Abstract

WEPE132 - Poster Exhibition

Evaluation of HIV-related care and treatment in Louisiana using monitored viral load and CD4 measures

D. Wendell

Louisiana Office of Public Health, STD/HIV Program, New Orleans, United States

Background: HIV surveillance data, in areas that have complete reporting of CD4 and viral loads (VL), can be used to evaluate care and treatment for persons living with HIV. Virologic suppression, monitored VL, and engagement in care are measures currently being monitored in Louisiana.
Methods: All CD4 and VL results are reportable in Louisiana, and an electronic system to obtain and import results has been developed. The proportion of persons living with HIV who had suppressed VL (< 200 copies/mL) using the most recent VL per person in 2010 were analyzed. Monitored VL was calculated according to CDC's recent guidance using most recent log transformed VL to reduce the influence of outliers. Engagement in care was defined as the proportion of persons with >2 CD4 or VL results > 90 days apart. Analyses by sex, race, type of care facility and Ryan White (RW) program were conducted.
Results: In 2010, the statewide mean VL was 36,818, and 62.5% of persons had suppressed VL. Females had a significantly higher mean log(10) VL compared to males (2.34 vs. 2.19, p< 0.0001) and a lower percentage had viral suppression (56.5% vs. 65.5%). Blacks had a significantly higher mean log(10) VL compared to whites (2.37 vs. 1.95, p< 0.0001) and a lower percentage had viral suppression (57.6% vs. 73.7%).

	No. of persons living with HIV as of 12/31/2010 with a VL in 2010	Mean of most recent VL	Mean of most recent log transformed VL	Percent with suppressed VL (<=200 copies/mL)
Total	10,523	36,818	2.24	62.5
Female	3,430	38,634	2.34*	56.5
Male	7,093	35,940	2.19	65.5
Black	7,169	37,331	2.37*	57.6
White	2,981	36,336	1.95	73.7
*p-value<0.0001 on Z-test for difference in mean

[Table 1. Most recent VL by sex and race, 2010]

Persons receiving care at community health centers and those receiving RW assistance with medications and health insurance premiums had a lower mean VL and greater VL suppression.

	No. of clients with a VL in 2010 *	Mean of most recent VL	Mean of most recent log transformed VL	Percent with suppressed VL (<=200 copies/mL)
Community health center	1,824	25,603	2.15	68.9
Correctional facility	437	49,180	2.26	65.9
Private hospital	1,664	61,490	2.29	66.7
Private physician	1,245	22,751	2.32	63.6
AIDS Drug Assistance Program (ADAP)	2,836	27,713	1.81	75.1
Ancillary services	2,993	37,253	2.07	66.5
Health Insurance Program (HIP)	1,063	8,655	1.70	80.2
*Persons may be included in more than one facility type and Ryan White program

[Table 2. Most recent VL by facility and program]

Persons receiving RW services were also more likely to be in continuous care.

	No. of persons living with HIV as of 12/31/2010 with at least one care visit in 2010	No. of persons living with HIV engaged in continuous care (>=2 visits >=90 days apart in 2010)	Percent of persons living with HIV engaged in continuous care
Total	11,291	8,410	74.5
Female	3,652	2,690	73.7
Male	7,639	5,720	74.9
Black	7,638	5,637	73.8
White	3,247	2,483	76.5
ADAP	2,891	2,475	85.6
Anclillary services	3,046	2,479	81.4
HIP	1,104	970	87.9

[Table 3. Persons engaged in continuous care, 2010]


Conclusions: CD4 and VL measures highlight several areas where enhanced interventions are needed to maintain persons in care and reduce health disparities, particularly among blacks and women. Persons receiving RW ADAP and HIP services have better VL outcomes and are more likely to be in continuous care.
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