Linkage, Access, ART Use & Viral Suppression in Four Large Cities in the US, 2009

Linkage, Access, ART Use and Viral Suppression in Four Large Cities in the United States, 2009 N. Benbow1, S. Scheer2, A. Wohl3, K. Brady4, A. Gagner1, A. Hughes2, J. Tejero3, M. Eberhart4, V. Hu3, S. Townsell11Chicago Department of Public Health, STI/HIV Division - Surveillance, Epidemiology and Research Section, Chicago, United States, 2San Francisco Department of Public Health, San Francisco, United States, 3Los Angeles County Department of Public Health, Los Angeles, United States, 4Philadelphia Department of Public Health, Philadelphia, United StatesBACKGROUNDSuccessful HIV treatment involves timely linkage to medical care, ongoing engagement in care, and adherence to effective HIV treatment regimens.Large urban areas may have significant variation in the level of successful engagement of people living with HIV/AIDS (PLWHA) in care and treatment.Identification of these differences can help reduce HIV disease transmission, morbidity and mortality.METHODS Chicago (CHI), Los Angeles County (LAC), Philadelphia (PHI) and San Francisco (SF) HIV case surveillance data for adults (>= 18 years old) diagnosed with HIV through 2008 and living with HIV through 2009 were used as the basis for the analysis of the HIV continuum of care. The estimate of HIV-infected adults was adjusted to reflect an additional 20% of people who were unaware of their status. HIV case surveillance data for those linked to care (defined as ≥1 CD4 or VL test within 3 months of diagnosis) and those who accessed care (defined as a CD4/VL tests in 2009) were applied to the estimated number of HIV-infected individuals to calculate the percentage of people living with HIV who were linked to and accessed care. City estimates using the 2009 weighted Medical Monitoring Project (MMP) data were applied to the estimated number of HIV-infected individuals to calculate the percentage who were on antiretroviral therapy (ART) and among those on ART, the percentage who were virally suppressed (most recent VL≤200 copies/ml). MMP data were used to further examine the characteristics of those in care on ART and virally suppressed. Chi-square tests and logistic regression were used to determine differences across and within cities.RESULTSThe percentage of HIV-infected persons linked to and engaged in care, on ART and virally Table 1. Significant demographic and sexual risksuppressed was significantly different across the four cities (p< .001; Figure1). Among HIV- behavior differences in the percentage of people ininfected adults, 68% in SF were linked to care, compared to 62% in Los Angeles, 58% in care who are on ART and virally suppressed, MMPPhiladelphia and 54% in Chicago. The percentage who accessed care was higher in San 2009Francisco (57%) and LA (54%) than Philadelphia (39%) and Chicago (30%). Among HIV-infected adults, 51% in SF were on ART, compared to 48% in Los Angeles, 34% in Philadelphia OR* (95% CI)and 26% in Chicago. In addition, viral suppression was achieved among 44% of individuals inSF which was higher than LAC (40%), Philadelphia (23%) and Chicago (21%). Using MMP Across citiesdata across cities, a higher percentage of Whites than Blacks who accessed care were on ARTand were virally suppressed (range: 91%-94% vs. 81%-85%) and (86%-100% vs. 74%-80%) On ARTrespectively. Significant demographic and risk differences were found in the percentage of Black vs. White 0.50 (0.27-0.94)people in care on ART and virally suppressed within most cities and for all cities combined(Table 1). Viral SuppressionFigure 1. Percentage of estimated number of HIV-infected persons* in stages of continuum Black vs. White 0.51 (0.27-0.98) of HIV care in four large United States cities through December 2009 Female vs. Male 0.38 (0.22-0.64) 100% Chicago (23,799) MSW vs. MSM 0.44 (0.23-0.85) 90% Los Angeles County (47,658) Within cities 80% Philadelphia (19,691) On ART Percent of total HIV-infected 70% 68% San Francisco (17,665) CHI: Female vs. Male 0.27 (0.13-0.58) 62% 60% 58% 57% CHI: WSM vs. MSM 0.28 (0.12-0.64) 54% 54% 51% PHI: Female vs. Male 0.36 (0.16-0.78) 50% 48% 44% 39% 40% PHI: WSM vs. MSM 0.29 (0.10-0.82) 40% 34% LAC: Black vs. White 0.31 (0.098-0.996) 30% 30% 26% 23% LAC: 18-29 vs. 50+ 0.18 (0.04-0.74) 21% 20% Viral Suppression 10% PHI: Female vs. Male 0.43 (0.20-0.91) 0% PHI: WSM vs. MSM 0.31 (0.14-0.68) Linked to Care Accessed Care On ART Suppressed viral load PHI: Black vs. White 0.34 (0.12-0.92)*Includes people diagnosed with HIV through 2008 and living with HIV through 2009 and an estimated additional 20% who are unaware of their infection. PHI: Hispanic vs. White 0.3 (0.10-0.92) Differences within cities PHI: 18-29 vs. 50+ 0.31 (0.10-0.98) •Among people in care, the percentage of those on ART was significantly (p<.05) higher LAC: Female vs. Male 0.46 (0.22-0.96) for males than females and higher for men who have sex with men (MSM) than for women who have sex with men (WSM) both in Chicago and Philadelphia. In LAC the percentage LAC: WSM vs. MSM 0.35 (0.15-0.83) of those on ART was significantly higher for Whites than Blacks, and for people over the *Adjusted odds ratio for analyses across cities. age of 50 as compared to those between the ages of 18-29. •The percentage virally suppressed among those on ART was significantly higher (p<.05) Differences across cities for males and MSM than for females and WSM respectively, both in LAC and •Whites were significantly more likely to be on ART Philadelphia. Additional significant differences were seen in Philadelphia in which Whites compared to Blacks (p<.05) and persons >50 years of age were more likely to be virally suppressed as compared to •Whites, males and MSM were significantly more Blacks and Hispanics and people between the ages of 18-29, respectively. likely to be virally suppressed compared to blacks, •There were no significant demographic and sexual behavior differences in the females and WSM (p<.05). percentage of people in care on ART and percentage virally suppressed in SF.CONCLUSIONSData from these cities highlight discrepancies in progress towards universal HIV care and help identify cities where interventions may be successfullypromoting access to care and treatment. However, these differences could be due in part to underlying differences in the demographic characteristics ofPLWHA in the four cities as well as differences in laboratory reporting laws and maturity of laboratory reporting systems. Targeted programs and fundingare needed to eliminate racial/ethnic disparities in the provision of ART and viral suppression. We would like to thank CDC MMP staff Chris Johnson and Christine Mattson, MMP project area staff, the Community and Provider Advisory Boards members, and providers and patients for their assistance and participation. For additional information please contact Nanette Benbow, MAS at nanette.benbow@cityofchicago.org.

Linkage, Access, ART Use & Viral Suppression in Four Large Cities in the US, 2009

by Chicago Department of Public Health on Jul 23, 2012

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Linkage, Access, ART Use & Viral Suppression in Four Large Cities in the US, 2009 Document Transcript