title: African American race and HIV virological suppression: beyond disparities in clinic attendance.
abstract: Racial disparities in clinic attendance may contribute to racial disparities in plasma human immunodeficiency virus type 1 : HIV-1) RNA levels among HIV-positive patients in care. Data from 946 African American and 535 Caucasian patients receiving HIV care at the University of North Carolina Center for AIDS Research HIV clinic between January 1, 1999, and August 1, 2012, were used to estimate the association between African American race and HIV virological suppression (i.e., undetectable HIV-1 RNA) when racial disparities in clinic attendance were lessened. Clinic attendance was measured as the proportion of scheduled clinic appointments attended (i.e., visit adherence) or the proportion of six 4-month intervals with at least 1 attended scheduled clinic appointment (i.e., visit constancy). In analyses accounting for patient characteristics, the risk ratio for achieving suppression when comparing African Americans with Caucasians was 0.91 (95% confidence interval: 0.85, 0.98). Lessening disparities in adherence or constancy lowered disparities in virological suppression by up to 44.4% and 11.1%, respectively. Interventions that lessen disparities in adherence may be more effective in eliminating disparities in suppression than interventions that lessen disparities in constancy. Given that gaps in care were limited to be no more than 2 years for both attendance measures, the impact of lessening disparities in adherence may be overstated.
authors.forename: Chanelle J
authors.initials: CJ
authors.lastname: Howe
authors.forename: Sonia
authors.initials: S
authors.lastname: Napravnik
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cole
authors.forename: Jay S
authors.initials: JS
authors.lastname: Kaufman
authors.forename: Adaora A
authors.initials: AA
authors.lastname: Adimora
authors.forename: Beth
authors.initials: B
authors.lastname: Elston
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Eron
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
mesh_terms: D000328:Adult; D001741:Black or African American; D000554:Ambulatory Care Facilities; D005260:Female; D015658:HIV Infections / Q000208:ethnology* / Q000821:virology; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification*; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000208:ethnology*; D012367:RNA, Viral / Q000097:blood; D019562:Viral Load; D044465:White People
chemical_list: D012367:RNA, Viral
keywords: clinic visits; cohort studies; health status disparities; human immunodeficiency virus; viral load