scholarly journals HIV Infection Care and Viral Suppression Among People Who Inject Drugs, 28 U.S. Jurisdictions, 2012-2013

2016 ◽  
Vol 10 (1) ◽  
pp. 127-135 ◽  
Author(s):  
Debra L. Karch ◽  
Kristen Mahle Gray ◽  
Jing Shi ◽  
H. Irene Hall
Keyword(s):  
Young People ◽  
Hiv Infection ◽  
Viral Suppression ◽  
People Who Inject Drugs ◽  
Early Stage ◽  
Linkage To Care ◽  
Retention In Care ◽  
Infected People ◽  
Hiv Surveillance ◽  
Stage Infection

Objectives: Assess outcomes along the care continuum for HIV-infected people who inject drugs (PWID), by type of facility and stage of infection at diagnosis. Methods: Data reported by 28 jurisdictions to the National HIV Surveillance System by December 2014 were used to identify PWID aged ≥13 years, diagnosed with HIV infection before December 31, 2013. Analyses used the CDC definition of linkage to care (LTC), retention in care (RIC), and viral suppression (VS), and are stratified by age, sex, race/ethnicity, and type of facility and stage of HIV infection at diagnosis. Results: Of 1,409 PWID diagnosed with HIV in 2013, 1,116 (79.2%) were LTC with the lowest percentages among males (78.4%); blacks (77.5%) ages 13-24 years (69.0%); those diagnosed in early stage infection (71.6%); and at screening, diagnostic, or referral agencies (60.0%). Of 80,958 PWID living with HIV in 2012, 40,234 (49.7%) were RIC and 34,665 (42.8%) achieved VS. The lowest percentages for RIC and VS were among males (47.1% and 41.3% respectively); those diagnosed with late stage disease (47.1% and 42.4%); and young people. Whites had the lowest RIC (47.0%) while blacks had the lowest VS (41.1%). Conclusion: Enhanced LTC activities are needed for PWID diagnosed at screening, diagnostic or referral agencies versus those diagnosed at inpatient or outpatient settings, especially among young people and blacks diagnosed in early stage infection. Less than half of PWID are retained in care or reach viral suppression indicating the need for continued engagement and return to care activities over the long term.

scholarly journals HIV Infection-Related Care Outcomes among U.S.-Born and Non-U.S.-Born Blacks with Diagnosed HIV in 40 U.S. Areas: The National HIV Surveillance System, 2016

2018 ◽  
Vol 15 (11) ◽  
pp. 2404 ◽  
Author(s):  
Hanna Demeke ◽  
Anna Johnson ◽  
Hong Zhu ◽  
Zanetta Gant ◽  
Wayne Duffus ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Late Stage ◽  
Surveillance System ◽  
Viral Suppression ◽  
Hiv Infections ◽  
Retention In Care ◽  
Hiv Care ◽  
Hiv Diagnosis ◽  
Hiv Surveillance ◽  
Care Outcomes

HIV care outcomes must be improved to reduce new human immunodeficiency virus (HIV) infections and health disparities. HIV infection-related care outcome measures were examined for U.S.-born and non-U.S.-born black persons aged ≥13 years by using National HIV Surveillance System data from 40 U.S. areas. These measures include late-stage HIV diagnosis, timing of linkage to medical care after HIV diagnosis, retention in care, and viral suppression. Ninety-five percent of non-U.S.-born blacks had been born in Africa or the Caribbean. Compared with U.S.-born blacks, higher percentages of non-U.S.-born blacks with HIV infection diagnosed during 2016 received a late-stage diagnoses (28.3% versus 19.1%) and were linked to care in ≤1 month after HIV infection diagnosis (76.8% versus 71.3%). Among persons with HIV diagnosed in 2014 and who were alive at year-end 2015, a higher percentage of non-U.S.-born blacks were retained in care (67.8% versus 61.1%) and achieved viral suppression (68.7% versus 57.8%). Care outcomes varied between African- and Caribbean-born blacks. Non-U.S.-born blacks achieved higher care outcomes than U.S.-born blacks, despite delayed entry to care. Possible explanations include a late-stage presentation that requires immediate linkage and optimal treatment and care provided through government-funded programs.

scholarly journals Trends in Care and Treatment for Persons Aged ≥13 Years with HIV Infection 17 U.S. Jurisdictions, 2012-2015

2018 ◽  
Vol 12 (1) ◽  
pp. 90-105 ◽  
Author(s):  
Debra L. Karch ◽  
Xueyuan Dong ◽  
Jing Shi ◽  
H. I. Hall
Keyword(s):  
Hiv Infection ◽  
Viral Suppression ◽  
Linkage To Care ◽  
Risk Groups ◽  
Sexual Contact ◽  
Hiv Diagnosis ◽  
Annual Percent Change ◽  
Hiv Surveillance ◽  
High Risk Populations ◽  
National Trends

Background: Care and viral suppression national goals for HIV infection are not being met for many at-risk groups. Assessment of the trends in national outcomes for linkage to care, receipt of care, and viral suppression among these groups is necessary to reduce transmission. Methods: Data reported to the National HIV Surveillance System by December 2016 were used to identify cases of HIV infection among persons aged 13 years and older in one of 17 identified jurisdictions with complete laboratory reporting. We estimated national trends in HIV-related linkage to care, receipt of care and viral suppression using estimated annual percent change from 2012-2015 for various characteristics of interest, overall and stratified by sex and race/ethnicity. Results: Overall, trends in linkage to and receipt of care and viral suppression increased from 2012-2015. Generally, linkage to and receipt of care increased among young black and Hispanic/Latino males, those with infection attributed to male-to-male sexual contact, and those not in stage 3 [AIDS] at HIV diagnosis. All sub-groups showed improvement in viral suppression. Within years, there remains a substantial disparity in receipt of care and viral suppression among racial/ethnic groups. Conclusion: While trends are encouraging, scientifically proven prevention programs targeted to high-risk populations are the foundation for stopping transmission of HIV infection. Frequent testing to support early diagnosis and prompt linkage to medical care, particularly among young men who have male to male sexual contact, black and Hispanic/Latino populations, are key to reducing transmission at all stages of disease.

scholarly journals Predictors of Linkage to and Retention in HIV Care Following Release from Connecticut Jails and Prisons

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S38-S38
Author(s):  
Kelsey B Loeliger ◽  
Frederick L Altice ◽  
Mayur M Desai ◽  
Maria M Ciarleglio ◽  
Colleen Gallagher ◽  
...  
Keyword(s):  
Case Management ◽  
Viral Suppression ◽  
Linkage To Care ◽  
Retention In Care ◽  
Hiv Treatment ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Surveillance ◽  
Targeted Interventions ◽  
Retention In Hiv Care

Abstract Background One in six people living with HIV (PLH) in the USA transition through prison or jail annually. During incarceration, people may engage in HIV care, but transition to the community remains challenging. Linkage to care (LTC) post-release and retention in care (RIC) are necessary to optimizing HIV outcomes, but have been incompletely assessed in prior observational studies. Methods We created a retrospective cohort of all PLH released from a Connecticut jail or prison (2007–2014) by linking Department of Correction demographic, pharmacy, and custody databases with Department of Public Health HIV surveillance monitoring and case management data. We assessed time to LTC, defined as time from release to first community HIV-1 RNA test, and viral suppression status at time of linkage. We used generalized estimating equations to identify correlates of LTC within 14 or 30 days after release. We also described RIC over three years following an initial release, comparing recidivists to non-recidivists. Results Among 3,302 incarceration periods from 1,350 unique PLH, 21% and 34% had LTC within 14 and 30 days, respectively, of which >25% had detectable viremia at time of linkage. Independent correlates of LTC at 14 days included incarceration periods >30 days (adjusted odds ratio [AOR] = 1.6; P < 0.001), higher medical comorbidity (AOR = 1.8; P < 0.001), antiretrovirals prescribed before release (AOR = 1.5; P = 0.001), transitional case management (AOR = 1.5; P < 0.001), re-incarceration (AOR = 0.7; P = 0.002) and conditional release (AOR = 0.6; P < 0.001). The 30-day model additionally included psychiatric comorbidity (AOR = 1.3; P = 0.016) and release on bond (AOR = 0.7; P = 0.033). Among 1,094 PLH eligible for 3-year follow-up, RIC after release declined over 1 year (67%), 2 years (51%) and 3 years (42%). Recidivists were more likely than nonrecidivists to have RIC but, among those retained, were less likely to be virally suppressed (Figure 1). Conclusion For incarcerated PLH, both LTC and RIC as well as viral suppression are suboptimal after release. PLH who receive case management are more likely to have timely LTC. Targeted interventions and integrated programming aligning health and criminal justice goals may improve post-release HIV treatment outcomes. Disclosures All authors: No reported disclosures.

scholarly journals Clinical and immunological characteristic of natural course at the early stages of HIV infection

2020 ◽  
Vol 22 (3) ◽  
pp. 519-526
Author(s):  
E. R. Manapova ◽  
V. Kh. Fazylov ◽  
A. T. Beshimov
Keyword(s):  
Hiv Infection ◽  
Clinical Course ◽  
Fungal Infections ◽  
Early Stage ◽  
Elisa Test ◽  
Natural Course ◽  
Early Stages ◽  
Duration Of Infection ◽  
Stage Infection ◽  
Pronounced Inhibition

An early-stage infection induces the most powerful reactions of immune system. 137 clinical histories of patients with HIV infection, and HCV/HIV-infected at the early stages of HIV infection were subjected to analysis. Patients and methods: a group of 45 patients at early terms of HIV infection included 25 cases of HCV/HIV-infected patients (first group), and 20 cases with HIV mono-infection (second group). Duration of infection was less than 1 year (with positive ELISA test), with mean terms of HIV immunoblot positivity of 5.5±0.6 months. For comparative analysis, the natural course group was examined, i.e., 43 patients with combined HCV/HIV infection (third group), and 49, with HIV monoinfection (fourth group) with a duration of HIV infection for 4.4±0.21 years. The group of healthy controls included 52 persons. We aimed to perform a comparative evaluation of clinical course and immunological features from the early stages of infection in the patients with combined HCV/HIV and HIV infection. Results: at early stages of infection, clinical pattern in HCV/HIV-infected patients was dominated by purulent-inflammatory, fungal infections and secondary diseases, along with more pronounced inhibition of cellular immunity and increased viral load of RNA HIV, as compared to data on HIV-infected patients.

scholarly journals Use of HIV Case Surveillance System to Design and Evaluate Site-Randomized Interventions in an HIV Prevention Study: HPTN 065

2012 ◽  
Vol 6 (1) ◽  
pp. 122-130 ◽  
Author(s):  
Deborah J Donnell ◽  
H Irene Hall ◽  
Theresa Gamble ◽  
Geetha Beauchamp ◽  
Angelique B Griffin ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Surveillance System ◽  
Viral Suppression ◽  
Laboratory Data ◽  
Linkage To Care ◽  
Baseline Data ◽  
Surveillance Data ◽  
Hiv Care ◽  
Hiv Surveillance ◽  
Hiv Test

Introduction:Modeling studies suggest intensified HIV testing, linkage-to-care and antiretroviral treatment to achieve viral suppression may reduce HIV transmission and lead to control of the epidemic. To study implementation of strategy, population-level data are needed to monitor outcomes of these interventions. US HIV surveillance systems are a potential source of these data.Methods:HPTN065 (TLC-Plus) Study is evaluating the feasibility of a test, linkage-to-care, and treat strategy for HIV prevention in two intervention communities - the Bronx, NY, and Washington, DC. Routinely collected laboratory data on diagnosed HIV cases in the national HIV surveillance system were used to select and randomize sites, and will be used to assess trial outcomes.Results:To inform study randomization, baseline data on site-aggregated study outcomes was provided from HIV surveillance data by New York City and Washington D.C. Departments of Health. The median site rate of linkage-to-care for newly diagnosed cases was 69% (IQR 50%-86%) in the Bronx and 54% (IQR 33%-71%) in Washington, D.C. In participating HIV care sites, the median site percent of patients with viral suppression (<400 copies/mL) was 57% (IQR 53%-61%) in the Bronx and 64% (IQR 55%-72%) in Washington, D.C.Conclusions:In a novel use of site-aggregated surveillance data, baseline data was used to design and evaluate site randomized studies for both HIV test and HIV care sites. Surveillance data have the potential to inform and monitor sitelevel health outcomes in HIV-infected patients.

scholarly journals Implementing Rapid Initiation of Antiretroviral Therapy for Acute HIV Infection Within a Routine Testing and Linkage to Care Program in Chicago

2020 ◽  
Vol 19 ◽  
pp. 232595822093975
Author(s):  
Moira McNulty ◽  
Jessica Schmitt ◽  
Eleanor Friedman ◽  
Bijou Hunt ◽  
Audra Tobin ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Hiv Testing ◽  
Viral Suppression ◽  
Linkage To Care ◽  
Care Program ◽  
Acute Hiv Infection ◽  
Screening Programs ◽  
Acute Hiv ◽  
Therapy Clients

Growing evidence suggests that rapid initiation of antiretroviral therapy for HIV improves care continuum outcomes. We evaluated process and clinical outcomes for rapid initiation in acute HIV infection within a multisite health care–based HIV testing and linkage to care program in Chicago. Through retrospective analysis of HIV testing data (2016-2017), we assessed linkage to care, initiation of antiretroviral therapy, and viral suppression. Of 334 new HIV diagnoses, 33 (9.9%) individuals had acute HIV infection. Median time to linkage was 11 (interquartile range [IQR]: 5-19.5) days, with 15 days (IQR 5-27) to initiation of antiretroviral therapy. Clients achieved viral suppression at a median of 131 (IQR: 54-188) days. Of all, 69.7% were retained in care, all of whom were virally suppressed. Sites required few additional resources to incorporate rapid initiation into existing processes. Integration of rapid initiation of antiretroviral therapy into existing HIV screening programs is a promising strategy for scaling up this important intervention.

scholarly journals Immediate Antiretroviral Therapy: The Need for a Health Equity Approach

2020 ◽  
Vol 17 (19) ◽  
pp. 7345
Author(s):  
Ofole Mgbako ◽  
Magdalena E. Sobieszczyk ◽  
Susan Olender ◽  
Peter Gordon ◽  
Jason Zucker ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Health Equity ◽  
Viral Suppression ◽  
Clinical Care ◽  
Linkage To Care ◽  
Retention In Care ◽  
Hiv Care ◽  
Medical Mistrust ◽  
Structural Racism ◽  
The Us

Immediate antiretroviral therapy (iART), defined as same-day initiation of ART or as soon as possible after diagnosis, has recently been recommended by global and national clinical care guidelines for patients newly diagnosed with human immunodeficiency virus (HIV). Based on San Francisco’s Rapid ART Program Initiative for HIV Diagnoses (RAPID) model, most iART programs in the US condense ART initiation, insurance acquisition, housing assessment, and mental health and substance use evaluation into an initial visit. However, the RAPID model does not explicitly address structural racism and homophobia, HIV-related stigma, medical mistrust, and other important factors at the time of diagnosis experienced more poignantly by African American, Latinx, men who have sex with men (MSM), and transgender patient populations. These factors negatively impact initial and subsequent HIV care engagement and exacerbate significant health disparities along the HIV care continuum. While iART has improved time to viral suppression and linkage to care rates, its association with retention in care and viral suppression, particularly in vulnerable populations, remains controversial. Considering that in the US the HIV epidemic is sharply defined by healthcare disparities, we argue that incorporating an explicit health equity approach into the RAPID model is vital to ensure those who disproportionately bear the burden of HIV are not left behind.

scholarly journals 1652. Equivalent HIV Outcomes for Persons with HIV after Re-engagement in HIV Care with Prior or New Provider

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S604-S604
Author(s):  
Chi-Chi N Udeagu ◽  
Sharmila Shah ◽  
Sarah Braunstein
Keyword(s):  
New York ◽  
Viral Suppression ◽  
Retention In Care ◽  
Health Department ◽  
Hiv Care ◽  
Heterosexual Transmission ◽  
Hiv Surveillance ◽  
History Of ◽  
Male Sex ◽  
Engagement In Hiv Care

Abstract Background New York City (NYC) health department staff assist people with HIV (PWH) deemed out of care (OOC) per NYC HIV Surveillance Registry to re-engage in HIV care with their last known treating provider/parent clinic or, if preferable/necessary (e.g., moved to a new neighborhood), a new NYC provider. We examined retention in care and viral suppression (VS) of PWH re-engaged in care in a group who agreed to return to care and were cared for by either their previous or a new provider. Methods We analyzed data from 2009 to 2015 on PWH who had ≥2 CD4 count or viral load (VL) test reports in the NYC HIV Registry who fell out of care and then re-engaged in care. We compared characteristics, timeliness and retention in care (≥2 CD4 or VL, ≥90 days apart) and VS (last VL ≤200 copies/mL) of PWH overall and also according to whether they returned to their last known vs. a new provider in year 2 post re-engagement in care. Results From 2009–2015, 882 persons were re-engaged in care by the health department. Most were diagnosed 5–10 (27%) or >10 (67%) years prior, and were OOC for 1–3 years (70%) or >3 years (20%). Most re-engaged PWH were male (63%), black (56%) or Hispanic (34%), US-born (79%), aged 30–49 (48%) or ≥50 (40%) years. Risk factors for HIV included heterosexual transmission (39%), male-sex-with-male (26%) or injection drug use (18%). Twenty-two percent had history of homelessness and 5% incarceration. Fifty-one percent and 49% re-engaged in care with their prior or a new provider, respectively. PWH re-engaged with prior providers vs. new providers had lower rates of prior or current homelessness (17% vs. 28%, P = 0.0001), PWH re-engaged to prior vs. new providers had their first lab reports and achieved VS earlier (1 vs. 2 months, and 4 vs. 5 months, respectively (both P < 0.05). Proportions of PWH re-engaged to prior or new providers and retained in care (92% vs. 91%, respectively) or with VS (73% vs. 75%, respectively) in year 2 did not differ. Conclusion Our results show that health department efforts to re-engage previously OOC-PWH in HIV care resulted in more than 70% achieving VS. Assignment to a new provider resulted in earlier VS but did not affect 2-year VS or care retention. PWH who re-engage in care can safely be given the choice between known or new providers. Disclosures All authors: No reported disclosures.

Sign in / Sign up

Export Citation Format

Share Document