scholarly journals HIV Care Visits and Time to Viral Suppression, 19 U.S. Jurisdictions, and Implications for Treatment, Prevention and the National HIV/AIDS Strategy

PLoS ONE ◽  
2013 ◽  
Vol 8 (12) ◽  
pp. e84318 ◽  
Author(s):  
H. Irene Hall ◽  
Tian Tang ◽  
Andrew O. Westfall ◽  
Michael J. Mugavero
Keyword(s):  
Viral Suppression ◽  
Hiv Care ◽  
Hiv Aids

scholarly journals 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

2014 ◽  
Vol 60 (1) ◽  
pp. 117-125 ◽  
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

scholarly journals HIV Care Outcomes among Hispanics/Latinos with Diagnosed HIV in the United States by Place of Birth-2015–2018, Medical Monitoring Project

2019 ◽  
Vol 17 (1) ◽  
pp. 171
Author(s):  
Hanna B. Demeke ◽  
Qingwei Luo ◽  
Ruth E. Luna-Gierke ◽  
Mabel Padilla ◽  
Gladys Girona-Lozada ◽  
...  
Keyword(s):  
Mental Health ◽  
United States ◽  
Viral Suppression ◽  
The United States ◽  
Hiv Care ◽  
Medical Monitoring ◽  
Place Of Birth ◽  
Sustained Viral Suppression ◽  
Medical Monitoring Project ◽  
Hiv Aids

Relocation from one’s birthplace may affect human immunodeficiency virus (HIV) outcomes, but national estimates of HIV outcomes among Hispanics/Latinos by place of birth are limited. We analyzed Medical Monitoring Project data collected in 2015–2018 from 2564 HIV-positive Hispanic/Latino adults and compared clinical outcomes between mainland US-born (referent group), Puerto Rican (PR-born), and those born outside the United States (non-US-born). We reported weighted percentages of characteristics and used logistic regression with predicted marginal means to examine differences between groups (p < 0.05). PR-born Hispanics/Latinos were more likely to be prescribed antiretroviral therapy (ART) (94%) and retained in care (94%) than mainland-US-born (79% and 77%, respectively) and non-US-born (91% and 87%, respectively) Hispanics/Latinos. PR-born Hispanics/Latinos were more likely to have sustained viral suppression (75%) than mainland-US-born Hispanics/Latinos (57%). Non-US-born Hispanics/Latinos were more likely to be prescribed ART (91% vs. 79%), retained in care (87% vs. 77%), and have sustained viral suppression (74% vs. 57%) than mainland-US-born Hispanics/Latinos. Greater Ryan White HIV/AIDS-funded facility usage among PR-born, better mental health among non-US-born, and less drug use among PR-born and non-US-born Hispanics/Latinos may have contributed to better HIV outcomes. Expanding programs with comprehensive HIV/AIDS services, including for mental health and substance use, may reduce HIV outcome disparities among Hispanics/Latinos.

scholarly journals Influence of Jail Incarceration and Homelessness Patterns on Engagement in HIV Care and HIV Viral Suppression among New York City Adults Living with HIV/AIDS

PLoS ONE ◽  
2015 ◽  
Vol 10 (11) ◽  
pp. e0141912 ◽  
Author(s):  
Sungwoo Lim ◽  
Denis Nash ◽  
Laura Hollod ◽  
Tiffany G. Harris ◽  
Mary Clare Lennon ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Viral Suppression ◽  
Hiv Care ◽  
Hiv Viral Suppression ◽  
Engagement In Hiv Care ◽  
Living With Hiv ◽  
Hiv Aids

scholarly journals 1030. Medicaid Expansion: How Does it Impact HIV Outcomes in One Non-urban Southeastern Ryan White HIV/AIDS Program Clinic?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S544-S546
Author(s):  
Kathleen A McManus ◽  
Karishma R Srikanth ◽  
Samuel D Powers ◽  
Rebecca Dillingham ◽  
Elizabeth T Rogawski McQuade
Keyword(s):  
Viral Suppression ◽  
Hiv Care ◽  
Baseline Viral Load ◽  
Medicaid Expansion ◽  
Engagement In Care ◽  
Medicaid Enrollment ◽  
Ryan White ◽  
Aids Program ◽  
Research Grant ◽  
Hiv Aids

Abstract Background People living with HIV (PLWH) with Medicaid historically have lower viral suppression (VS) rates than those with other insurance. VS rates with Medicaid expansion (ME) are unknown. We examined HIV outcomes (engagement in care, VS) by insurance status for a non-urban Southeastern Ryan White HIV/AIDS Program (RWHAP) Clinic cohort for year after ME. Methods Participants were PLWH ages 18-63 who attended &gt; 1 HIV medical visit/year in 2018 and 2019. Log-binomial models were used to estimate the association of characteristics with Medicaid enrollment prevalence and one-year risks of engagement in care and VS in 2019. Results Among 577 patients, 241 (42%) were newly eligible for Medicaid due to ME and 79 (33%) enrolled (Figure 1a). For those without Medicare, Medicaid enrollment was higher for those with incomes &lt; 100% FPL (adjusted prevalence ratio [aPR] 1.67; 95% confidence interval [CI] 1.00-1.86) compared to those with incomes &gt; 101% FPL. Those enrolled in Medicaid due to ME had 87% engagement in care compared to 80-92% for other insurance plans (Figure 1b). Controlling for 2018 engagement, older age (adjusted risk ratio [aRR] for 10 years 1.03, 95% CI 1.00-1.05; Table 1) was associated with being engaged in 2019. Engagement was lower for those with employment-based insurance (aRR 0.91, 95% CI 0.83-0.99) and Medicare (aRR 0.87, 95% CI 0.78-0.96). Of those with viral loads in 2018 and 2019 (n=549), those who newly enrolled in Medicaid due to ME had 85% VS compared to 87-99% for other insurance plans (Figure 1c). In univariate analysis, age, income, and baseline viral load status were associated with viral suppression (Table 2), and those with Medicaid due to ME (aRR 0.90, 95% CI 0.81-1.00) were less likely to achieve VS compared with others. Figure 1 Table 1 Table 2 Conclusion The low uptake of ME was likely influenced by many PLWH already having Medicare. While the RWHAP supports high quality HIV care, Medicaid enrollment improves access to non-HIV care and should be supported by RWHAP. Given that engagement in care was high for PLWH who newly enrolled in Medicaid, the finding of lower VS is surprising. The discordance may be due to medication access gaps associated with changes in pharmacy logistics. Future studies with larger cohorts will need to examine how ME contributes to PLWH’s overall health and to ending the HIV epidemic. Disclosures Kathleen A. McManus, MD, MSCR, Gilead Sciences, Inc (Research Grant or Support, Shareholder) Rebecca Dillingham, MD, MPH, Gilead Sciences, Inc (Research Grant or Support)Warm Health Technologies, Inc (Consultant)

scholarly journals HIV incidence fall in Italy: a –20% fall in 2018 to be explained

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Salvati ◽  
R Croci ◽  
A Odone ◽  
C Signorelli
Keyword(s):  
At Risk ◽  
Viral Suppression ◽  
Preventive Measures ◽  
European Countries ◽  
Hiv Care ◽  
Hiv Incidence ◽  
Screening Programs ◽  
At Risk Populations ◽  
Incident Cases ◽  
Hiv Aids

Abstract Background HIV is still a critical public health threat in Europe, especially in some at-risk populations. Stigma keeps undermining access to prevention, diagnosis, and care. Treatment as Prevention (TasP) and Pre-Exposure Prophylaxis (PrEP) have spread heterogeneously across the continent. The study aimed to compare recent HIV incidence trends in five European countries (Italy, Spain, Germany, France, UK), and to speculate about TasP and PrEP's relative contribution as preventive measures in Italy. Methods We collected incidence data by consulting the ECDC HIV/AIDS Surveillance Report 2019, and a preliminary Italian 2019 report issued by the National Institute of Health. We used the latest ECDC Continuum of HIV care data to appraise European trends in HIV viral suppression. Results All the considered European countries reported a decreasing trend in 2018, compared to 2017. In Italy, according to raw preliminary data, the number of new HIV infections dropped from 3,561 (5.9/100,000) to 2,847 (4.7/100,000), thus resulting in a -20% fall. Interestingly, Spain shows an even sharper decrease of -22%, dropping from 3,795 new cases in 2017 to 2,527 in 2018, that is from a rate of 8.2/100,000 to 6.4/100,000. Conclusions Since 2008, when the coordinated ECDC/WHO Regional Office for Europe HIV/AIDS surveillance system was set up, Italy has never witnessed such a sharp yearly fall in incident cases, thus representing, together with Spain, an epidemiological peculiarity in the European context. TasP could have played a major role in Italy. Indeed, Continuum of HIV care data show a positive trend in viral suppression in European countries. PrEP has been introduced in the Italian guidelines in 2016 and is nowadays adopted in a few urban areas, as a co-pay, on-demand service for high-risk populations with limited diffusion. It is thus plausible that PrEP carries a much lower epidemiologic weight in the Italian 2018 incidence reduction. Key messages We need to spread PrEP, TasP and screening programs, especially in at-risk populations. We must search for a causal association between preventive measures and decreasing incidence.

scholarly journals 1010. Effective Management of HIV in Rural Georgia Using Telemedicine

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S533-S533
Author(s):  
Folake J Lawal ◽  
Arni S R Srinivasa Rao ◽  
Jose A Vazquez
Keyword(s):  
Rural Areas ◽  
Viral Suppression ◽  
Retrospective Chart Review ◽  
Cd4 Count ◽  
Hiv Care ◽  
Resistance Mutations ◽  
Remote Communities ◽  
Hiv Viral Load ◽  
Viral Control ◽  
Significant Difference

Abstract Background The increasing incidence of HIV and lack of care in rural areas contributes to the ongoing epidemic. The dearth of specialized health services within remote communities and access of this population to available services poses a challenge to HIV care. Telemedicine (TM) is a potential tool to improve HIV care in these remote communities, but little is known about its effectiveness when compared to traditional (face-to-face) (F2F) care. The objective of this study is to examine the effectiveness of HIV care delivered through TM, and compare to F2F care. Methods This is a retrospective chart review of all HIV positive patients who attended either the F2F clinic (Augusta, GA) or the TM clinic (Dublin, GA) between May 2017 to April 2018. Data extracted included demographics, CD4 count, HIV PCR, co-morbidities, dates of clinic attendance, HIV resistance mutations and ART changes. Viral suppression and gain in CD4 counts were compared. T-test was conducted to test differences in characteristics and outcomes between the two groups. Results 385 cases were included in the study (52.5% black, 82% females, F2F=200, TM=185). Mean CD4 count in the TM group was statistically higher (643.9 cells/mm3) than the F2F group (596.3 cells/mm3) (p&lt; 0.001). There was no statistically significant difference in mean HIV viral load (F2F= 416.8 cp/ml, TM=713.4 cp/ml, p=0.3) and rates of year-round viral control (F2F= 73% vs TM = 77% p= 0.54). 38 patients achieved viral suppression during the study period (F2F= 24, TM =14) with a mean change of -3.34 x 104 vs -1.24 x 104, respectively. The difference in mean change was not statistically significant by Snedacor’s W Statistics. This indicates there was no significant difference between the two populations in terms of mean viral suppression among patients who were otherwise not suppressed before the study period. Conclusion To achieve an HIV cure, HIV care is required to extend to rural areas of the country and the world. Through delivery of care using TM, trained specialists can target communities with little or no health care. Moreover, use of TM achieves target outcome measures comparable to F2F clinics. Increase in the use of TM will improve the access to specialty HIV care and help achieve control of HIV in rural communities. Disclosures All Authors: No reported disclosures

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

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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