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US blacks infrequently receive consistent HIV care
From 2011 to 2013, blacks living in the United States less frequently received ongoing HIV medical care than patients of other ethnicities, according to a recent report from the CDC.
Furthermore, black men were less likely to receive consistent care than black women, as was also the case among blacks whose infections were attributable to a combination of injection drug use and male-to-male sexual contact, researchers wrote in MMWR.
Jonathan Mermin
“Consistent care matters. It enables people with HIV to live longer, healthier lives, and it prevents new infections,” Jonathan Mermin, MD, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, said in a press release. “Closing this gap in care will be essential if we are to see the narrowing racial divide in HIV diagnoses close completely.”
Less than two-fifths of blacks retained in care
Previous data has shown blacks to be disproportionately affected by HIV, as they comprised nearly half of all diagnoses in 2014 despite representing only 12% of the U.S. population, according to the press release. Because linkage to continuing care and treatment can improve outcomes and interrupt transmission, the CDC researchers wrote that it is crucial to improve engagement with care among blacks, as well as other less-affected ethnic groups.
To gauge recent efforts and identify racial disparities in care, the researchers reviewed National HIV Surveillance System data from 12 jurisdictions reported from January 2010 to December 2013. They examined persons aged 13 years or older who received an HIV diagnoses in 2010 and were alive until the end of the study period in July 2015 for annual retention in HIV care, which was defined as two or more CD4 or viral load tests at least 3 months apart during a given calendar year. The percentage of persons partially or fully retained in care was identified, and then analyzed by race, sex, transmission category and state to determine potential disparities in retention.
There were 9,824 adults and adolescents included in the analysis. Of these, 54% were black, 24% were white, and 17% were Hispanic. Fourteen percent were retained in care for only a single year, 19% were retained for 2 years and 43% were retained for all 3 years.
Complete coverage from 2011 to 2013 was low among blacks (38%), and more common among whites (49%) and Hispanics (50%). This imbalance remained when analysis was stratified by sex or transmission category, and was more pronounced in certain jurisdictions with even lower rates of blacks retained in care. In addition, black men were less likely than black women to receive full coverage (35% vs. 44%), and retention among all groups was lowest among black men who have sex with men and reported injection drug use.
These data highlight a major disparity in HIV care, the researchers wrote, and support interventions promoting early linkage to and retention in care for currently underreached demographics.
Eugene McCray
“CDC has been working for many years to eliminate the HIV disparities that exist within the black community,” Eugene McCray, MD, director of the CDC’s Division of HIV/AIDS Prevention, said in the press release. “While we are seeing signs of success, we must continue our focus on prevention strategies that will have the greatest impact on African-American communities and the nation overall. A key area of focus is ensuring that people living with HIV are diagnosed early, quickly linked to care and receive consistent care that improves their lives and protects the health of their partners.”
Linkage to care increases among black females
While linkage to care has improved among black females with newly diagnosed infection during the past few years, the approximately 50% rate is well below the target set by the National HIV/AIDS Strategy, according to another study published today in MMWR.
From 2012 to 2014, the CDC funded HIV testing, linkage to care, partner services and behavioral risk reduction programs through 61 state and local health departments and 151 community-based organizations. To gauge the impact of these interventions, researchers examined data collected from the National HIV Prevention Program Monitoring and Evaluation concerning testing events and related services collected during this time period. The researchers then determined the rate of HIV test positivity and linkage to HIV care within 90 days among non-Hispanic black women with new infection.
The number of annual CDC-funded testing events during this time period ranged from 702,328 to 793,894, and women aged 20 to 29 years accounted for 44.7% of all tests among black women. New diagnoses decreased 17% from 2012 to 2014; however, HIV test positivity rates remained relatively similar year to year.
Among black women with newly diagnosed infection, linkage to care within 90 days of diagnoses increased from a rate of 33.8% in 2012 to 50.1% in 2014. Although this growth was seen across all ages and regions, increases were greatest among those aged 13 to 19 years (32.7% to 57.9%), and the greatest overall rate of linkage to care was seen within the Northeast census region. In addition, partner services interview receipt among newly diagnosed black women rose from 32.8% to 51.7%, with increases seen among all age groups and every region except the Midwest.
The researchers wrote that while these increases are beneficial to black women with newly diagnosed HIV, more interventions within the group may be needed to reach the 85% linkage rate targeted by the National HIV/AIDS Strategy.
“To continue to reduce HIV-related health disparities for black females in the United States, increasing HIV testing efforts among this group is needed to increase the percentage of black females living with HIV who are aware of their status, and to ensure that every black female with HIV infection is linked to HIV medical care soon after her diagnosis, is retained in care and achieves viral suppression,” the researchers wrote. – by Dave Muoio
Disclosure: The researchers report no relevant financial disclosures.