Researchers Propose Adding Viral Suppression Within 3 Months of HIV Diagnosis to HIV/AIDS Strategy

In 2015, the 5-year National HIV/AIDS Strategy for gaining hold of and ending the HIV epidemic was released. To monitor progress, the strategy includes 10 process and outcome indicators, including increasing the percentage of people living with HIV who know their status to 90%, increasing the percentage of those with HIV who are retained in HIV medical care to at least 90%, and increasing the percentage of people diagnosed with HIV who are virally suppressed to at least 80%.

However, there is just 1 process indicator for those recently diagnosed with HIV: the percentage of newly diagnosed person linked to HIV medical care within 1 month of diagnoses, with a target of 85% by 2020. Recognizing a need for an outcome indicator for those newly diagnosed with HIV, researchers have proposed including the percentage of newly diagnosed persons achieving viral suppression within 3 months of diagnosis.

“Outcome indicators reflect the impact of a healthcare service or an intervention on the health status of the population and are often treated as the ‘gold standard’ in measuring quality of care,” explained the researchers.

Using HIV registry data of people living with HIV in New York, New York, as of December 2017, the researchers determined that among the 27,520 diagnoses, the percentage of virally suppressed persons increased from 9% in 2007 to 37% in 2016. While men were less likely to achieve viral suppression in 2007 (7.6% vs 13.3%), they had a larger increase during the study period and had nearly equal rates by 2016 (37% vs 38.9%).

These increased rates of viral suppression are due in large part to improvement in timely linkage to care following an HIV diagnosis, as well as antiretroviral therapy (ART), which is currently recommended for immediate initiation for all people living with HIV.

Despite these improvements, the researchers still observed disparities among race and ethnicity. Compared with whites, blacks and Hispanics were more likely to be virally suppressed from 2007-2009, but were less likely from 2013-2015. In 2016, percentages were similar among whites and Hispanics (40% and 39.5%, respectively) and higher among those 2 groups than among blacks (33.6%).

“The higher proportion of blacks and Hispanics achieving higher viral suppression in earlier years could be explained by differences in ART prescription,” noted the researchers. “During 2007-2011, the treatment guidelines recommended ART for person with CD4 count <500 cell/ μL. Because more blacks and Hispanics than whites had a CD4 count <500 cells/μL at diagnosis, they were more likely to be prescribed ART after diagnosis and hence more likely to achieve viral suppression.”

Reference:

Xia Q, Coeytaux K, Braunstein S, et al. Proposing a new indicator for the National Human Immunodeficiency Virus/AIDS Strategy: Percentage of newly diagnosed persons achieving viral suppression within 3 months of diagnosis [published October 10, 2018]. J Infect Dis.