  
Qingjiang Hou ◽  
Rachel Hart ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Hiv Care ◽  
Virologic Suppression ◽  
Washington Dc ◽  
Community Clinics ◽  
Logistic Regression Models ◽  
Hiv Rna ◽  
Durable Viral Suppression ◽  
Publicly Insured ◽  
Privately Insured

Abstract 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, 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 privately-insured PWH in Washington, DC. Programs serving PWH must improve efforts to address barriers creating inequity in HIV outcomes.

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

2020 ◽  
Author(s):  
Deborah Goldstein ◽  
David Hardy ◽  
Anne Monroe ◽  
Qingjiang Hou ◽  
Rachel Hart ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Hiv Care ◽  
Virologic Suppression ◽  
Washington Dc ◽  
Community Clinics ◽  
Logistic Regression Models ◽  
Hiv Rna ◽  
Durable Viral Suppression ◽  
Publicly Insured ◽  
Privately Insured

Abstract 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, 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 privately-insured PWH in Washington, DC. Programs serving PWH must improve efforts to address barriers creating inequity in HIV outcomes.

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

2019 ◽  
Author(s):  
Deborah Goldstein ◽  
Arpi Terzian ◽  
Anne Monroe ◽  
Qingjiang Hou ◽  
Rachel Hart ◽  
...  
Keyword(s):  
Universal Access ◽  
Hiv Care ◽  
Virologic Suppression ◽  
Washington Dc ◽  
Community Clinics ◽  
Logistic Regression Models ◽  
Hiv Rna ◽  
Durable Viral Suppression ◽  
Publicly Insured ◽  
Privately Insured

Abstract Background: Despite near-universal 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, 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 privately-insured PWH in Washington, DC. Programs serving PWH must improve efforts to address barriers creating inequity in HIV outcomes.

scholarly journals “Is a Bird in the Hand Worth 5 in the Bush?”: A Comparison of 3 Data-to-Care Referral Strategies on HIV Care Continuum Outcomes in San Francisco

2020 ◽  
Vol 7 (9) ◽  
Author(s):  
Darpun D Sachdev ◽  
Elise Mara ◽  
Alison J Hughes ◽  
Erin Antunez ◽  
Robert Kohn ◽  
...  
Keyword(s):  
San Francisco ◽  
Health Care Providers ◽  
Viral Suppression ◽  
Hiv Care ◽  
Care Providers ◽  
Care Continuum ◽  
Hiv Surveillance ◽  
Relative Risks ◽  
Linkage To Hiv Care ◽  
Durable Viral Suppression

Abstract Background Health departments utilize HIV surveillance data to identify people with HIV (PWH) who need re-linkage to HIV care as part of an approach known as Data to Care (D2C.) The most accurate, effective, and efficient method of identifying PWH for re-linkage is unknown. Methods We evaluated referral and care continuum outcomes among PWH identified using 3 D2C referral strategies: health care providers, surveillance, and a combination list derived by matching an electronic medical record registry to HIV surveillance. PWH who were enrolled in the re-linkage intervention received short-term case management for up to 90 days. Relative risks and 95% confidence intervals were calculated to compare proportions of PWH retained and virally suppressed before and after re-linkage. Durable viral suppression was defined as having suppressed viral loads at all viral load measurements in the 12 months after re-linkage. Results After initial investigation, 233 (24%) of 954 referrals were located and enrolled in navigation. Although the numbers of surveillance and provider referrals were similar, 72% of enrolled PWH were identified by providers, 16% by surveillance, and 12% by combination list. Overall, retention and viral suppression improved, although relative increases in retention and viral suppression were only significant among individuals identified by surveillance or providers. Seventy percent of PWH who achieved viral suppression after the intervention remained durably virally suppressed. Conclusions PWH referred by providers were more likely to be located and enrolled in navigation than PWH identified by surveillance or combination lists. Overall, D2C re-linkage efforts improved retention, viral suppression, and durable viral suppression.

scholarly journals Rapid Antiretroviral Therapy (ART) Initiation at a Community-Based Clinic in Jackson, MS

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Courtney E. Sims Gomillia ◽  
Kandis V. Backus ◽  
James B. Brock ◽  
Sandra C. Melvin ◽  
Jason J. Parham ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Median Time ◽  
Viral Suppression ◽  
Hiv Care ◽  
Virologic Suppression ◽  
Community Based ◽  
Art Initiation ◽  
Healthcare Center ◽  
The Impact

Abstract Background Rapid antiretroviral therapy (ART), ideally initiated within twenty-four hours of diagnosis, may be crucial in efforts to increase virologic suppression and reduce HIV transmission. Recent studies, including demonstration projects in large metropolitan areas such as Atlanta, Georgia; New Orleans, Louisiana; San Francisco, California; and Washington D.C., have demonstrated that rapid ART initiation is a novel tool for expediting viral suppression in clinical settings. Here we present an evaluation of the impact of a rapid ART initiation program in a community-based clinic in Jackson, MS. Methods We conducted a retrospective chart review of patients who were diagnosed with HIV at Open Arms Healthcare Center or were linked to the clinic for HIV care by the Mississippi State Department of Health Disease Intervention Specialists from January 1, 2016 to December 31, 2018. Initial viral load, CD4+ T cell count, issuance of an electronic prescription (e-script), subsequent viral loads until suppressed and patient demographics were collected for each individual seen in clinic during the review period. Viral suppression was defined as a viral load less than 200 copies/mL. Rapid ART initiation was defined as receiving an e-script for antiretrovirals within seven days of diagnosis. Results Between January 1, 2016 and December 31, 2018, 70 individuals were diagnosed with HIV and presented to Open Arms Healthcare Center, of which 63 (90%) completed an initial HIV counseling visit. Twenty-seven percent of patients were provided with an e-script for ART within 7 days of diagnosis. The median time to linkage to care for this sample was 12 days and 5.5 days for rapid ART starters (p < 0.001). Median time from diagnosis to viral suppression was 55 days for rapid ART starters (p = 0.03), a 22 day decrease from standard time to viral suppression. Conclusion Our results provide a similar level of evidence that rapid ART initiation is effective in decreasing time to viral suppression. Evidence from this evaluation supports the use of rapid ART initiation after an initial HIV diagnosis, including same-day treatment.

A retrospective evaluation of highly active antiretroviral therapy simplification in patients with end-stage renal disease receiving hemodialysis

2021 ◽  
pp. 095646242110119
Author(s):  
Ashley Otto ◽  
Patricia Pecora Fulco
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Viral Suppression ◽  
Hiv Care ◽  
Fixed Dose ◽  
People Living With Hiv ◽  
Virologic Suppression ◽  
Once Daily ◽  
Stage Renal Disease ◽  
End Stage

Antiretroviral (ARV) therapy in people living with HIV (PLWH) and end-stage renal disease (ESRD) on hemodialysis (HD) is complicated, requiring renally adjusted nucleoside reverse transcriptase inhibitors (NRTIs) and daily administration of non-renally eliminated agents. Recent data in PLWH with ESRD on HD demonstrate maintenance of viral suppression (82% with viral loads (VLs) <50 copies/mL) and favorable safety/tolerability profiles after ARV simplification with a fixed dose combination single tablet [elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF)]. Extrapolation of these data to all F/TAF formulations would allow ARV simplification to most PLWH with ESRD receiving HD. The objective of this retrospective study was to identify if ARV-experienced PLWH with ESRD on HD receiving renally adjusted NRTIs may be simplified to once daily ARV formulations without adverse effects while maintaining viral suppression. This single-center retrospective analysis assessed virologic control (3–12 months) and ARV tolerability post-regimen simplification (primarily NRTI once-daily dose adjustment) in PLWH with ESRD on thrice weekly HD receiving human immunodeficiency virus (HIV) care in an ambulatory clinic. Seventeen PLWH with ESRD on HD were included after documented ARV simplification. At 12 months, 12 patients (71%) remained undetectable (HIV VL <50 copies/mL) with two additional maintaining viral suppression (<200 copies/mL). One patient remained undetectable at month eight but became non-adherent with viral rebound. Two patients did not complete the 6- and 12-month evaluation after documented nonadherence ( N = 1) and an adverse effect (pruritus) ( N = 1). At 12 months, virologic suppression and tolerability resulted after a simplified ARV regimen including once daily F/TAF was initiated in PLWH with ESRD on thrice weekly HD with a reduction in pill burden.

scholarly journals Progress Toward Achieving the UNAIDS 90-90-90 Goals in HIV Care From Diagnosis to Durable Viral Suppression in the Country of Georgia

2017 ◽  
Vol 33 (10) ◽  
pp. 999-1003 ◽  
Author(s):  
Nikoloz Chkhartishvili ◽  
Otar Chokoshvili ◽  
Akaki Abutidze ◽  
Natia Dvali ◽  
Carlos del Rio ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Hiv Care ◽  
Country Of Georgia ◽  
Durable Viral Suppression

scholarly journals Partial Normalization of Biomarkers of Inflammation and Immune Activation Among Virally Suppressed Men With HIV Infection and High ART Adherence

2020 ◽  
Vol 7 (4) ◽  
Author(s):  
Jose R Castillo-Mancilla ◽  
Todd T Brown ◽  
Frank J Palella ◽  
Bernard J C Macatangay ◽  
Elizabeth C Breen ◽  
...  
Keyword(s):  
Immune Activation ◽  
Interleukin 6 ◽  
Viral Suppression ◽  
Interferon Γ ◽  
Virologic Suppression ◽  
Art Adherence ◽  
Gamma Model ◽  
Hiv Rna ◽  
Interleukin 6 Receptor ◽  
Ifn Γ

Abstract Background The objective of this study was to investigate whether 100% antiretroviral therapy (ART) adherence in men with HIV (MWH) is associated with normalization of concentrations of biomarkers of inflammation and immune activation compared with HIV-uninfected men. Methods We analyzed person-visits with available biomarker data from the Multicenter AIDS Cohort Study (MACS) among MWH receiving ART with HIV RNA &lt;50 copies/mL and among HIV-uninfected men. Self-reported adherence was classified as 100% if no missed ART doses in the past 4 days were reported. We evaluated associations between ART adherence and concentrations of 24 serum biomarkers compared with HIV-uninfected visits using a generalized gamma model, adjusting for potential confounders. Results Person-visits (2565 from MWH reporting 100% ART adherence and 1588 from HIV-uninfected men) from a total of 1469 men were included in the analysis. Serum concentrations of interleukin-6 (IL-6), soluble interleukin-6 receptor (sIL-6R), IL-1β, interferon-γ (IFN-γ), chemokine C-C motif ligand 2 (CCL2), and CCL14 from person-visits among MWH who reported 100% adherence were similar to HIV-uninfected person-visits. Comparatively higher concentrations of 11 biomarkers and lower concentrations of 7 biomarkers were observed in person-visits from MWH who reported 100% ART adherence, compared with HIV-uninfected person-visits. Conclusions Although MWH with virologic suppression who reported 100% ART adherence exhibited overall higher concentrations of biomarkers of inflammation and immune activation compared with HIV-uninfected men, some biomarker concentrations were similar in both groups. These findings suggest that optimal ART adherence could have clinical implications beyond achieving and sustaining viral suppression.

scholarly journals Impact of an HIV Care Coordination Program on Durable Viral Suppression

2019 ◽  
Vol 80 (1) ◽  
pp. 46-55 ◽  
Author(s):  
McKaylee M. Robertson ◽  
Kate Penrose ◽  
Mary K. Irvine ◽  
Rebekkah S. Robbins ◽  
Sarah Kulkarni ◽  
...  
Keyword(s):  
Care Coordination ◽  
Viral Suppression ◽  
Hiv Care ◽  
Durable Viral Suppression
Sign in / Sign up

Export Citation Format

Share Document