Testing for comorbid conditions among people with HIV in medical care

People living with HIV (PLWH) are frequently affected by comorbid medical conditions. Despite the importance of diagnosing and treating these conditions, testing rates for common comorbidities often fall short of primary care recommendations for PLWH. Clinical care data were obtained from the 2012 New York City (NYC) Medical Monitoring Project (MMP), a multi-site surveillance project that includes demographically representative cohorts of PLWH receiving medical care. Medical record abstraction data were analyzed to determine testing frequencies for potential comorbid conditions, including tuberculosis, hepatitis B and C, diabetes, syphilis, gonorrhea, and chlamydia, and to assess demographic, behavioral, and clinical factors associated with testing. Among the NYC MMP cohort (N = 439), testing frequencies ranged from 18% for hepatitis B to 66% for diabetes in a 12-month period. In multivariate analyses, having three or more medical visits with a CD4 or HIV viral load test over 12 months was significantly associated with sexually transmitted infection (STI) and hepatitis C testing. Compared with Black PLWH, Latino/Hispanics were more likely to be tested for hepatitis C and Whites were less likely to be tested for diabetes. Self-reported sexual risk behaviors were not associated with testing for STI, and history of injection drug use was not associated with testing for hepatitis C. These results indicate a need for improved risk assessment, adherence to clinical guidelines, and integration of primary care services with HIV care.

Hospitalization Rates Among People With HIV/AIDS in New York City, 2013

Background

Hospitalizations are an important indicator of healthcare quality and access for people with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS). This study assesses hospitalization rates among people with HIV/AIDS in New York City.

Methods

We performed a deterministic match between people in the New York City HIV surveillance registry alive as of 1 January 2013 and diagnosed with HIV as of 31 December 2013 and patient-level inpatient hospitalization records during 2013. Event-level data were analyzed to determine characteristics of and reasons for hospitalizations. Primary diagnoses were classified using the International Classification of Diseases, Ninth Revision, Clinical Modification. We estimated hospitalization rates as the number of hospitalizations per 100 person-years for all causes, AIDS-defining illnesses, and non-AIDS-defining infections.

Results

Nearly one-fifth of hospitalizations were attributed to non-AIDS-defining infections, whereas AIDS-defining illness diagnoses were infrequent (3.6% of hospitalizations). Other common causes were cardiovascular (10.9%) and substance use (9.8%). The estimated all-cause hospitalization rate was 36.7 per 100 person-years. Higher all-cause hospitalization rates were observed among females (46.8 per 100 person-years), Black and Latino/Hispanic people (41.8 and 39.5 per 100 person-years, respectively), people living in high-poverty neighborhoods (47.4 per 100 person-years), and people with a history of injection drug use (74.9 per 100 person-years). The estimated AIDS-defining illness and non-AIDS-defining infection hospitalization rates were 1.3 and 7.2 per 100 person-years, respectively.

Conclusions

People with HIV in New York City were frequently hospitalized. While AIDS-defining illnesses were relatively rare, non-AIDS-defining infection hospitalizations were more common. Disparities in hospitalization rates indicate a need for targeted improved primary care and comorbid disease management.

Antiretroviral medication treatment for all HIV-infected individuals: a protocol using innovative multilevel methodologies to evaluate New York City's universal ART policy among problem substance users

Background

The intersection of HIV-related health outcomes and problem substance use has been well documented. New York City continues to be a focal point of the U.S. HIV epidemic. In 2011, the NYC Department of Health and Mental Hygiene (NYC DOHMH) issued a recommendation that all HIV infected individuals should be offered antiretroviral therapy (ART) regardless of CD4 cell count or other indicators of disease progression. This policy is based in the concept of “treatment as prevention,” in which providing ART to people living with HIV (PLWH) greatly reduces the likelihood of HIV transmission, while also improving individual health. The “ART for ALL” (AFA) study was designed to inform modifications to and identify gaps in the implementation of universal ART, and specifically to help guide allocation of resources to obtain local policy goals for increasing viral suppression among PLWH who have problem substance use.

Methods/Design

The AFA Study is informed by two complementary frameworks: Glasgow and colleagues’ RE-AIM model, a multi-level framework developed to guide the evaluation of implementation of new policies, and Bronfrenbrenner’s ecological systems model, which conceptualizes the bi-directional interplay between people and their environment. Using multi-level data and mixed methods, the primary aims of the AFA Study are to assess rates of viral load suppression, using the NYC HIV Surveillance Registry, within 12 months of HIV diagnosis with (a) yearly cohorts of high-risk-to-transmit, difficult-to-treat, substance using patients recruited from NYC Sexually Transmitted Disease clinics and a large detoxification unit and (b) yearly cohorts of all newly HIV diagnosed people in NYC. Further goals include (c) recruiting cross-sectional samples of HIV/AIDS service providers to assess ART initiation with problem substance users and d) examining geographic factors that influence rates of viral load suppression. An Implementation Collaborative Board meets regularly to guide study procedures and interpret results.

Discussion

The AFA Study has the unique strength of accessing and analyzing data at multiple levels using mixed methodology, taking advantage of NYC DOHMH biomedical surveillance data. If successful, others may benefit from lessons learned to inform local and state policies to improve the health of PLWH and further reduce HIV transmission.