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CDC: 68% in HIV Care in USA had Sustained Viral Suppression - Increased antiretroviral therapy prescription and HIV viral suppression among persons receiving clinical care for HIV infection
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IAC/Durban/2016:Adherence With Combination Antiretroviral Therapy (cART): Do Challenges Still Persist? "31% non-adherent" - (08/03/16).....- Approximately 68.8% of participants were adherent with their HIV medications and 31.2% were non-adherent
- Approximately 22% of PCPs and 29.6% of ID specialists reported that almost all or all of their treatment-naive patients were fully adherent to their HIV medications
-Forgetting to take medication and availability of pills were the most commonly cited reasons for non-adherence by both groups [patients and doctors]
- Those taking more than 1 pill to treat their HIV were significantly more likely to be non-adherent than those taking 1 pill (41.0% vs 12.2%)
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from Jules: not very good.....newly published data from CDC
there is still a significant gap between the percentage of patients who are prescribed ART and who have sustained viral suppression.
Helping patients to achieve and sustain viral suppression may require enhanced efforts from clinical care providers and supportive service organizations to address the underlying social and behavioral factors that affect access to care, long-term medication adherence, and overall health.
In 2013, 68.0% of adults in HIV clinical care had sustained viral suppression compared with 57.6% in 2009, representing a 17% increase over time (β = 0.027, P for trend <0.01) (Fig. 1c).
In 2013, 94.1% of adults in HIV clinical care were prescribed ART (Fig. 1a). This represents a 6% increase from 88.7% in 2009 (β = 0.013,Pfor trend <0.01).
Arguably the most important was rapid accumulation of evidence supporting early initiation of ART, prompting two major changes in clinical guidelines. In 2009, guidelines began recommending ART prescription for persons with CD4+ cell counts <500 cells/μl, and the 2012 guidelines recommended ART prescription for all persons living with HIV regardless of CD4+ cell count [9]. These guideline changes may account for the large increase in ART prescription among young people, who are less likely to have advanced HIV disease than older people.
The progress demonstrated in levels of ART prescription, and viral suppression is somewhat tempered by persisting sociodemographic disparities. In 2013, sustained viral suppression was 46% lower among 18-29 year olds compared with persons aged 50 years and older and 25% lower among blacks compared with whites. These disparities likely reflect social determinants of health such as poverty, access to healthcare, health literacy, and quality of health provider-patient relationships [32-34]. The significant increases in ART prescription and viral suppression among young people and non-Hispanic blacks are encouraging, but a sustained focus on addressing social determinants of health for access to and delivery of clinical care and supportive services is needed for elimination of these disparities.
Although persons could be characterized as having sustained suppression with only one documented viral load test during the previous year, the median number of viral load tests during the previous 12 months was 2.3 tests (median ranged from 2.4 tests in 2009 to 2.2 tests in 2013)
Sustained viral suppression increased in every sub-group and varied similarly to trends in viral suppression at last viral load test (Table 3). Sustained viral suppression increased 21% among women and 16% among men; in 2013, 63.5% of women and 69.6% of men had sustained viral suppression (P < 0.01). Sustained viral suppression increased 60% among persons aged 18-29 years and 36% among those aged 30-39 years. Large disparities in sustained viral suppression persisted in 2013, however, with 50.5% of 18-29 year olds having sustained viral suppression compared with 73.9% of those aged 50 years and older (P < 0.01). A 23% increase in sustained viral suppression was observed among blacks, compared with a 17% increase among Hispanics and a 14% increase among whites. Still, 61.0% of blacks were had sustained viral suppression in 2013 compared with 76.0% of whites (P < 0.01).
Increases in ART prescription also accounted for some of the increase over time in sustained viral suppression. The three percentage point average annual increase in sustained viral suppression (β = 0.027, P for trend <0.01) decreased to two percentage points (β = 0.022, P for trend <0.01) after adjustment for ART prescription; ART prescription accounted for nearly 19% of the increase in sustained viral suppression (not shown).
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Viral suppression at last viral load test increased 11% from 2009 to 2013, from 71.6 to 80.1% (β = 0.020, P for trend <0.01) (Fig. 1b).
The magnitude of this increase was larger among women (16% increase) than among men (10% increase). However, some disparity by sex remained in 2013; 81.3% of men were virally suppressed at last viral load test compared with 76.5% of women (P < 0.01). Increases in viral suppression were larger among younger age groups, with a 20% increase among 18-29 year olds, and a 22% increase among 30-39 year olds. The percentage increase in viral suppression among blacks (18% increase) was twice as high as the increase among whites (8% increase) and Hispanics (9% increase). In 2013, 75.5% of blacks were virally suppressed compared with 86.0% of whites. Last, viral suppression increased more among heterosexual persons (14-16% increase) compared with MSM (9% increase).
Overall and in all demographic sub-groups, increases in viral suppression were at least partially mediated by increases in ART prescription, although most linear trends in viral suppression remained significant after adjustment for ART prescription.
Among persons aged 18-29 years, increases in ART prescription accounted for most (75%) of the linear increase in viral suppression at last viral load test (Table 2).
Although a larger increase in ART prescription was observed among blacks compared with whites, ART prescription accounted for a similar proportion of the increase in viral suppression in both groups, accounting for 25% of the increase among whites and 29% among blacks. However, increases in ART prescription accounted for 42% of the change in viral suppression among Hispanics. The trend for viral suppression among Hispanics was no longer significant after adjustment for ART prescription (β = 0.009, P for trend = 0.07).
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Increased antiretroviral therapy prescription and HIV viral suppression among persons receiving clinical care for HIV infection
AIDS Aug 24 2016 Bradley, Heather; Mattson, Christine L.; Beer, Linda; Huang, Ping; Shouse, R. Luke; for the Medical Monitoring Project.
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Abstract
Objective: To assess trends during 2009-2013 in antiretroviral therapy (ART) prescription and viral suppression among adults receiving HIV clinical care in the United States.
Design: We used data from the Medical Monitoring Project, a surveillance system producing national estimates of characteristics of HIV-infected adults receiving clinical care in the United States.
Methods: We estimated weighted proportions of persons receiving HIV medical care who were prescribed ART and achieved HIV viral suppression (<200 copies/ml) at both last test and at all tests in the previous 12 months during 2009-2013. We assessed trends overall and by gender, age, race/ethnicity, and sexual behavior/orientation.
Results: ART prescription and viral suppression increased significantly during 2009-2013, overall and in subgroups. ART prescription increased from 89 to 94% (P for trend <0.01). Viral suppression at last measurement increased from 72 to 80% (P for trend <0.01). The largest increases were among 18-29 year olds (56-68%), 30-39 year olds (62-75%), and non-Hispanic blacks (64-76%). Sustained viral suppression increased from 58 to 68% (P for trend <0.01). The largest increases were among 18-29 year olds (32-51%), 30-39 year olds (47-63%), and non-Hispanic blacks (49-61%).
Conclusion: Adults receiving HIV medical care are increasingly likely to be prescribed ART and achieve viral suppression. Recent efforts to promote early antiretroviral therapy use may have contributed to these increases, bringing us closer to realizing key goals of the National HIV/AIDS Strategy.
US Department of Health and Human Services’ clinical guidelines were revised in 2012 to recommend ART initiation for all persons living with HIV regardless of immune status [9].
One of the goals of the US National HIV/AIDS Strategy (NHAS) is to “increase access to care and improve health outcomes for people living with HIV,” including increasing viral suppression in this population [10,11]. Progress toward this goal is monitored using the HIV care continuum framework, which illustrates the importance of being diagnosed, engaged in clinical care, and prescribed ART as requisite steps for achieving viral suppression. Because engagement in clinical care does not guarantee attainment of viral suppression, it is important to routinely monitor ART prescription and viral suppression among persons receiving HIV clinical care. Using data from the Medical Monitoring Project (MMP), a nationally representative sample of HIV-infected adults in care, we estimated trends from 2009 to 2013 in ART prescription and viral suppression among persons receiving HIV clinical care.
![Graph](../images/090616/090616-1/Graph.gif)
Antiretroviral therapy prescription
In 2013, 94.1% of adults in HIV clinical care were prescribed ART (Fig. 1a). This represents a 6% increase from 88.7% in 2009 (β = 0.013, P for trend <0.01). There were increasing linear trends in ART prescription from 2009 to 2013 in every sex, age, racial/ethnic, and sexual orientation group apart from persons of ‘other’ race/ethnicity (Table 1). A larger increase was observed among women (10% increase) compared with men (5% increase), eliminating the 2009 disparity, when 85.6% of women were prescribed ART compared with 89.8% of men (P < 0.01). ART prescription increased by 24% among persons aged 18-29 years, from 72.2% in 2009 to 89.3% in 2013 (β = 0.04, P for trend <0.01). The magnitude of this change was smaller in older age groups. By race/ethnicity, ART prescription increased more among blacks (8% increase) and Hispanics (7% increase) compared with whites (3% increase). In 2013, 95.2% of whites and Hispanics were prescribed ART, compared with 92.9% of blacks (P = 0.01).
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