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October 3 -7, 2019
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Community Clinics Control HIV as Well
as Hospital Clinic in Chicago MSM

  IDWeek, October 2-6, 2019, Washington, DC
Mark Mascolini
Community clinics controlled HIV load in Chicago men who have sex with men (MSM) and transgender women as well as a hospital clinic, even though the community-care group faced documented hurdles to HIV care more often than the hospital group [1]. Younger age, alcohol use, and lack of insurance predicted virologic failure.
MSM and transgender women continue to account for a high proportion of HIV infections in the United States and countries with similar epidemics. People living with HIV in metropolitan areas may receive care at community clinics or hospital-based clinics for a variety of reasons, not always including choice. University of Illinois at Chicago researchers conducted this study to see if HIV control measured by viral load differed between Chicago-area MSM and transgender women depending on whether they received care at a community clinic or a hospital clinic.
This retrospective cohort study involved MSM and transgender women in care at one of six community clinics or a single hospital clinic in Chicago between January 2010 and December 2014. The main study outcome was cumulative probability of virologic failure, defined as a viral load at or above 200 copies. The researchers used a multivariable Cox proportional hazards model to explore associations between type of HIV clinic, other variables, and virologic failure.
The analysis involved 258 people, 19 of them (7%) transgender women. The cohort had a median age of 39 (range 19 to 72). People getting care at a community clinic were significantly more likely to be black (71% versus 59%, P = 0.04), uninsured (48% versus 39%, P < 0.01), former prison inmates (14% versus 2%, P < 0.01), and drug users during the study period (40% versus 25%, P < 0.01).
Despite these disadvantages in the community population, they did not differ significantly from the hospital group in proportion with virologic failure (58% and 53%) or incidence of virologic failure (24 and 20 per 100 person-semesters, adjusted hazard ratio [aHR] 1.1, 95% confidence interval [CI] 0.9 to 1.4).
Three factors did predict virologic failure: younger age, public insurance or no insurance, and alcohol use during the study:
Compared with age 50 or older:
Age 40 to 49: aHR 2.31, 95% CI 1.51 to 3.52
Age 30 to 39: aHR 2.27, 95% CI 1.47 to 3.50
Age under 30: aHR 3.79, 95% CI 2.48 to 5.81
Compared with private insurance:
Medicare, Medicaid, or other public insurance: aHR 1.91, 95% CI 1.31 to 2.78
No insurance: aHR 1.70, 95% CI 1.18 to 2.47
Compared with no alcohol use during study:
Alcohol use: aHR 1.63, 95% CI 1.29 to 2.05
The University of Illinois team suggested that antiretroviral treatment success in the community clinics may be partly explained by targeted case management, intensive street outreach, and "sexual orientation-affirming services."
1. Brito MO, Khosla S, Mehta SD, Novak RM. Virologic failure in HIV infected men who have sex with men and transgender women treated in a community based model vs. a hospital based model. IDWeek, October 2-6, 2019, Washington, DC. Abstract 1307.