TUPE212 Poster Exhibition
Controlling the Massachusetts HIV epidemic: triangulated measures of care access and HIV incidence
Presented by Kevin Cranston (United States).
K. Cranston1, H.D. Fukuda2, M. Goldrosen3, L. Kunches4, J. Holman4
1Massachusetts Department of Public Health, Bureau of Infectious Disease, Boston, United States, 2Massachusetts Department of Public Health, Office of HIV/AIDS, Boston, United States, 3Boston Public Health Commission, HIV/AIDS Services Division, Boston, United States, 4JSI Research and Training Institute, Inc., Boston, United States
Background: U.S. HIV incidence is stable and models suggest fewer than 30% of HIV+ persons are achieving viral suppression. National policy promotes early identification of HIV infection, linkage to care, and access to ARVs to promote health and reduce transmission.
Methods: State HIV incidence reports (2000 and 2009) were compared. Health care measures were collected through a self-reported 2009 survey tool by 1,006 HIV+ persons recruited through community-based care and support services providers. Nurse-abstracted clinical charts (n=967) from 14 state-, city-, and federal Ryan White-funded HIV/AIDS clinics were reviewed in 2008. Measures included indicated ARV use consistent with treatment guidelines and rates of viral suppression (VL< 400 copies/mL)
Results: Reported new HIV diagnoses in Massachusetts have declined by 52% (1,193 to 567) between 2000 and 2009. Seventy-two percent of survey respondents and 71% of patient charts indicate current/sustained viral suppression. Nearly all (99%) survey respondents were in medical care and 92% of patients had had at least two medical visits separated by at least four months in the past year; 91% of survey respondents and 96% of indicated patients were prescribed and were taking ARVs.
Conclusions: Massachusetts is the first state in the U.S. to implement health care reform; 98% of its residents are insured. Coupled with high-quality HIV specialty care, an extensive community health center system, and universal ARV access, Massachusetts is able to offer the standard of HIV care to nearly all persons with HIV/AIDS in the state. It is consistent with current models to assume that this extraordinary treatment access and utilization have contributed significantly to the observed reduction in HIV incidence in the state.
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