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Missed Opportunities: Adapting the HIV Care Continuum to Reduce HIV-related Deaths.

Missed Opportunities: Adapting the HIV Care Continuum to Reduce HIV-related Deaths.
Author Information (click to view)

Braunstein SL, Robbins RS, Daskalakis DC,


Braunstein SL, Robbins RS, Daskalakis DC, (click to view)

Braunstein SL, Robbins RS, Daskalakis DC,

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Journal of acquired immune deficiency syndromes (1999) 2017 07 26() doi 10.1097/QAI.0000000000001509

Abstract
INTRODUCTION
With advances in HIV care, persons with HIV/AIDS (PWHA) can lead healthy lives, but avoidable, HIV-related deaths continue to occur in New York City (NYC).

METHODS
We selected PWHA from our surveillance registry who died between 2007-2013, resided in NYC, and survived ≥15 months post-diagnosis to generate an HIV Mortality Reduction Continuum of Care (HMRCC) describing pre-death care patterns among PWHA. We used HIV laboratory test reports to measure care outcomes during an "intervenable period" (IP) during which deaths may have been avoided. The continuum was stratified by underlying cause of death (COD) (HIV-related vs. other), and the HIV-related HMRCC was stratified by demographic characteristics.

RESULTS
11,187 analysis-eligible PWHA died during 2007-2013. 98% linked to care; 80% were retained in care during the IP; 66% were prescribed ART; 47% had VL≤1,500 copies/mL; 40% achieved viral suppression (VS). Half (47%) of deaths were HIV-related. Retention was higher among HIV-related COD (83% vs. 78%), but VS was lower (34% vs. 46%). The HIV-related HMRCC revealed disparities in VS. Despite comparable retention rates, Whites had the highest VS (42%, vs. 32% Blacks and 33% Latinos/Hispanics). Additionally, retention and VS increased with increasing age. People with a history of injection drug use had relatively high rates of retention (88%) and VS (37%).

DISCUSSION
The HMRCC is a novel framework for evaluating pre-death care patterns among PWHA and identifying opportunities to reduce preventable deaths. In NYC, reducing mortality will require increasing VS among those already in care, particularly for Blacks and Latinos/Hispanics.

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