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Byrne M, Monroe AK, Doshi RK, Horberg MA, Castel AD. A Latent Class Analysis of Substance Use and Longitudinal HIV RNA Patterns Among PWH in DC Cohort. AIDS Behav 2024; 28:682-694. [PMID: 38319460 PMCID: PMC10952057 DOI: 10.1007/s10461-023-04257-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 02/07/2024]
Abstract
People with HIV (PWH) with substance use disorders (SUD) have worse health outcomes than PWH without SUD. Our objective was to characterize substance use patterns and their impact on longitudinal HIV RNA trajectories among those enrolled in an observational study of PWH in care in Washington, DC. Substance use by type (alcohol, cannabis, opioid, stimulant, hallucinogen, inhalant, sedative) was used to identify shared patterns of substance use using Latent Class Analysis (LCA). A multinomial logistic regression model evaluated the association between the resulting substance use classes and the membership probability in longitudinal HIV RNA trajectory groups. There were 30.1% of participants with at least one substance reported. LCA resulted in a three-class model: (1) Low-Level Substance Use, (2) Opioid Use, and (3) Polysubstance. The Opioid and Polysubstance Use classes were more likely to have a mental health diagnosis (45.4% and 53.5%; p < 0.0001). Members in the Opioid Use class were older (median age of 54.9 years (IQR 50.3-59.2) than both the Polysubstance and Low-Level Substance Use Classes (p < 0.0001). There were 3 HIV RNA trajectory groups: (1) Undetectable, (2) Suppressed, and (3) Unsuppressed HIV RNA over 18 months of follow-up. The probability of being in the unsuppressed HIV RNA group trajectory when a member of the Opioid Use or Polysubstance Use classes was 2.5 times and 1.5 times greater than the Low-Level Substance Use class, respectively. The Opioid Use and Polysubstance Use classes, with higher-risk drug use, should be approached with more targeted HIV-related care to improve outcomes.
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Affiliation(s)
- Morgan Byrne
- George Washington University, Washington, DC, USA.
| | | | | | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD, USA
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Castel AD, Barth S, Wilbourn BC, Horberg M, Monroe AK, Greenberg AE. Trends in COVID-19 Vaccine Hesitancy and Uptake Among Persons Living With HIV in Washington, DC. J Acquir Immune Defic Syndr 2023; 94:124-134. [PMID: 37368934 PMCID: PMC10529778 DOI: 10.1097/qai.0000000000003243] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE The COVID-19 pandemic has disproportionately affected older people, people with underlying health conditions, racial and ethnic minorities, socioeconomically disadvantaged, and people living with HIV (PWH). We sought to describe vaccine hesitancy and associated factors, reasons for vaccine hesitancy, and vaccine uptake over time in PWH in Washington, DC. METHODS We conducted a cross-sectional survey between October 2020 and December 2021 among PWH enrolled in a prospective longitudinal cohort in DC. Survey data were linked to electronic health record data and descriptively analyzed. Multivariable logistic regression was performed to identify factors associated with vaccine hesitancy. The most common reasons for vaccine hesitancy and uptake were assessed. RESULTS Among 1029 participants (66% men, 74% Black, median age 54 years), 13% were vaccine hesitant and 9% refused. Women were 2.6-3.5 times, non-Hispanic Blacks were 2.2 times, Hispanics and those of other race/ethnicities were 3.5-8.8 times, and younger PWH were significantly more likely to express hesitancy or refusal than men, non-Hispanic Whites, and older PWH, respectively. The most reported reasons for vaccine hesitancy were side effect concerns (76%), plans to use other precautions/masks (73%), and speed of vaccine development (70%). Vaccine hesitancy and refusal declined over time (33% in October 2020 vs. 4% in December 2021, P < 0.0001). CONCLUSIONS This study is one of the largest analyses of vaccine hesitancy among PWH in a US urban area highly affected by HIV and COVID-19. Multilevel culturally appropriate approaches are needed to effectively address COVID-19 vaccine concerns raised among PWH.
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Affiliation(s)
- Amanda D Castel
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
| | - Shannon Barth
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
| | - Brittany C Wilbourn
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
| | | | - Anne K Monroe
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
| | - Alan E Greenberg
- Department of Epidemiology, The George Washington University School of Public Health, Washington, DC; and
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Caldwell S, Flickinger T, Hodges J, Waldman ALD, Garofalini C, Cohn W, Dillingham R, Castel A, Ingersoll K. An mHealth Platform for People With HIV Receiving Care in Washington, District of Columbia: Qualitative Analysis of Stakeholder Feedback. JMIR Form Res 2023; 7:e48739. [PMID: 37725419 PMCID: PMC10548330 DOI: 10.2196/48739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND HIV viral suppression and retention in care continue to be challenging goals for people with HIV in Washington, District of Columbia (DC). The PositiveLinks mobile app is associated with increased retention in care and viral load suppression in nonurban settings. The app includes features such as daily medication reminders, mood and stress check-ins, an anonymized community board for peer-to-peer social support, secure messaging to care teams, and resources for general and clinic-specific information, among other features. PositiveLinks has not been tailored or tested for this distinct urban population of people with HIV. OBJECTIVE This study aimed to inform the tailoring of a mobile health app to the needs of people with HIV and their providers in Washington, DC. METHODS We conducted a 3-part formative study to guide the tailoring of PositiveLinks for patients in the DC Cohort, a longitudinal cohort of >12,000 people with HIV receiving care in Washington, DC. The study included in-depth interviews with providers (n=28) at study clinics, focus groups with people with HIV enrolled in the DC Cohort (n=32), and a focus group with members of the DC Regional Planning Commission on Health and HIV (COHAH; n=35). Qualitative analysis used a constant comparison iterative approach; thematic saturation and intercoder agreement were achieved. Emerging themes were identified and grouped to inform an adaptation of PositiveLinks tailored for patients and providers. RESULTS Emerging themes for patients, clinic providers, and COHAH providers included population needs and concerns, facilitators and barriers to engagement in care and viral suppression, technology use, anticipated benefits, questions and concerns, and suggestions. DC Cohort clinic and COHAH provider interviews generated an additional theme: clinic processes. For patients, the most commonly discussed potential benefits included improved health knowledge and literacy (mentioned n=10 times), self-monitoring (n=7 times), and connection to peers (n=6 times). For providers, the most common anticipated benefits were improved communication with the clinic team (n=21), connection to peers (n=14), and facilitation of self-monitoring (n=11). Following data review, site principal investigators selected core PositiveLinks features, including daily medication adherence, mood and stress check-ins, resources, frequently asked questions, and the community board. Principal investigators wanted English and Spanish versions depending on the site. Two additional app features (messaging and documents) were selected as optional for each clinic site. Overall, 3 features were not deployed as not all participating clinics supported them. CONCLUSIONS Patient and provider perspectives of PositiveLinks had some overlap, but some themes were unique to each group. Beta testing of the tailored app was conducted (August 2022). This formative work prepared the team for a cluster randomized controlled trial of PositiveLinks' efficacy. Randomization of clinics to PositiveLinks or usual care occurred in August 2022, and the randomized controlled trial launched in November 2022. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/37748.
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Affiliation(s)
- Sylvia Caldwell
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Science, University of Virginia, Charlottesville, VA, United States
| | - Tabor Flickinger
- Division of General Medicine, Geriatrics and Palliative Care, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Jacqueline Hodges
- Division of Infectious Disease and International Health, University of Virginia, Charlottesville, VA, United States
| | - Ava Lena D Waldman
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Science, University of Virginia, Charlottesville, VA, United States
| | - Chloe Garofalini
- Milken Institute School of Public Health, George Washington University, Washingon, DC, United States
| | - Wendy Cohn
- Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Rebecca Dillingham
- Division of Infectious Disease and International Health, University of Virginia, Charlottesville, VA, United States
| | - Amanda Castel
- Milken Institute School of Public Health, George Washington University, Washingon, DC, United States
| | - Karen Ingersoll
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Science, University of Virginia, Charlottesville, VA, United States
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Akselrod H, Byrne M, Lundberg J, Czeresnia JM, Lucar J, Secco A, Levy M, Monroe A, Castel A, Horberg M, Doshi R, Rivasplata H, Squires L, Parenti D, Benator D. Improvements in Virologic Control Among PWH Over Time: Narrowing the Gap Between Those With and Without STIs. AIDS Behav 2023; 27:673-677. [PMID: 35984609 PMCID: PMC10176187 DOI: 10.1007/s10461-022-03802-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 11/28/2022]
Abstract
Using the incidence of bacterial sexually transmitted infection (STI) as a surrogate for condomless sexual behavior, we assessed the association between STI and uncontrolled HIV replication among in-care persons with HIV (PWH) enrolled in a longitudinal HIV cohort study in the District of Columbia (the DC Cohort). Although STI occurrence initially correlated with higher HIV viral load (VL), this difference became more attenuated over time (2012-2016). This was true overall and among those with the greatest number of STIs [age 18-34, men who have sex with men (MSM)]. This likely reflects gains in population-wide virologic control through improved antiretroviral therapy and access to care, which helps mitigate the risk of HIV transmission.
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Affiliation(s)
- Hana Akselrod
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Morgan Byrne
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA.
| | - Jeannette Lundberg
- Infectious Diseases Section, DC Veterans Administration Medical Center, Washington, DC, USA
| | - Jonathan Mamber Czeresnia
- Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Jose Lucar
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Alessandra Secco
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Matt Levy
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA
- Westat, Rockville, MD, USA
| | - Anne Monroe
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Amanda Castel
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Michael Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD, USA
| | - Rupali Doshi
- DC Department of Health, HIV/AIDS, Hepatitis, STD, and TB Administration, Washington, DC, USA
| | - Heather Rivasplata
- Infectious Diseases Section, DC Veterans Administration Medical Center, Washington, DC, USA
| | - Leah Squires
- Department of Psychology, DC Veterans Affairs Medical Center, Washington, DC, USA
| | - David Parenti
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Debra Benator
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Infectious Diseases Section, DC Veterans Administration Medical Center, Washington, DC, USA
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Jaurretche M, Byrne M, Happ LP, Levy M, Horberg M, Greenberg A, Castel AD, Monroe AK. HIV care continuum outcomes among recently diagnosed people with HIV (PWH) in Washington, DC. Epidemiol Infect 2023; 151:e45. [PMID: 36715051 PMCID: PMC10052391 DOI: 10.1017/s0950268823000043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The Ending the HIV Epidemic initiative aims to decrease new HIV infections and promote test-and-treat strategies. Our aims were to establish a baseline of HIV outcomes among newly diagnosed PWH in Washington, DC (DC), a 'hotspot' for the HIV epidemic. We also examined sociodemographic and clinical factors associated with retention in care (RIC), antiretroviral therapy (ART) initiation and viral suppression (VS) among newly diagnosed PWH in the DC Cohort from 2011-2016. Among 455 newly diagnosed participants, 92% were RIC at 12 months, ART was initiated in 65% at 3 months and 91% at 12 months, VS in at least 17% at 3 months and 82% at 12 months and 55% of those with VS at 12 months had sustained VS for an additional 12 months. AIDS diagnosis was associated with RIC (aOR 2.99; 1.13-2.28), ART initiation by 3 months (aOR 2.58; 1.61-4.12) and VS by 12 months (aOR4.87; 1.69-14.03). This analysis contributes to our understanding of the HIV treatment dynamics of persons with recently diagnosed HIV infection in a city with a severe HIV epidemic.
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Affiliation(s)
- Maria Jaurretche
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Morgan Byrne
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Lindsey Powers Happ
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | | | - Michael Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
| | - Alan Greenberg
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Amanda D Castel
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Anne K Monroe
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA
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Monroe AK, Xiao J, Greenberg AE, Levy ME, Temprosa M, Resnik JB, Castel AD. Risk of Severe COVID-19 Disease and the Pandemic's Impact on Service Utilization Among a Longitudinal Cohort of Persons with HIV-Washington, DC. AIDS Behav 2022; 26:3289-3299. [PMID: 35416594 PMCID: PMC9005919 DOI: 10.1007/s10461-022-03662-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/28/2022]
Abstract
People with HIV (PWH) have a high burden of medical comorbidities, potentially putting them at increased risk for severe COVID-19. Additionally, during the COVID-19 pandemic, HIV care delivery has been restructured and the impact on HIV outcomes is unknown. The objectives of this study were first, to examine the risk of severe COVID-19 among PWH, using a definition incorporating clinical risk factors, and second, to examine the pandemic's impact on HIV care. We used data from the DC Cohort, a large cohort of people receiving HIV care in Washington, DC. We found that a high proportion of participants across all age groups qualified as increased (58%) or high risk (34%) for severe COVID-19. Between 2019 and 2020, encounters increased (17.7%, increasing to 23.5% of active DC Cohort participants had an encounter) while laboratory utilization decreased (14.4%, decreasing to 11.4% of active DC Cohort participants had an HIV RNA test performed). Implications of our work include the importance of protecting vulnerable people with HIV from acquiring COVID-19 and potentially manifesting severe complications through strategies including vaccination. Additionally, acknowledging that HIV service delivery will likely be changed long-term by the pandemic, adaptation is required to ensure continued progress towards 90-90-90 goals.
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Affiliation(s)
- Anne K Monroe
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, NW, Washington, DC, 20052, USA.
| | - Jiayang Xiao
- Department of Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Alan E Greenberg
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, NW, Washington, DC, 20052, USA
| | - Matt E Levy
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, NW, Washington, DC, 20052, USA
- Department of Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
- Westat, Rockville, MD, USA
| | - Marinella Temprosa
- Department of Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Jenna B Resnik
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, NW, Washington, DC, 20052, USA
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, NW, Washington, DC, 20052, USA
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Hodges J, Caldwell S, Cohn W, Flickinger T, Waldman AL, Dillingham R, Castel A, Ingersoll K. Evaluation of the implementation and effectiveness of a mobile health intervention to improve outcomes for people with HIV in the DC Cohort: a study protocol for a cluster randomized controlled trial. JMIR Res Protoc 2022; 11:e37748. [PMID: 35349466 PMCID: PMC9077495 DOI: 10.2196/37748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 12/01/2022] Open
Abstract
Background Gaps remain in achieving retention in care and durable HIV viral load suppression for people with HIV in Washington, DC (hereafter DC). Although people with HIV seeking care in DC have access to a range of supportive services, innovative strategies are needed to enhance patient engagement in this setting. Mobile health (mHealth) interventions have shown promise in reaching previously underengaged groups and improving HIV-related outcomes in various settings. Objective This study will evaluate the implementation and effectiveness of a clinic-deployed, multifeature mHealth intervention called PositiveLinks (PL) among people with HIV enrolled in the DC Cohort, a longitudinal cohort of people with HIV receiving care in DC. A cluster randomized controlled trial will be conducted using a hybrid effectiveness-implementation design and will compare HIV-related outcomes between clinics randomized to PL versus usual care. Methods The study aims are threefold: (1) We will perform a formative evaluation of PL in the context of DC Cohort clinics to test the feasibility, acceptability, and usability of PL and tailor the platform for use in this context. (2) We will conduct a cluster randomized controlled trial with 12 DC Cohort clinics randomized to PL or usual care (n=6 [50%] per arm) and measure the effectiveness of PL by the primary outcomes of patient visit constancy, retention in care, and HIV viral load suppression. We aim to enroll a total of 482 participants from DC Cohort clinic sites, specifically including people with HIV who show evidence of inconsistent retention in care or lack of viral suppression. (3) We will use the Consolidated Framework for Implementation Research (CFIR) and the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework to measure implementation success and identify site, patient, provider, and system factors associated with successful implementation. Evaluation activities will occur pre-, mid-, and postimplementation. Results Formative data collection was completed between April 2021 and January 2022. Preliminary mHealth platform modifications have been performed, and the first round of user testing has been completed. A preimplementation evaluation was performed to identify relevant implementation outcomes and design a suite of instruments to guide data collection for evaluation of PL implementation throughout the trial period. Instruments include those already developed to support DC Cohort Study activities and PL implementation in other cohorts, which required modification for use in the study, as well as novel instruments designed to complete data collection, as guided by the CFIR and RE-AIM frameworks. Conclusions Formative and preimplementation evaluations will be completed in spring 2022 when the trial is planned to launch. Specifically, comprehensive formative data analysis will be completed following data collection, coding, preliminary review, and synthesis. Corresponding platform modifications are ready for beta testing within the DC Cohort. Finalization of the platform for use in the trial will follow beta testing. Trial Registration ClinicalTrials.gov NCT04998019; https://clinicaltrials.gov/ct2/show/NCT04998019 International Registered Report Identifier (IRRID) PRR1-10.2196/37748
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Affiliation(s)
- Jacqueline Hodges
- Division of Infectious Diseases and International Health, University of Virginia, 1215 Lee St, Charlottesville, US
| | - Sylvia Caldwell
- Division of Infectious Diseases and International Health, University of Virginia, 1215 Lee St, Charlottesville, US
| | - Wendy Cohn
- Public Health Sciences, University of Virginia, Charlottesville, US
| | - Tabor Flickinger
- Department of Medicine, University of Virginia, Charlottesville, US
| | - Ava Lena Waldman
- Division of Infectious Diseases and International Health, University of Virginia, 1215 Lee St, Charlottesville, US
| | - Rebecca Dillingham
- Division of Infectious Diseases and International Health, University of Virginia, 1215 Lee St, Charlottesville, US
| | - Amanda Castel
- Milken Institute School of Public Health, George Washington University, Washington, US
| | - Karen Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, US
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8
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Byrne M, Akselrod H, Monroe AK, Horberg M, Lucar J, Castel AD, Denyer R, Doshi R, Secco A, Squires L, Schroeter S, Benator D. Identifying geographic areas of Washington DC with increased potential for sexual HIV transmission among People with HIV with STIs and concurrent elevated HIV RNA: Data from the DC Cohort. Open Forum Infect Dis 2022; 9:ofac139. [PMID: 35450084 PMCID: PMC9017371 DOI: 10.1093/ofid/ofac139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/17/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The U=U (Undetectable=Untransmittable) campaign advances the goal of ending the HIV epidemic by promoting durable viral suppression and therefore reducing sexual transmission. We used geospatial analysis to assess the potential for sexual HIV transmission by ZIP code of residence in the District of Columbia (DC) using data from DC Cohort Longitudinal HIV Study (DC Cohort), a city-wide cohort of persons with HIV (PWH).
Methods
DC Cohort participants ages ≥13 were included in the study period between April 1, 2016 and March 31, 2018. Potential for sexual HIV transmission was defined as the proportion of participants with incident sexually transmitted infection (STI - gonorrhea, chlamydia, syphilis) and with HIV RNA ≥200 copies/mL from 9 months prior to 3 months after STI diagnosis. We performed geographic information system (GIS) analysis to determine the ZIP codes with the highest potential for sexual HIV transmission.
Results
Of 3,467 participants, 367 (10.6%) had at least one incident STI, with 89.4% residing in 11 of the 20 residential ZIP codes in DC. Of the 367 participants with an incident STI, at least one HIV RNA was available for 348 (94.8%). 97 (27.9%) of individuals with an incident STI had HIV RNA ≥200 copies/ml in the defined time window. Of these 97, 66 (68.0%) resided in 5 of the 20 DC ZIP codes.
Conclusions
In DC, 5 ZIP codes of residence accounted for the majority of the estimated potential for HIV transmission among participants in the DC Cohort. These results support focused neighborhood-level interventions to help end the HIV epidemic.
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Affiliation(s)
- Morgan Byrne
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Hana Akselrod
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Anne K Monroe
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Michael Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD, USA
| | - Jose Lucar
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Amanda D Castel
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Rachel Denyer
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Infectious Diseases Section, DC Veterans Administration Medical Center, Washington, DC, USA
| | - Rupali Doshi
- DC Department of Health, HIV/AIDS, Hepatitis, STD, and TB Administration, Washington, DC ,USA
| | | | - Leah Squires
- Department of Psychology, DC Veterans Affairs Medical Center, Washington, DC, USA
| | - Stefanie Schroeter
- Infectious Diseases Section, DC Veterans Administration Medical Center, Washington, DC, USA
| | - Debra Benator
- Division of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Infectious Diseases Section, DC Veterans Administration Medical Center, Washington, DC, USA
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Monroe AK, Levy ME, Greenberg AE, Keruly JC, Moore RD, Horberg MA, Kulie P, Mohanraj BS, Kumar PN, Castel AD. Integrase Inhibitor Prescribing Disparities in the DC and Johns Hopkins HIV Cohorts. Open Forum Infect Dis 2021; 8:ofab338. [PMID: 34631925 PMCID: PMC8496514 DOI: 10.1093/ofid/ofab338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/29/2021] [Indexed: 11/20/2022] Open
Abstract
Integrase inhibitors (INSTIs) are recommended by expert panels as initial therapy
for people with HIV. Because there can be disparities in prescribing and uptake
of novel and/or recommended therapies, this analysis assessed potential INSTI
prescribing disparities using a combined data set from the Johns Hopkins HIV
Clinical Cohort and the DC Cohort. We performed multivariable logistic
regression to identify factors associated with ever being prescribed an INSTI.
Disparities were noted, including clinic location, age, and being transgender.
Identifying disparities may allow clinicians to focus their attention on these
individuals and ensure that therapy decisions are grounded in valid clinical
reasons.
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Affiliation(s)
- Anne K Monroe
- The George Washington University, Washington, DC, USA
| | | | | | - Jeanne C Keruly
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Richard D Moore
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Paige Kulie
- The George Washington University, Washington, DC, USA
| | | | - Princy N Kumar
- Georgetown University School of Medicine, Washington, DC, USA
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Wilbourn B, Saafir-Callaway B, Jair K, Wertheim JO, Laeyendeker O, Jordan JA, Kharfen M, Castel A. Characterization of HIV Risk Behaviors and Clusters Using HIV-Transmission Cluster Engine Among a Cohort of Persons Living with HIV in Washington, DC. AIDS Res Hum Retroviruses 2021; 37:706-715. [PMID: 34157853 PMCID: PMC8501467 DOI: 10.1089/aid.2021.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Molecular epidemiology (ME) is one tool used to end the HIV epidemic in the United States. We combined clinical and behavioral data with HIV sequence data to identify any overlap in clusters generated from different sequence datasets; to characterize HIV transmission clusters; and to identify correlates of clustering among people living with HIV (PLWH) in Washington, District of Columbia (DC). First, Sanger sequences from DC Cohort participants, a longitudinal HIV study, were combined with next-generation sequences (NGS) from participants in a ME substudy to identify clusters. Next, demographic and self-reported behavioral data from ME substudy participants were used to identify risks of secondary transmission. Finally, we combined NGS from ME substudy participants with Sanger sequences in the DC Molecular HIV Surveillance database to identify clusters. Cluster analyses used HIV-Transmission Cluster Engine to identify linked pairs of sequences (defined as distance ≤1.5%). Twenty-eight clusters of ≥3 sequences (size range: 3-12) representing 108 (3%) participants were identified. None of the five largest clusters (size range: 5-12) included newly diagnosed PLWH. Thirty-four percent of ME substudy participants (n = 213) reported condomless sex during their last sexual encounter and 14% reported a Syphilis diagnosis in the past year. Seven transmission clusters (size range: 2-19) were identified in the final analysis, each containing at least one ME substudy participant. Substudy participants in clusters from the third analysis were present in clusters from the first analysis. Combining HIV sequence, clinical and behavioral data provided insights into HIV transmission that may not be identified using traditional epidemiological methods alone. Specifically, the sexual risk behaviors and STI diagnoses reported in the substudy survey may not have been disclosed during Partner Services activities and the survey data complemented clinical data to fully characterize transmission clusters. These findings can be used to enhance local efforts to interrupt transmission and avert new infections.
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Affiliation(s)
- Brittany Wilbourn
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Brittani Saafir-Callaway
- HIV/AIDS, Hepatitis, STD and TB Administration, DC Health, Washington, District of Columbia, USA
| | - Kamwing Jair
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Joel O. Wertheim
- Department of Medicine, University of California San Diego, LA Jolla, California, USA
| | - Oliver Laeyendeker
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, USA
| | - Jeanne A. Jordan
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Michael Kharfen
- HIV/AIDS, Hepatitis, STD and TB Administration, DC Health, Washington, District of Columbia, USA
| | - Amanda Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
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Association of Substance Use Disorders with Engagement in Care and Mortality among a Clinical Cohort of People with HIV in Washington, DC. AIDS Behav 2021; 25:2289-2300. [PMID: 33521909 DOI: 10.1007/s10461-021-03157-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2021] [Indexed: 12/15/2022]
Abstract
Substance use disorders (SUDs) are common among people with HIV and can prevent achievement of optimal health outcomes. Using data from a longitudinal HIV cohort study in the District of Columbia (2011-2018), we calculated the prevalence and correlates of SUD (alcohol, stimulant, and/or opioid use disorders) and determined the association of SUD with engagement in HIV care, ART prescription, viral suppression, and mortality. Of 8420 adults, 3168 (37.6%) had a history of any SUD, most commonly history of alcohol use disorder (29.6%). SUDs disproportionately affected Black individuals (aOR 1.33) and heterosexuals (aOR 1.18), and women had a lower risk of SUD (aOR 0.65). SUD was not associated with engagement in care, ART prescription, or viral suppression. SUD was associated with mortality (aHR 1.31). Addressing alcohol use disorder and preventable causes of death among people with HIV and substance use disorders should be priorities for clinical care and public health.
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Shade SB, Kirby VB, Stephens S, Moran L, Charlebois ED, Xavier J, Cajina A, Steward WT, Myers JJ. Outcomes and costs of publicly funded patient navigation interventions to enhance HIV care continuum outcomes in the United States: A before-and-after study. PLoS Med 2021; 18:e1003418. [PMID: 33983925 PMCID: PMC8118317 DOI: 10.1371/journal.pmed.1003418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 03/29/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In the United States, patients with HIV face significant barriers to linkage to and retention in care which impede the necessary steps toward achieving the desired clinical outcome of viral suppression. Individual-level interventions, such as patient navigation, are evidence based, effective strategies for improving care engagement. In addition, use of surveillance and clinical data to identify patients who are not fully engaged in care may improve the effectiveness and cost-effectiveness of these programs. METHODS AND FINDINGS We employed a pre-post design to estimate the outcomes and costs, from the program perspective, of 5 state-level demonstration programs funded under the Health Resources and Services Administration's Special Projects of National Significance Program (HRSA/SPNS) Systems Linkages Initiative that employed existing surveillance and/or clinical data to identify individuals who had never entered HIV care, had fallen out of care, or were at risk of falling out of care and navigation strategies to engage patients in HIV care. Outcomes and costs were measured relative to standard of care during the first year of implementation of the interventions (2013 to 2014). We followed patients to estimate the number and proportion of additional patients linked, reengaged, retained, and virally suppressed by 12 months after enrollment in the interventions. We employed inverse probability weighting to adjust for differences in patient characteristics across programs, missing data, and loss to follow-up. We estimated the additional costs expended during the first year of each intervention and the cost per outcome of each intervention as the additional cost per HIV additional care continuum target achieved (cost per patient linked, reengaged, retained, and virally suppressed) 12 months after enrollment in each intervention. In this study, 3,443 patients were enrolled in Louisiana (LA), Massachusetts (MA), North Carolina (NC), Virginia (VA), and Wisconsin (WI) (147, 151, 2,491, 321, and 333, respectively). Patients were a mean of 40 years old, 75% male, and African American (69%) or Caucasian (22%). At baseline, 24% were newly diagnosed, 2% had never been in HIV care, 45% had fallen out of care, and 29% were at risk of falling out of care. All 5 interventions were associated with increases in the number and proportion of patients with viral suppression [percent increase: LA = 90.9%, 95% confidence interval (CI) = 88.4 to 93.4; MA = 78.1%, 95% CI = 72.4 to 83.8; NC = 47.5%, 95% CI = 45.2 to 49.8; VA = 54.6, 95% CI = 49.4 to 59.9; WI = 58.4, 95% CI = 53.4 to 63.4]. Overall, interventions cost an additional $4,415 (range = $3,746 to $5,619), $2,009 (range = $1,516 to $2,274), $920 (range = $627 to $941), $2,212 (range = $1,789 to $2,683), and $3,700 ($2,734 to $4,101), respectively per additional patient virally suppressed. The results of this study are limited in that we did not have contemporaneous controls for each intervention; thus, we are only able to assess patients against themselves at baseline and not against standard of care during the same time period. CONCLUSIONS Patient navigation programs were associated with improvements in engagement of patients in HIV care and viral suppression. Cost per outcome was minimized in states that utilized surveillance data to identify individuals who were out of care and/or those that were able to identify a larger number of patients in need of improvement at baseline. These results have the potential to inform the targeting and design of future navigation-type interventions.
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Affiliation(s)
- Starley B. Shade
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Institute for Global Health Sciences, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Valerie B. Kirby
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Sally Stephens
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Institute for Global Health Sciences, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Lissa Moran
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Edwin D. Charlebois
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Jessica Xavier
- Independent Consultant, Silver Spring, Maryland, United States of America
| | - Adan Cajina
- Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Wayne T. Steward
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Janet J. Myers
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
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13
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Individual-Level and Clinic-Level Factors Associated With Achieving Glycemic Control in a Large Cohort of People With HIV in Care-Washington, DC. J Acquir Immune Defic Syndr 2021; 85:113-122. [PMID: 32541383 DOI: 10.1097/qai.0000000000002416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Optimal management of noncommunicable diseases, including diabetes mellitus (DM), is crucially important as people with HIV (PWH) live longer with antiretroviral therapy. Our objective was to assess patient-level and clinic-level factors associated with achieving hemoglobin A1c (HbA1c) ≤7.0% among PWH and DM. SETTING The DC Cohort, an observational clinical cohort of PWH, followed from 2011 to 2019 at 12 sites in Washington, DC. METHODS Among PWH with diagnosed DM and elevated HbA1c (>7.0%), we examined the association between achieving HbA1c ≤7.0% and demographic and clinical factors, including time-updated medication data, and clinic-level factors related to services and structure. A multilevel marginal extended Cox regression model was generated to identify factors associated with time to HbA1c ≤7.0%. RESULTS Over half (52.3%) of 419 participants achieved HbA1c ≤7.0%. Individual-level factors associated with HbA1c ≤7.0% included a diagnosis of DM after enrollment and a longer time since HIV diagnosis [hazard ratio (HR) = 2.65 and 1.13, P < 0.05 for both]. Attending a clinic with an endocrinologist was associated with the outcome [adjusted HR (aHR) = 1.41 95% confidence interval (CI): (1.01 to 1.97)]. In addition, comparing clinics that treat everyone, refer everyone or have a mix of treating and referring, showed an association between attending a clinic that treats everyone [aHR = 1.52 95% CI: (1.21 to 1.90)] or a clinic that refers everyone [aHR = 2.24 95% CI: (1.63 to 3.07)] compared with clinics with a mix in achieving glycemic control. CONCLUSION Multiple factors are associated with achieving glycemic control in an urban cohort of PWH. Determining if specific services or structures improve DM outcomes may improve health outcomes for PWH and DM.
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14
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Jaurretche M, Levy M, Castel AD, Happ LP, Monroe AK, Wyche KF. Factors Influencing Successful Recruitment of Racial and Ethnic Minority Patients for an Observational HIV Cohort Study in Washington, DC. J Racial Ethn Health Disparities 2021; 9:767-778. [PMID: 33721291 DOI: 10.1007/s40615-021-01015-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 01/07/2023]
Abstract
The process of recruiting racial and ethnic minority persons living with HIV (PLWH) is important for research studies to ensure inclusivity of underrepresented groups. To understand factors associated with recruitment of minority PLWH, this study examined the recruitment process of PLWH for an observational study of their routine medical care at 14 clinics in Washington, DC. Research assistant (RA) recruiters were interviewed to assess their consenting processes and strategies. Data were collected on clinic services, patient demographics, and recruitment logs of patient approaches for obtaining informed consent resulting in agreement or refusal. A median of 96% of eligible patients was approached to obtain consent, yielding a median consent rate of 78% across all sites. A total of 8438 patients consented and 1326 refused study participation. Clinical sites with more comprehensive services had higher consent rates. black/African American and Hispanic/Latinx PLWH consented or refused study participation in similar proportions, while significantly more white patients enrolled than refused. More men, compared with women, enrolled than refused study participation. The most frequent reasons for refusing study participation were the lack of interest in research (33.2%) and no specific reason provided (28%). RAs identified that effective recruitment strategies used culturally sensitive approaches, built rapport with patients, and obtained provider support for the study. Recruitment strategies that are gender sensitive to address the disparity of underrepresentation of women, address perceived barriers, and examine clinic-specific services are needed to maximize research participation for minority PLWH to improve prevention and health outcomes.
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Affiliation(s)
- Maria Jaurretche
- Milken Institute School of Public Health, Department of Epidemiology, The George Washington University, Washington, DC, USA
| | - Matthew Levy
- Milken Institute School of Public Health, Department of Epidemiology, The George Washington University, Washington, DC, USA.,Westat, Rockville, MD, USA
| | - Amanda D Castel
- Milken Institute School of Public Health, Department of Epidemiology, The George Washington University, Washington, DC, USA
| | - Lindsey Powers Happ
- Milken Institute School of Public Health, Department of Epidemiology, The George Washington University, Washington, DC, USA
| | - Anne K Monroe
- Milken Institute School of Public Health, Department of Epidemiology, The George Washington University, Washington, DC, USA
| | - Karen F Wyche
- School of Nursing, The George Washington University, Washington, DC, USA.
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15
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Goldstein D, Hardy WD, Monroe A, Hou Q, Hart R, Terzian A. Despite early Medicaid expansion, decreased durable virologic suppression among publicly insured people with HIV in Washington, DC: a retrospective analysis. BMC Public Health 2020; 20:509. [PMID: 32299421 PMCID: PMC7164348 DOI: 10.1186/s12889-020-08631-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 04/01/2020] [Indexed: 11/14/2022] Open
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 8000 PWH from 14 clinics. We included those ≥18 years old enrolled between 2011 and 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 3908 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.
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Affiliation(s)
- Deborah Goldstein
- Whitman-Walker Institute, 1525 14th Street, NW, Washington, DC, 20005, USA. .,Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, DC, USA.
| | - W David Hardy
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anne Monroe
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | | | - Arpi Terzian
- Patient-centered Outcomes Research Institute, Washington, DC, USA
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16
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Opoku J, Doshi RK, Castel AD, Sorensen I, Horberg M, Allston A, Kharfen M, Greenberg AE. Comparison of Clinical Outcomes of Persons Living With HIV by Enrollment Status in Washington, DC: Evaluation of a Large Longitudinal HIV Cohort Study. JMIR Public Health Surveill 2020; 6:e16061. [PMID: 32293567 PMCID: PMC7191350 DOI: 10.2196/16061] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/16/2019] [Accepted: 12/20/2019] [Indexed: 12/20/2022] Open
Abstract
Background HIV cohort studies have been used to assess health outcomes and inform the care and treatment of people living with HIV disease. However, there may be similarities and differences between cohort participants and the general population from which they are drawn. Objective The objective of this analysis was to compare people living with HIV who have and have not been enrolled in the DC Cohort study and assess whether participants are a representative citywide sample of people living with HIV in the District of Columbia (DC). Methods Data from the DC Health (DCDOH) HIV surveillance system and the DC Cohort study were matched to identify people living with HIV who were DC residents and had consented for the study by the end of 2016. Analysis was performed to identify differences between DC Cohort and noncohort participants by demographics and comorbid conditions. HIV disease stage, receipt of care, and viral suppression were evaluated. Adjusted logistic regression assessed correlates of health outcomes between the two groups. Results There were 12,964 known people living with HIV in DC at the end of 2016, of which 40.1% were DC Cohort participants. Compared with nonparticipants, participants were less likely to be male (68.0% vs 74.9%, P<.001) but more likely to be black (82.3% vs 69.5%, P<.001) and have a heterosexual contact HIV transmission risk (30.3% vs 25.9%, P<.001). DC Cohort participants were also more likely to have ever been diagnosed with stage 3 HIV disease (59.6% vs 47.0%, P<.001), have a CD4 <200 cells/µL in 2017 (6.2% vs 4.6%, P<.001), be retained in any HIV care in 2017 (72.9% vs 59.4%, P<.001), and be virally suppressed in 2017. After adjusting for demographics, DC Cohort participants were significantly more likely to have received care in 2017 (adjusted odds ratio 1.8, 95% CI 1.70-2.00) and to have ever been virally suppressed (adjusted odds ratio 1.3, 95% CI 1.20-1.40). Conclusions These data have important implications when assessing the representativeness of patients enrolled in clinic-based cohorts compared with the DC-area general HIV population. As participants continue to enroll in the DC Cohort study, ongoing assessment of representativeness will be required.
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Affiliation(s)
- Jenevieve Opoku
- HIV/AIDS, Hepatitis, STD, and TB Administration, DC Health, Washington, DC, United States
| | - Rupali K Doshi
- HIV/AIDS, Hepatitis, STD, and TB Administration, DC Health, Washington, DC, United States.,Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Ian Sorensen
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Michael Horberg
- Kaiser Permanente Medical Group, Rockville, MD, United States
| | - Adam Allston
- HIV/AIDS, Hepatitis, STD, and TB Administration, DC Health, Washington, DC, United States
| | - Michael Kharfen
- HIV/AIDS, Hepatitis, STD, and TB Administration, DC Health, Washington, DC, United States
| | - Alan E Greenberg
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
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Buchbinder M, Blue C, Juengst E, Brinkley-Rubinstein L, Rennie S, Rosen DL. Expert stakeholders' perspectives on a Data-to-Care strategy for improving care among HIV-positive individuals incarcerated in jails. AIDS Care 2020; 32:1155-1161. [PMID: 32160760 DOI: 10.1080/09540121.2020.1737641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Data-to-Care (D2C) uses surveillance data (e.g., laboratory, Medicaid billing) to identify out-of-care HIV-positive persons to re-link them to care. Most US states are implementing D2C, yet few studies have explored stakeholders' perspectives on D2C, and none have addressed these perspectives in the context of D2C in jail. This article reports findings from qualitative, semi-structured interviews conducted with expert stakeholders regarding their perspectives on the ethical challenges of utilizing D2C to understand and improve continuity of care among individuals incarcerated in jails. Participants included 47 professionals with expertise in ethics and privacy, public health and HIV care, the criminal justice system, and community advocacy. While participants expressed a great deal of support for extending D2C to jails, they also identified many possible risks. Stakeholders discussed many issues specific to D2C in jails, such as heightened stigma in the jail setting, the need for training of jail staff and additional non-medical community-based resources, and the high priority of this vulnerable population. Many experts suggested that the actual likelihood of benefits and harms would depend on contextual details. Implementation of D2C in jails may require novel strategies to minimize risk of disclosing out-of-care patients' HIV status.
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Affiliation(s)
- Mara Buchbinder
- Department of Social Medicine, Center for Bioethics, UNC Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Colleen Blue
- Institute for Global Health and Infectious Diseases, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Eric Juengst
- Department of Social Medicine, Center for Bioethics, UNC Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Lauren Brinkley-Rubinstein
- Department of Social Medicine, Center for Health Equity Research, UNC Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Stuart Rennie
- Department of Social Medicine, Center for Bioethics, UNC Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - David L Rosen
- Division of Infectious Diseases, Department of Medicine, UNC Chapel Hill, School of Medicine, Chapel Hill, NC, USA
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18
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Terzian AS, Younes N, Greenberg AE, Opoku J, Hubbard J, Happ LP, Kumar P, Jones RR, Castel AD. Identifying Spatial Variation Along the HIV Care Continuum: The Role of Distance to Care on Retention and Viral Suppression. AIDS Behav 2018; 22:3009-3023. [PMID: 29603112 DOI: 10.1007/s10461-018-2103-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Distance to HIV care may be associated with retention in care (RIC) and viral suppression (VS). RIC (≥ 2 HIV visits or labs ≥ 90 days apart in 12 months), prescribed antiretroviral therapy (ART), VS (< 200 copies/mL at last visit) and distance to care were estimated among 3623 DC Cohort participants receiving HIV care in 13 outpatient clinics in Washington, DC in 2015. Logistic regression models and geospatial statistics were computed. RIC was 73%; 97% were on ART, among whom 77% had VS. ZIP code-level clusters of low RIC and high VS were found in Northwest DC, and low VS in Southeast DC. Those traveling ≥ 5 miles had 30% lower RIC (adjusted odds ratio (aOR) 0.71, 95% CI 0.58, 0.86) and lower VS (OR 0.70, 95% CI 0.52, 0.94). Geospatial clustering of RIC and VS was observed, and distance may be a barrier to optimal HIV care outcomes.
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Affiliation(s)
- A S Terzian
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA.
| | - N Younes
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - A E Greenberg
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - J Opoku
- District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD, and TB Administration, Washington, DC, USA
| | - J Hubbard
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - L P Happ
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - P Kumar
- School of Medicine, Georgetown University, Washington, DC, USA
| | - R R Jones
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - A D Castel
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
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