Research has shown that the percentages of blacks who are linked to and retained in HIV care, taking antiretroviral therapy (ART), and achieving viral suppression are lower than those of other racial and ethnic groups. According to recent estimates, blacks account for 44% of the total number of people in the United States living with HIV but represent just 12% of the U.S. population. The National HIV/AIDS Strategy was developed in an effort to reduce the number of new HIV infections, increase access to care, improve health outcomes for those with HIV, and reduce HIV-related health disparities. “To achieve these goals, blacks with HIV need high levels of care and viral suppression,” says Y. Omar Whiteside, PhD. Achieving these goals calls for 85% of blacks with diagnosed HIV to be linked to care, 80% to be retained in care, and the proportion with undetectable viral loads to increase by 20% by 2015.
A Large Analysis
In an issue of the Morbidity & Mortality Weekly Report, Dr. Whiteside and colleagues conducted a study to provide clinicians with proxy measures to determine where the U.S. stands in achieving the goals outlined in the National HIV/AIDS Strategy. The analysis included 19 jurisdictions with complete reporting of all levels of CD4 and viral load test results. These jurisdictions represented 44% of all blacks with HIV living in the U.S. in 2010.
The study found that about 75% of blacks diagnosed with HIV were linked to care, but less than half received regular care or were prescribed ART, and only about one-third had achieved viral suppression. “One of the most important findings was that black men had lower levels of care and viral suppression than black women,” says Dr. Whiteside. “We were surprised to learn that there were differences in levels of HIV care and viral suppression based on sex. In addition, levels of care and viral suppression for blacks younger than 25 years of age were lower than those of blacks aged 25 and older at each step along the continuum.”
In light of the findings, targeted strategies for different patient groups, such as males and youths, might be needed to achieve improvements at each step of the HIV care continuum. “A greater emphasis on increasing linkage to care, retention in care, and viral suppression for blacks could lead to reductions in HIV incidence and health inequalities,” says Dr. Whiteside. “Successfully implementing the National HIV/AIDS Strategy will enable clinicians to reduce HIV infections in the black community and, consequently, reduce the overall number of new HIV infections.” He adds that future analyses would be improved if complete reporting were available from all jurisdictions in the U.S.
Whiteside YO, Cohen SM, Bradley H, et al. Progress along the continuum of HIV care among blacks with diagnosed HIV- United States, 2010. MMWR Morb Mortal Wkly Rep. 2014;63:85-89. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6305a2.htm.
CDC. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data: United States and 6 U.S. dependent areas—2011. HIV surveillance supplemental report, 2013. Vol. 18(No. 5). Atlanta, GA: US Department of Health and Human Services, CDC; 2013. Available at www.cdc.gov/hiv/library/reports/surveillance.
Hall HI, Frazier EL, Rhodes P, et al. Differences in human immunodeficiency virus care and treatment among subpopulations in the United States. JAMA Intern Med. 2013;173:1337-1341.
Valdiserri RO, Forsyth AD, Yakovchenko V, Koh HK. Measuring what matters: development of standard HIV core indicators across the U.S. Department of Health and Human Services. Public Health Rep. 2013;128:354-359.