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Despite highest HIV incidence, blacks show low linkage to care
New data suggest that 74.9% of blacks with diagnosed HIV infection were linked to care in 2010, according to an MMWR report.
The HIV Care Continuum Initiative, an executive order issued by President Barack Obama in July, called for achieving a goal of 85% of blacks to be linked to care and 80% to be retained in care by 2015. It also called for the number of blacks with viral suppression to increase by 20%. In 2010, only 35.2% had achieved viral suppression.
“Focusing on prevention and care efforts on populations that bear a disproportionate burden of HIV disease could lead to reductions in HIV incidence and health inequities and help achieve the goals of the National HIV/AIDS Strategy,” CDC researchers wrote.
The researchers used 2010 data reported to the National HIV Surveillance System to determine the number of blacks with diagnosed HIV in 19 jurisdictions and the percentage of those linked to care and retained in care by the end of 2010. Among the 8,261 blacks diagnosed with HIV, 6,186 (74.9%) were linked to care within 3 months of diagnosis. In addition, among 153,581 blacks aged at least 13 years with HIV, only 48% were retained in care.
Data from the CDC’s Medical Monitoring Project were used to calculate prescriptions for antiretroviral therapy and viral suppression. Throughout the United States and Puerto Rico, only 46.2% of the 353,653 blacks aged at least 18 years with diagnosed HIV infection have a prescription for ART. In addition, only 35.2% of these patients achieved viral suppression at their latest test.
“Increasing the proportion of black persons living with HIV who are receiving care is critical for achieving the goals of the National HIV/AIDS Strategy to reduce new infections, improve health outcomes and decrease health disparities,” the researchers wrote. “Among blacks, targeted strategies for different groups, such as males and youths, might be needed to achieve improvements at each step of the HIV care continuum.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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There are a few different ways to look at recent data on the continuum of HIV care. On the one hand, there has been some progress. More and more people are being tested for HIV and generally, there have been some improvements in the number of people linked to care. On the other hand, as this report clearly indicates, there is still a lot of work to be done, in the black population of the United States and really in all populations across the board. Even among groups in this report that are doing better, such as older people and men, none are doing particularly well in terms of retention in care and viral suppression.
We have evidence that there is improvement in linking people to care. But linkage is not the “weakest link” in the continuum of care because it’s just a one-time incident. Retention in care is more complicated because it requires ongoing engagement with the health care system. That’s a big challenge. There are a lot of factors that go along with that, including issues at the health care system level and issues at the patient level. The jury is still out if you’re looking for a strong, evidence-based method to improve retention in care. But there are some approaches that we can use that are established by evidence that doesn’t quite meet the rigor of replicated, randomized, controlled trial. There is a reasonable evidence base to support case management and reducing unmet needs like housing instability, substance abuse, mental health treatment and access to care. There are also data supporting regular clinic-based contact with people at risk for poor retention, in the form of reminders, personal attention and brief messaging by clinical personnel, as well as outreach programs for out-of-care populations. If you can meet some unmet needs and reduce barriers, people will be more likely to stay in care.