People with HIV are receiving treatment earlier, but disparities remain
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Timely ART is more common in the United States since the release of HHS treatment guidelines for HIV in 2012, including among groups who have faced racial, ethnic and some geographic disparities in the past, researchers reported.
However, people with HIV who have a drug dependence and/or abuse diagnosis still face disparities, suggesting a need for additional support services, according to researchers at the virtual Conference on Retroviruses and Opportunistic Infections.
“We needed to study the trends and sociodemographic and clinical disparities in the timely receipt of ART prescriptions to pinpoint which subpopulations need additional support services,” Jun Li, MD, PhD, MPH, an epidemiologist in the CDC’s Division of HIV/AIDS Prevention, told Healio. “These data will be important to help identify and close gaps in HIV treatment to achieve better health outcomes.”
Li and colleagues examined HIV treatment-naive adults who newly presented to HIV care at 13 U.S. North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) clinical cohorts between 2012 and 2018 who had a recorded CD4 at presentation.
According to the study, the researchers calculated the cumulative incidence of timely ART within 30 days of entry into care and used models to assess trends in timely ART by calendar year, adjusted for age, sex, risk group, race/ethnicity, geographic region, AIDS diagnosis, history of alcohol or drug dependence/abuse, mental health diagnoses, and CD4 and viral load at presentation.
Among the 11,853 eligible treatment-naive participants included in the study, 48% were men who had sex with men, 14% were women, 45% were Black, 15% were Hispanic/Latino, 32% were aged 18 to 29 years, and 7% were aged 60 years or older.
The study demonstrated that the cumulative incidence of timely ART increased from 42% in 2012 to 82% in 2018. However, a multivariable model for 2012 to 2018 showed lower rates of timely ART among more Black than white participants (adjusted HR = 0.89; 95% CI, 0.83-0.94), people living in the South than the West (aHR = 0.78; 95% CI, 0.69-0.88) and participants with a history of drug dependence/abuse diagnosis (aHR = 0.81; CI, 0.74-0.9).
The researchers also found that during 2016 to 2018, Black participants (aHR = 0.92; 95% CI, 0.83-1.02) and people in the South (aHR = 0.97; 95% CI, 0.75-1.26) no longer had significantly lower rates of timely ART, but participants in the Northeast had higher rates (aHR = 1.37; 95% CI, 0.99-1.9) than people in the West. Additionally, drug dependence and abuse history remained associated with delayed ART (aHR = 0.72; 95% CI, 0.61-0.85).
“Substantial improvements in timely ART initiation after the release of the 2012 HIV treatment guidelines suggest great acceptance and implementation of these guidelines among health care providers,” Li said. “However, ending the HIV epidemic in the U.S. can only be achieved by eliminating the barriers that prevent equitable access to HIV treatment and care. This includes addressing the root causes and social determinants that have contributed to disparities among certain population groups for far too long.”
Perspective
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Although it is extremely heartening to see the increase in the cumulative incidence of timely ART, this study provides a reality check as to where we need to continue focus and, in fact, bolster our efforts toward timely ART ⎼⎼ the vulnerable and often sidelined group with drug dependency and abuse. This is an important step toward public health, and we owe it to not only the individual’s health but also to society to strive toward timely ART, in keeping with the maxim of “Undetectable = Untransmittable.” The stakes are high, and we must be prepared to go the extra mile to ensure timely ART in this population.
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Li J, et al. Abstract 104. Presented at: Conference on Retroviruses and Opportunistic Infections; March 6-10, 2021 (virtual meeting).
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