Everything counts - a method to determine viral suppression among people living with HIV using longitudinal data for the HIV care continuum - results of two large, German, multi-center real-life cohort studies over 20 years (1999–2018)

Abstract Background The aim of this study was to develop a standardized method to reconstruct persons’ individual viral load (VL) courses to determine viral suppression and duration of viremia for the HIV care continuum in Germany using longitudinal cohort data. Methods We analyzed data from two large, multi-center German cohort studies under the direction of the Robert Koch Institute. We included data from 1999 to 2018 of all diagnosed people and of people who initiated antiretroviral treatment (ART). We developed a model generating virtual VL values and an individual VL course corresponding to real VL measurements with a maximum distance of 180 days, considering ART status and VL dynamics. If the distance between VL measurements was > 180 days, the time between was defined as gap time. Additionally, we considered blips, which we defined as a single detectable VL < 1000 copies/ml within 180 days. Results A total of 22,120 people (164,691 person-years, PY) after ART initiation were included in the analyses. The proportion of people with viral suppression (VL < 50 copies/ml) increased from 34% in 1999 to 93% in 2018. The proportion of people with VL < 200 copies/ml increased from 47% in 1999 to 96% in 2018. The proportion of people with viremia > 1000 copies/ml decreased from 37% in 1999 to 3% in 2018. The proportion of people with gap time fluctuated and ranged between 18 and 28%. An analysis of the first VL after gap time showed that 90% showed viral suppression, 5% VL between 50- < 1000 copies/ml and 5% VL > 1000 copies/ml. Conclusion We provide a method for estimating viral suppression and duration of viremia using longitudinal VL data. We observed a continuous and remarkable increase of viral suppression. Furthermore, a notable proportion of those with viremia showed low-level viremia and were therefore unlikely to transmit HIV. Individual health risks and HIV drug resistance among those with low-level viremia are problematic, and viral suppression remains the goal. In 2018, 93 and 96% of people after ART initiation showed VL < 50 copies/ml and VL < 200 copies/ml, respectively. Therefore, using the threshold of VL < 200 copies/ml, Germany reached the UNAIDS 95 target of viral suppression since 2017.

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Everything Counts -- A Method to Determine Viral Suppression Among People Living With Hiv Using Longitudinal Data for the Hiv Care Continuum. - Results of two large, German, multi-center real-life cohort studies over 20 years (1999-2018)

10.21203/rs.3.rs-36030/v2 ◽

2020 ◽

Author(s):

Daniel Schmidt ◽

Christian Kollan ◽

Matthias Stoll ◽

Osamah Hamouda ◽

Viviane Bremer ◽

...

Keyword(s):

Cohort Studies ◽

Viral Suppression ◽

Real Life ◽

Hiv Care ◽

People Living With Hiv ◽

Hiv Care Continuum ◽

Care Continuum ◽

Low Level ◽

Art Initiation ◽

Gap Time

Abstract BackgroundThe aim of this study was to develop a standardized method to reconstruct persons' individual VL courses to determine viral suppression and duration of viremia for the HIV care continuum in Germany using longitudinal cohort data.MethodsWe analyzed data from two large, multi-center German cohort studies under the direction of the Robert Koch Institute. We included data from 1999-2018 of all diagnosed people and of people who initiated antiretroviral treatment (ART). We developed a model generating virtual VL values and an individual VL course corresponding to real VL measurements with a maximum distance of 180 days, considering ART status and VL dynamics. If the distance between VL measurements was >180 days, the time between was defined as gap time. Additionally, we considered blips, which we defined as a single detectable VL <1,000 copies/ml within 180 days.ResultsA total of 22,120 people (164,691 person-years, PY) after ART initiation were included in the analyses. The proportion of people with viral suppression (VL <50 copies/ml) increased from 34% in 1999 to 93% in 2018. The proportion of people with VL <200 copies/ml increased from 47% in 1999 to 96% in 2018. The proportion of people with viremia >1,000 copies/ml decreased from 37% in 1999 to 3% in 2018. The proportion of people with gap time fluctuated and ranged between 18% and 28%. An analysis of the first VL after gap time showed that 90% showed viral suppression, 5% VL between 50-<1,000 copies/ml and 5% VL >1,000 copies/ml.ConclusionWe provide a method for estimating viral suppression and duration of viremia using longitudinal VL data. We observed a continuous and remarkable increase of viral suppression. Furthermore, a notable proportion of those with viremia showed low-level viremia and were therefore unlikely to transmit HIV. Individual health risks and HIV drug resistance among those with low-level viremia are problematic, and viral suppression remains the goal. In 2018, 93% and 96% of people after ART initiation showed VL <50 copies/ml and VL <200 copies/ml, respectively. Therefore, using the threshold of VL <200 copies/ml, Germany reached the UNAIDS 95 target of viral suppression since 2017.

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Everything Counts -- A Method To Determine Viral Suppression Among People Living With Hiv Using Longitudinal Data For The Hiv Care Continuum. - Results Of Two Large, German, Multi-Center Real-Life Cohort Studies Over 20 Years (1999-2018)

10.21203/rs.3.rs-36030/v1 ◽

2020 ◽

Author(s):

Daniel Schmidt ◽

Christian Kollan ◽

Matthias Stoll ◽

Osamah Hamouda ◽

Viviane Bremer ◽

...

Keyword(s):

Cohort Studies ◽

Viral Suppression ◽

Real Life ◽

Hiv Care ◽

People Living With Hiv ◽

Hiv Care Continuum ◽

Care Continuum ◽

Low Level ◽

Art Initiation ◽

Gap Time

Abstract Background The aim of this study was to develop a standardized method to reconstruct persons' individual VL courses to determine viral suppression and duration of viremia for the HIV care continuum in Germany using data longitudinal cohort data. Methods We analyzed data from two large, multi-center German cohort studies under the direction of the Robert Koch Institute. We included data from 1998 to 2018 of all diagnosed people and of people who initiated antiretroviral treatment (ART). We developed a model generating virtual VL points and an individual VL course corresponding to real VL measurements with a maximum distance of 180 days, considering ART status and VL dynamics. If the distance between VL measurements was > 180 days, the time between was defined as gap-time. Additionally, we considered blips, which we defined as a single detectable VL < 1,000 copies/ml within 180 days. Results A total of 22,120 people (164,691 person-years, PY) after ART initiation were included in the analyses. The proportion of people with viral suppression (VL < 50 copies/ml) increased from 34% in 1999 to 93% in 2018. The proportion of people with VL < 200 copies/ml increased from 47% in 1999 to 96% in 2018. The proportion of people with viremia > 1,000 copies/ml decreased from 37% in 1999 to 3% in 2018. The proportion of people with gap-time fluctuated and ranged between 18% and 28%. An analysis of the first VL after gap-time showed that 90% showed viral suppression, 5% VL between 50-<1,000 copies/ml and 5% VL > 1,000 copies/ml. Conclusion We provide a method for estimating viral suppression and duration of viremia using longitudinal VL data. We observed a continuous and remarkable increase of viral suppression. Furthermore, a notable proportion of those with viremia showed low-level viremia and were therefore unlikely to transmit HIV. Individual health risks and HIV drug resistance among those with low-level viremia are problematic, and viral suppression remains the goal. In 2018, 93% and 96% of people after ART initiation showed VL < 50 copies/ml and VL < 200 copies/ml, respectively. Therefore, using the threshold of VL < 200 copies/ml, Germany reached the UNAIDS 95 target of viral suppression since 2017.

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1311. Ryan White HIV Care Continuum Model Doubled the Rate of Community HIV Viral Suppression for Newly Diagnosed Patients: A 10-Year Review

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1174 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S473-S473

Author(s):

Christina Rizk ◽

Alice Zhao ◽

Janet Miceli ◽

Portia Shea ◽

Merceditas Villanueva ◽

...

Keyword(s):

Viral Suppression ◽

Linkage To Care ◽

Hiv Care ◽

Hiv Care Continuum ◽

Newly Diagnosed ◽

New Haven ◽

Care Continuum ◽

Art Initiation ◽

Ryan White ◽

Hiv Viral Suppression

Abstract Background It is estimated that 1,295 per 100,000 are people living with HIV (PLWH) in New Haven, which is the second highest rate of HIV prevalence in Connecticut. Since 2009, New Haven has established the Ryan White (RW) HIV Care Continuum. The main goals of HIV care are early linkage to care, ART initiation, and HIV viral suppression. This study is designed to understand the trends and outcomes in newly diagnosed PLWH in New Haven County. Methods This study is a retrospective medical record review of all newly diagnosed RW eligible PLWH from January 1, 2009 to December 31, 2018. The data were collected in REDCap database and included demographics, HIV risk factor, presence of mental health and/or substance abuse disorder, date of diagnosis, date of initial visit, and ART initiation. Health outcomes such as AIDS at diagnosis and rate of viral suppression were evaluated. The data were then analyzed to show the trends over 10 years. Results From January 1, 2009 to December 31, 2018 there were 420 newly diagnosed RW PLWH. Sixty-seven percent of those were male, 56% were non-white, 47% self-identified as Men who have Sex with Men (MSM), and 41% were heterosexual. Twenty-nine percent had AIDS-defining condition at the time of the diagnosis. Thirty-four percent of the 420 patients had a mental health and/or substance use disorder; 53% of those were MSM and 51% were non-white. Over the 10-year period, it was noted that the duration between date of HIV diagnosis and linkage to care as well as ART initiation decreased. This decline was associated with a substantial increase in viral suppression. The average time between the dates of HIV diagnosis and initial visit decreased from 269 days in 2009 to 13 days in 2018. Moreover, the average time between the dates of diagnosis and ART initiation dropped from 308 days in 2009 to 15 days in 2018. The 1-year HIV viral suppression rate subsequently doubled from 44% in 2009 to 87% in 2018 (P < 0.01). Conclusion The Ryan White HIV Care Continuum Model with emphasis on early linkage to care and ART initiation can have a significant impact on HIV viral suppression at a community level for newly diagnosed patients. Another important observation in this study was the alarming high rate of AIDS at diagnosis, which highlights the need for universal HIV testing, and early diagnosis. Disclosures All authors: No reported disclosures.

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1322. A Mobile Technology-Based Intervention Improves HIV Care Continuum for Young People Living with HIV

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1185 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S478-S478

Author(s):

Ping Du ◽

John Zurlo ◽

Tarek Eshak ◽

Tonya Crook ◽

Cynthia Whitener

Keyword(s):

Mobile Technology ◽

Viral Suppression ◽

Retention In Care ◽

Hiv Care ◽

People Living With Hiv ◽

Hiv Care Continuum ◽

Care Continuum ◽

Hiv Viral Suppression ◽

Study Participants ◽

Living With Hiv

Abstract Background Young people living with HIV (YPLWH) have lower rates of retention in care and HIV viral suppression. Multiple barriers exist to engage YPLWH in care. As nearly all YPLWH use their mobile phones to access health information and to communicate with other people, we implemented a mobile technology-based intervention with the goal to improve HIV care continuum in YPLWH. Methods YPLWH were eligible for this study if they were: (1) aged 18–34 years; (2) newly diagnosed with HIV; (3) having a history of being out of care; or (4) not virally suppressed. We recruited YPLWH during January 2017-May 2018 and followed them every 6 months. We developed a HIPAA-compliant mobile application, “OPT-In For Life,” and let participants use this app to manage their HIV care. The app integrated multiple features that enabled users to communicate with the HIV treatment team via a secure messaging function, to access laboratory results and HIV prevention resources, and to set up appointment or medication reminders. We obtained participants’ demographics, app-usage data, and medical records to evaluate if this mobile technology-based intervention would improve HIV care continuum among YPLWH. We used a quasi-experiment study design to compare the rates of retention in care and HIV viral suppression every 6 months between study participants and YPLWH who were eligible but not enrolled in the study. Results 92 YPLWH participated in this study (70% male, 56% Hispanics or Blacks, 54% retained in care, and 66% virally suppressed at baseline). On average study participants used the app 1–2 times/week to discuss various health issues and supportive services with HIV providers, to access HIV-related health information, and to manage their HIV care. At the 6-month evaluation, compared with 88 eligible YPLWH who were not enrolled in this intervention, study participants had increased rates of retention in care (baseline-to-6-month between participants and nonparticipants: 54%–84% vs. 26%–25%) and HIV viral suppression (66%–80% vs. 56%–60%). Conclusion Our study demonstrates using a HIPAA-compliant mobile app as an effective intervention to engage YPLWH in care. This intervention can be adapted by other HIV programs to improve HIV care continuum for YPLWH or broader HIV populations. Disclosures All authors: No reported disclosures.

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Effects of Gender-Affirming Hormone Therapy on Progression Along the HIV Care Continuum in Transgender Women

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab404 ◽

2021 ◽

Author(s):

Nathan A Summers ◽

Trang T Huynh ◽

Ruth C Dunn ◽

Sara L Cross ◽

Christian J Fuchs

Keyword(s):

Hormone Therapy ◽

Viral Suppression ◽

Transgender Women ◽

Hiv Care ◽

Study Entry ◽

People Living With Hiv ◽

Hiv Care Continuum ◽

Care Continuum ◽

Icd Codes ◽

Over Time

Abstract Background Progression along the HIV care continuum has been a key focus for improving outcomes for people living with HIV (PLWH). Transgender women with HIV (TGWWH) have not made the same progress as their cisgender counterparts. Methods All PLWH identifying as transgender women receiving care at our clinic from 1/1/2015 to 12/31/2019 were identified from the electronic health records (EHR) using ICD codes. Demographics, laboratory data, prescription of gender-affirming hormone therapy (GAHT), and visit history were abstracted from the EHR. Retention in care and viral suppression were defined using CDC definitions. The proportions of TGWWH who were consistently retained in care or virally suppressed over time was calculated using a binary response generalized mixed model including random effects and correlated errors. Results Of the 76 PLWH identified by ICD codes, two were excluded for identifying as cisgender and 15 for insufficient records, leaving 59 TGWWH included for analysis. Patients were on average 35 years old, black (86%), with a median CD4 count of 464 cells/µL. There were 13 patients on GAHT at study entry and 31 receiving GAHT at any point during the study period. 55% were virally suppressed at study entry and 86% at GAHT initiation. The proportion of TGWWH who were consistently virally suppressed over time was greater among those receiving GAHT compared to those who were not (p=0.04). Conclusions Rates of viral suppression were significantly greater among TGWWH receiving GAHT when compared to those who were not. More research to evaluate reasons behind this effect are needed.

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High Rates of Retention and Viral Suppression in the US HIV Safety Net System: HIV Care Continuum in the Ryan White HIV/AIDS Program, 2011

Clinical Infectious Diseases ◽

10.1093/cid/ciu722 ◽

2014 ◽

Vol 60 (1) ◽

pp. 117-125 ◽

Cited By ~ 66

Author(s):

R. K. Doshi ◽

J. Milberg ◽

D. Isenberg ◽

T. Matthews ◽

F. Malitz ◽

...

Keyword(s):

Viral Suppression ◽

Safety Net ◽

Hiv Care ◽

Hiv Care Continuum ◽

Care Continuum ◽

Ryan White ◽

The Us ◽

Aids Program ◽

Hiv Aids

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Influence of Material Deprivation on Clinical Outcomes Among People Living with HIV in High-Income Countries: A Systematic Review and Meta-analysis

AIDS and Behavior ◽

10.1007/s10461-021-03551-y ◽

2021 ◽

Author(s):

Vasiliki Papageorgiou ◽

Bethan Davies ◽

Emily Cooper ◽

Ariana Singer ◽

Helen Ward

Keyword(s):

Systematic Review ◽

Social Determinants ◽

Meta Analysis ◽

Hiv Treatment ◽

Material Deprivation ◽

Hiv Care ◽

People Living With Hiv ◽

Hiv Care Continuum ◽

Care Continuum ◽

Living With Hiv

AbstractDespite developments in HIV treatment and care, disparities persist with some not fully benefiting from improvements in the HIV care continuum. We conducted a systematic review to explore associations between social determinants and HIV treatment outcomes (viral suppression and treatment adherence) in high-income countries. A random effects meta-analysis was performed where there were consistent measurements of exposures. We identified 83 observational studies eligible for inclusion. Social determinants linked to material deprivation were identified as education, employment, food security, housing, income, poverty/deprivation, socioeconomic status/position, and social class; however, their measurement and definition varied across studies. Our review suggests a social gradient of health persists in the HIV care continuum; people living with HIV who reported material deprivation were less likely to be virologically suppressed or adherent to antiretrovirals. Future research should use an ecosocial approach to explore these interactions across the lifecourse to help propose a causal pathway.

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HIV Care Continuum and COVID-19 Outcomes Among People Living with HIV During the COVID-19 Pandemic, Chicago, IL

AIDS and Behavior ◽

10.1007/s10461-020-02905-2 ◽

2020 ◽

Vol 24 (10) ◽

pp. 2770-2772 ◽

Cited By ~ 14

Author(s):

Jessica P. Ridgway ◽

Jessica Schmitt ◽

Eleanor Friedman ◽

Michelle Taylor ◽

Samantha Devlin ◽

...

Keyword(s):

Hiv Care ◽

People Living With Hiv ◽

Hiv Care Continuum ◽

Care Continuum ◽

Living With Hiv

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Efficacy and Impact of Digital HIV Care Navigation in Young People Living With HIV in San Francisco, California: Prospective Study (Preprint)

10.2196/preprints.18597 ◽

2020 ◽

Author(s):

Sean Arayasirikul ◽

Caitlin Turner ◽

Dillon Trujillo ◽

Victory Le ◽

Erin C Wilson

Keyword(s):

Primary Care ◽

Young People ◽

San Francisco ◽

Text Messaging ◽

Hiv Care ◽

Computer Assisted ◽

People Living With Hiv ◽

Hiv Care Continuum ◽

Care Continuum ◽

Living With Hiv

BACKGROUND Young people are disproportionately impacted by HIV infection and exhibit poor HIV care continuum outcomes. Mobile health (mHealth) interventions are promising approaches to meet the unique needs of young people living with HIV. Youth-focused interventions are needed to improve HIV care continuum outcomes. OBJECTIVE This study assessed the preliminary efficacy and impact of a digital HIV care navigation intervention among young people living with HIV in San Francisco. Health electronic navigation (eNavigation or eNav) is a 6-month, text message–based, digital HIV care navigation intervention, in which young people living with HIV are connected to their own HIV care navigator through text messaging to improve engagement in HIV primary care. METHODS This study had a single-arm, prospective, pre-post design. The analysis included 120 young men who have sex with men or transwomen living with HIV aged between 18 and 34 years. We analyzed self-reported sociobehavioral information pre- and postintervention at baseline and 6 months, which was collected using computer-assisted self-interviewing surveys. We characterized the sample and built generalized estimating equation (GEE) models to assess differences in HIV care continuum outcomes at baseline and 6 months. RESULTS The characteristics according to the intervention completion status were not different from those of the overall sample. The mean age of the participants was 27.75 years (SD 4.07). Most participants (103/120, 85.8%) identified as men, and the sample was racially/ethnically diverse. At baseline, majority (99/120, 82.5%) of the participants had recently received primary HIV care, yet this was more likely in those who completed the intervention than in those who did not (54/60, 90% vs 45/60, 75%; χ21=4.68, P=.03). More than half of the sample reported taking antiretroviral therapy (92/120, 76.7%) and having an undetectable viral load (65/120, 54.2%). The 6-month follow-up surveys were completed by 73.3% (88/120) of participants, and these participants were not characteristically different from the overall sample at baseline. GEE models indicated that participants had increased odds of viral suppression at 6 months as compared with baseline. No relevant additive or multiplicative interactions were noted on comparing outcome effects over time according to intervention completion. CONCLUSIONS Digital HIV care navigation fills a critical gap in public health and HIV care systems, making these systems more responsive and accountable to the needs of the most vulnerable individuals. Our intervention bridges the time between primary care visits with interactive, tailored, personalized, and peer-delivered social support; information; and motivational interviewing to scaffold behavioral change. This study is part of the next wave of system-informed mHealth intervention research that will offer potentially disruptive solutions to traditional in-person delivered interventions and improve the health of the most vulnerable individuals. INTERNATIONAL REGISTERED REPORT RR2-10.2196/16406

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