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Li J, Humes E, Lee JS, Althoff KN, Colasanti JA, Bosch RJ, Horberg M, Rebeiro PF, Silverberg MJ, Nijhawan AE, Parcesepe A, Gill J, Shah S, Crane H, Moore R, Lang R, Thorne J, Sterling T, Hanna DB, Buchacz K. Toward Ending the HIV Epidemic: Temporal Trends and Disparities in Early ART Initiation and Early Viral Suppression Among People Newly Entering HIV Care in the United States, 2012-2018. Open Forum Infect Dis 2022; 9:ofac336. [PMID: 35937648 PMCID: PMC9348610 DOI: 10.1093/ofid/ofac336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Indexed: 10/28/2023] Open
Abstract
Background In 2012, the US Department of Health and Human Services updated their HIV treatment guidelines to recommend antiretroviral therapy (ART) for all people with HIV (PWH) regardless of CD4 count. We investigated recent trends and disparities in early receipt of ART prescription and subsequent viral suppression (VS). Methods We examined data from ART-naïve PWH newly presenting to HIV care at 13 North American AIDS Cohort Collaboration on Research and Design clinical cohorts in the United States during 2012-2018. We calculated the cumulative incidence of early ART (within 30 days of entry into care) and early VS (within 6 months of ART initiation) using the Kaplan-Meier survival function. Discrete time-to-event models were fit to estimate unadjusted and adjusted associations of early ART and VS with sociodemographic and clinical factors. Results Among 11 853 eligible ART-naïve PWH, the cumulative incidence of early ART increased from 42% in 2012 to 82% in 2018. The cumulative incidence of early VS among the 8613 PWH who initiated ART increased from 83% in 2012 to 93% in 2018. In multivariable models, factors independently associated with delayed ART and VS included non-Hispanic/Latino Black race, residence in the South census region, being a male with injection drug use acquisition risk, and history of substance use disorder (SUD; all P ≤ .05). Conclusions Early ART initiation and VS have substantially improved in the United States since the release of universal treatment guidelines. Disparities by factors related to social determinants of health and SUD demand focused attention on and services for some subpopulations.
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Affiliation(s)
- Jun Li
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth Humes
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer S Lee
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Ronald J Bosch
- Department of Biostatistics, Harvard University, Boston, Massachusetts, USA
| | - Michael Horberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Peter F Rebeiro
- Departments of Medicine & of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Michael J Silverberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland, USA
| | - Ank E Nijhawan
- Division of Infectious Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Angela Parcesepe
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John Gill
- Southern Alberta HIV Clinic, Calgary, Alberta, Canada
| | - Sarita Shah
- Rollins School of Public Health & School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Heidi Crane
- Center for AIDS Research, University of Washington, Seattle, Washington, USA
| | - Richard Moore
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Raynell Lang
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - David B Hanna
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kate Buchacz
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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