title: Increased Antiretroviral Therapy Use and Virologic Suppression in the Bronx in the Context of Multiple HIV Prevention Strategies.
abstract: Multiple population-based HIV prevention strategies from national, state, local, and institutional levels have been implemented in the Bronx, which has one of the highest HIV prevalences in the U.S. We examined changes in antiretroviral therapy (ART) use and associated outcomes between 2007 and 2014 among patients seen at one of >20 outpatient clinics affiliated with the largest Bronx HIV care provider. Among eligible HIV-infected patients age ≥13 years, we examined annual trends in ART use, mean HIV RNA level, and virologic suppression (<200 copies/ml) overall and among prespecified subgroups. In a subset with suppressed HIV RNA at the end of each year, we determined the percentage whose levels remained suppressed within the next year. Regression models assessed disparities in outcomes. Among 7,196 patients (median age 50, 47% Hispanic, 45% black), we identified consistent increases over time in the percent prescribed ART (78% in 2007 to 93% in 2014) and with virologic suppression (58% to 80%), as mean HIV RNA decreased (351 to 73 copies/ml) (all p < .001). Sustained virologic suppression improved markedly beginning in 2011, coinciding with local test-and-treat initiatives and adoption of expanded treatment guidelines. While disparities among population groups were most pronounced for sustained virologic suppression, those aged 13-24 fared relatively poorly for all outcomes examined (e.g., rate ratio 0.57 for virologic suppression, 95% confidence interval 0.52-0.62, vs. age 65+). Population-wide HIV prevention strategies coincided with improvements in virologic suppression among most population groups. However, more attention is needed to address continued disparities in the HIV care continuum among young people.
authors.affiliation: 1 Department of Epidemiology and Population Health, Albert Einstein College of Medicine , Bronx, New York.
authors.forename: David B
authors.initials: DB
authors.lastname: Hanna
authors.affiliation: 2 Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center , Bronx, New York.
authors.forename: Uriel R
authors.initials: UR
authors.lastname: Felsen
authors.affiliation: 1 Department of Epidemiology and Population Health, Albert Einstein College of Medicine , Bronx, New York.
authors.forename: Mindy S
authors.initials: MS
authors.lastname: Ginsberg
authors.affiliation: 2 Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center , Bronx, New York.
authors.forename: Barry S
authors.initials: BS
authors.lastname: Zingman
authors.affiliation: 2 Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center , Bronx, New York.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Beil
authors.affiliation: 3 Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center , Bronx, New York.
authors.forename: Donna C
authors.initials: DC
authors.lastname: Futterman
authors.affiliation: 1 Department of Epidemiology and Population Health, Albert Einstein College of Medicine , Bronx, New York.
authors.forename: Howard D
authors.initials: HD
authors.lastname: Strickler
authors.affiliation: 1 Department of Epidemiology and Population Health, Albert Einstein College of Medicine , Bronx, New York.|2 Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center , Bronx, New York.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Anastos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D004363:Drug Utilization; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City; D012367:RNA, Viral / Q000097:blood; D000072230:Sustained Virologic Response; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D012367:RNA, Viral
keywords: HIV prevention; HIV viral load; antiretroviral therapy; community viral load; test-and-treat; young adult