Needs for shelter or housing assistance among people with diagnosed HIV by jurisdiction: United States, 2015-2020

A Novel Method for Assessing Poor Quality of Life Among People With HIV

BACKGROUND

The US National HIV/AIDS Strategy prioritizes improving quality of life (QoL) among people with HIV (PWH) but co-occurrence of different aspects of QoL is not well described. We developed and applied a novel, multi-item assessment of poor QoL among PWH and examined associations with selected outcomes.

SETTING

2018-2021 CDC Medical Monitoring Project data on 15,855 U.S. PWH.

METHODS

The poor QoL index, measured by the number of indicators of poor QoL experienced included: poor/fair self-rated health, unmet needs for mental health services, and subsistence needs (hunger/food insecurity, unstable housing/homelessness, and unemployment). Score distributions were analyzed alongside data on individual QoL indicators. Associations with selected adverse outcomes were assessed, including not being retained in care, missing ≥1 HIV medical appointments, missing ≥1 ART dose, not having sustained viral suppression, and having ≥1 emergency room visit or ≥1 hospitalization.

RESULTS

Overall, 55.1% of PWH had ≥1 indicator of poor QoL; 8.4% had ≥3 indicators. Over a quarter (26.5%) of people who inject drugs experienced ≥3 indicators of poor QoL. A large percentage of people aged 18-24 years had subsistence needs; 36.4% of Black women had poor/fair self-rated health. After adjusting for age, race/ethnicity, and sex, higher poor QoL index scores-and each indicator of poor QoL-were associated with worse outcomes.

CONCLUSIONS

We demonstrated the utility in using the poor QoL index to identify those at higher risk of experiencing health challenges. Expanding national recommendations to include this QoL assessment could help in meeting National HIV/AIDS Strategy goals for improving PWH's well-being.

Social Determinants of Health and Unmet Needs for Services Among Young Adults With HIV: Medical Monitoring Project, 2018-2021

BACKGROUND

Persons aged 13-24 years are a priority population in the National HIV/AIDS Strategy. Young adults with HIV have poorer health outcomes-including not being retained in care, antiretroviral nonadherence, and not being virally suppressed-than other persons with HIV.

SETTING

Centers for Disease Control and Prevention's Medical Monitoring Project data collected June 2018 through May 2022.

METHODS

We compared demographic characteristics, social determinants of health, and mental health between persons aged 18-24 years with HIV versus persons aged ≥25 years with HIV. Among those aged 18-24 years, we analyzed total and unmet needs for ancillary services, defined as those that support care engagement, viral suppression, and overall health and well-being among people with HIV.

RESULTS

Persons aged 18-24 years were more likely to have a household income <100% of the federal poverty level (48% vs. 39%), and experience unstable housing or homelessness (37% vs. 18%) or hunger/food insecurity (29% vs. 18%) than those aged ≥25 years. Persons aged 18-24 years had higher median HIV stigma scores (40 vs. 29) and were more likely to experience symptoms of generalized anxiety disorder (21% vs. 15%) than those aged ≥25 years. Of persons aged 18-24 years, 96% had a need for ≥1 ancillary service, of whom 56% had ≥1 unmet need; unmet needs were highest for subsistence services (53%) and non-HIV medical services (41%).

CONCLUSIONS

Addressing unmet needs for subsistence and non-HIV medical services could help reduce disparities in social determinants of health and mental health that drive inequities in health outcomes among persons with HIV aged 18-24 years.

Progress Toward Achieving National HIV/AIDS Strategy Goals for Quality of Life Among Persons Aged ≥50 Years with Diagnosed HIV - Medical Monitoring Project, United States, 2017-2023

Ensuring good quality of life (QoL) among persons with diagnosed HIV (PWH) is a priority of the National HIV/AIDS Strategy (NHAS), which established 2025 goals for improving QoL. Goals are monitored through five indicators: self-rated health, unmet needs for mental health services, unemployment, hunger or food insecurity, and unstable housing or homelessness. Among the growing population of PWH aged ≥50 years, progress toward these goals has not been assessed. Data collected during the 2017-2022 cycles of the Medical Monitoring Project, an annual complex sample survey of U.S. adults with diagnosed HIV, assessed progress toward NHAS 2025 QoL goals among PWH aged ≥50 years, overall and by age group. The recent estimated annual percentage change from baseline (2017 or 2018) to 2022 was calculated for each indicator. Among PWH aged ≥50 years, the 2025 goal of 95% PWH with good or better self-rated health is 46.2% higher than the 2022 estimate. The 2025 goals of a 50% reduction in the other indicators range from 26.3% to 56.3% lower than the 2022 estimates. Decreasing hunger or food insecurity by 50% among PWH aged ≥65 was the only goal met by 2022. If recent trends continue, other NHAS QoL 2025 goals are unlikely to be met. Multisectoral strategies to improve access to housing, employment, food, and mental health will be needed to meet NHAS 2025 goals for QoL among older PWH.

Progress towards achieving national goals for improved quality of life among cis-gender Black women with HIV

Data from the CDC's Medical Monitoring Project indicate that the United States is on track to meet one of five National HIV/AIDS Strategy (NHAS) Quality of Life goals among cisgender Black women, specifically, hunger/food insecurity. Substantial work needs to be done to improve self-rated health and to decrease unmet need for mental health services. Enhanced and coordinated action are necessary to reach all Quality of Life goals in this NHAS priority population.

Unmet Needs for HIV Ancillary Services Among Persons With Diagnosed HIV Aged 55 years and Older

BACKGROUND

Approximately 2 in 5 persons with HIV (PWH) in the United States are aged 55 years or older. HIV ancillary services, such as case management and transportation services, can help older PWH remain engaged in care. We used data from the Medical Monitoring Project (MMP) to describe the prevalence of unmet needs for ancillary services among persons with diagnosed HIV aged 55 years or older.

SETTING

MMP is an annual cross-sectional study that reports representative estimates on adults with diagnosed HIV in the United States.

METHODS

We used MMP data collected during June 2019-May 2021 to calculate weighted percentages of cisgender men and cisgender women with HIV aged 55 years or older with unmet needs for ancillary services, overall and by selected characteristics (N = 3200). Unmet need was defined as needing but not receiving a given ancillary service. We assessed differences between groups using prevalence ratios (PRs) and 95% confidence intervals with predicted marginal means.

RESULTS

Overall, 37.7% of cisgender men and women with HIV aged 55 years or older had ≥1 unmet need for ancillary services. Overall, 16.6% had ≥1 unmet need for HIV support services, 26.9% for non-HIV medical services, and 26.7% for subsistence services. There were no statistically significant differences in unmet needs for services by gender. The prevalence of ≥1 unmet need was higher among non-White persons (PR range: 1.35-1.63), persons who experienced housing instability (PR = 1.70), and those without any private insurance (PR range: 1.49-1.83).

CONCLUSION

A large percentage of older PWH have unmet needs for ancillary services. Given the challenges that older PWH face related to the interaction of HIV and aging-associated factors, deficits in the provision of ancillary services should be addressed.

Comparison of Demographic Characteristics and Social Determinants of Health Between Adults With Diagnosed HIV and All Adults in the U.S

Introduction

Quantifying disparities in social determinants of health between people with HIV and the total population could help address health inequities, and ensure health and well-being among people with HIV in the U.S., but estimates are lacking.

Methods

Several representative data sources were used to assess differences in social determinants of health between adults with diagnosed HIV (Centers for Disease Control and Prevention Medical Monitoring Project) and the total adult population (U.S. Census Bureau's decennial census, American Community Survey, Household Pulse Survey, the Current Population Survey Annual Social and Economic Supplements; the Department of Housing and Urban Development's point-in-time estimates of homelessness; and the Bureau of Justice Statistics). The differences were quantified using standardized prevalence differences and standardized prevalence ratios, adjusting for differences in age, race/ethnicity, and birth sex between people with HIV and the total U.S. population.

Results

Overall, 35.6% of people with HIV were living in a household with an income at or below the federal poverty level, and 8.1% recently experienced homelessness. Additionally, 42.9% had Medicaid and 27.6% had Medicare; 39.7% were living with a disability. Over half (52.3%) lived in large central metropolitan counties and 20.6% spoke English less than very well based on survey responses. After adjustment, poverty (standardized prevalence difference=25.1%, standardized prevalence ratio=3.5), homelessness (standardized prevalence difference=8.5%, standardized prevalence ratio=43.5), coverage through Medicaid (standardized prevalence difference=29.5%, standardized prevalence ratio=3.0) or Medicare (standardized prevalence difference=7.8%), and disability (standardized prevalence difference=30.3%, standardized prevalence ratio=3.0) were higher among people with HIV than the total U.S. population. The percentage of people with HIV living in large central metropolitan counties (standardized prevalence difference=13.4%) or who were recently incarcerated (standardized prevalence ratio=5.9) was higher than the total U.S. population.

Conclusions

These findings provide a baseline for assessing national-level disparities in social determinants of health between people with HIV and the total U.S. population, and it can be used as a model to assess local disparities. Addressing social determinants of health is essential for achieving health equity, requiring a multipronged approach with interventions at the provider, facility, and policy levels.