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Black people have low levels of engagement and retention in HIV care in the US
Michael Carter, 2014-02-10 10:30:00
efforts are needed to improve engagement by black people in the HIV care
continuum in the United States, according to data published in the 7 February
edition of Morbidity and Mortality Weekly
In 2010, an
estimated 75% of black, HIV-positive adults were linked to care, 48%
were retained in care, 46% were taking antiretrovirals and 35% had an
undetectable viral load. These outcomes are well below the goals of the
National HIV/AIDS Strategy and the HIV Care Continuum Initiative. Engagement
with care was especially low among male and younger people.
demonstrate the need for implementation of interventions and public health
strategies that increase linkage to care and consistent ART among blacks,”
comment the investigators. They note achievement of the goals of the national
HIV strategy and HIV care continuum require 85% of black people diagnosed
with HIV to be linked to care, 80% to be retained in care, and the proportion
with an undetectable viral load to increase by a fifth.
Black people are the
racial group most affected by the HIV epidemic in the US, comprising 44% of all
new infections and 44% of all people living with HIV. Control of the US HIV epidemic
therefore requires high levels of engagement among black people with all
stages of the HIV care continuum.
data collected from the National HIV Surveillance System and Medical Monitoring
Project to assess engagement with HIV care and antiretroviral treatment
outcomes among black people in 2010.
black people diagnosed with HIV in 2010 were linked to HIV care within three
months of diagnosis. The rate of linkage to care was higher among females than males
(81 vs 72%). People aged 13 to 24 years had the lowest rate of linkage to care
of any age group (69%); linkage increased with age group (e.g., over 55 years =
81%). As regards transmission category, individuals in the men who have sex
with men risk group had the lowest rate of linkage to care (72%), and the women
in the injecting drug use and heterosexual risk categories had the highest
rates of linkage (82 and 81%, respectively).
Overall, 48% of
black people were retained in care. A higher proportion of women were
retained in care than men (51 vs 47%, respectively). Retention in care was
lower in younger age groups compared to older age groups. Analysis by
transmission category showed the rate of retention in care was lowest among
male injecting drug users (44%) and highest among women infected via drug use
or heterosexual contact (both 51%).
Well under half
(46%) of black people were prescribed HIV therapy. Women were more likely
than men to be utlitising antiretroviral treatment (51 vs 44%, respectively).
The prevalence of antiretroviral useage increased with age, from 21% among the
18 to 24 age group, to 57% among those aged over 55 years. Males infected via
injecting drug use were the risk group least likely to be taking HIV treatment
(34%), whereas useage was highest among heterosexual women (51%).
Just over a third
(35%) of black people had an undetectable viral load. The rate of virological
suppression was higher in women than men (40 vs 33%, respectively) and
increased with age. Only a fifth of male injecting drug users had an
undetectable viral load compared to 41% of female heterosexuals.
“Blacks with HIV
might not seek, receive, or adhere to HIV care or achieve viral suppression for
reasons including lack of health insurance, poverty and stigma,” suggest the
authors. “HIV programs that focus on care and treatment for blacks might
strengthen these efforts to link and retain HIV-infected persons in care and
promote adherence to medication to achieve optimal health outcomes.”
They suggest that
interventions are especially needed for male and younger people. “Focusing
prevention and care efforts on populations that bear a disproportionate burden
of HIV disease could lead to reductions in HIV incidence and health
inequalities and help achieve the goals of the National HIV/AIDS Strategy.”