title: Racial Disparities in HIV Care Extend to Common Comorbidities: Implications for Implementation of Interventions to Reduce Disparities in HIV Care.
abstract: Prior studies have described racial disparities in the quality of care for persons with HIV infection, but it is unknown if these disparities extend to common comorbid conditions. To inform implementation of interventions to reduce disparities in HIV care, we examined racial variation in a set of quality measures for common comorbid conditions among Veterans in care for HIV in the United States.
  
  
  
  The cohort included 23,974 Veterans in care for HIV in 2013 (53.4% black; 46.6% white). Measures extracted from electronic health record and administrative data were receipt of combination antiretroviral therapy (cART), HIV viral control (serum RNA < 200 copies/ml among those on cART), hypertension control (blood pressure < 140/90 mm Hg among those with hypertension), diabetes control (hemoglobin A1C < 9% among those with diabetes), lipid monitoring, guideline-concordant antidepressant prescribing, and initiation and engagement in substance use disorder (SUD) treatment. Black persons were less likely than their white counterparts to receive cART (90.2% vs. 93.2%, p<.001), and experience viral control (84.6% vs. 91.3%, p<.001), hypertension control (61.9% vs. 68.3%, p<.001), diabetes control (85.5% vs. 89.5%, p<.001), and lipid monitoring (81.5% vs. 85.2%, p<.001). Initiation and engagement in SUD treatment were similar among blacks and whites. Differences remained after adjusting for age, comorbidity, retention in HIV care, and a measure of neighborhood social disadvantage created from census data.
  
  
  
  Implementation of interventions to reduce racial disparities in HIV care should comprehensively address and monitor processes and outcomes of care for key comorbidities.
authors.affiliation: Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, 601 Hwy 6 West, Iowa City, IA 52246, USA. Electronic address: Kelly.richardson@va.gov.
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Richardson
authors.affiliation: Center for Healthcare Organization & Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Healthcare System, 200 Springs Road, Bedford, MA 01730, USA; Boston University School of Public Health, Department of Health Law, Policy, and Management, 715 Albany St, Boston, MA 02118, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bokhour
authors.affiliation: Center for Healthcare Organization & Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Healthcare System, 200 Springs Road, Bedford, MA 01730, USA; Boston University School of Public Health, Department of Health Law, Policy, and Management, 715 Albany St, Boston, MA 02118, USA.
authors.forename: D Keith
authors.initials: DK
authors.lastname: McInnes
authors.affiliation: Center for Healthcare Organization & Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Healthcare System, 200 Springs Road, Bedford, MA 01730, USA; Boston University School of Public Health, Department of Health Law, Policy, and Management, 715 Albany St, Boston, MA 02118, USA.
authors.forename: Vera
authors.initials: V
authors.lastname: Yakovchenko
authors.affiliation: Center for Innovation to Implementation, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA.
authors.forename: Leonore
authors.initials: L
authors.lastname: Okwara
authors.affiliation: Center for Innovation to Implementation, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Midboe
authors.affiliation: Center for Healthcare Organization & Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Healthcare System, 200 Springs Road, Bedford, MA 01730, USA.
authors.forename: Avy
authors.initials: A
authors.lastname: Skolnik
authors.affiliation: Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, 601 Hwy 6 West, Iowa City, IA 52246, USA; Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Vaughan-Sarrazin
authors.affiliation: Center for Innovation to Implementation, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA; Division of General Medical Science, Department of Medicine, Stanford University School of Medicine, 875 Blake Wilbur Dr, Palo Alto, CA 94304, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.affiliation: Center for Healthcare Organization & Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Healthcare System, 200 Springs Road, Bedford, MA 01730, USA; Boston University School of Public Health, Department of Health Law, Policy, and Management, 715 Albany St, Boston, MA 02118, USA.
authors.forename: Allen L
authors.initials: AL
authors.lastname: Gifford
authors.affiliation: Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, 601 Hwy 6 West, Iowa City, IA 52246, USA; Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Ohl
mesh_terms: D001741:Black or African American; D019380:Anti-HIV Agents / Q000627:therapeutic use; D015897:Comorbidity; D003920:Diabetes Mellitus; D005006:Ethnicity / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000453:epidemiology / Q000628:therapy*; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D044469:Racial Groups; D014481:United States; D044465:White People
chemical_list: D019380:Anti-HIV Agents
keywords: Comorbidity; HIV; Racial disparities; Vet