XIX International AIDS Conference

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FRLBX05 - Oral Abstract Session


Continuum of HIV care: differences in care and treatment by sex and race/ethnicity in the United States

Presented by H Irene Hall (United States).

H.I. Hall1, E.L. Frazier1, P. Rhodes1, D.R. Holtgrave2, C. Furlow-Parmley1, T. Tang3, K.M. Gray1, S.M. Cohen1, J. Skarbinski1


1Centers for Disease Control and Prevention, Atlanta, United States, 2Johns Hopkins Bloomberg School of Public Health, Baltimore, United States, 3ICF International, Atlanta, United States

Background: Early diagnosis of HIV, prompt linkage and sustained care, and antiretroviral therapy are associated with reduced individual morbidity and mortality and onward transmission of the virus. However, optimal levels of these indicators may not be achieved by all population groups with HIV.
Methods: Using data from CDC's National HIV Surveillance System, we determined the number of persons living with HIV aware and unaware of their infection using back-calculation models, and the percentage of persons linked to care within three months of diagnosis based on CD4 and viral load tests. We estimated the percentages of persons retained in care, prescribed antiretroviral therapy, and with viral suppression using data from the Medical Monitoring Project, a surveillance system of persons in HIV care in select areas representative of all such persons in the United States. Using these data, we determined the continuum of care indicators for persons with HIV by sex and race/ethnicity.
Results: Of the estimated 1,148,200 persons living with HIV in 2009 in the United States, 869,000 (76%) were male, 510,600 (44%) black or African American, and 220,400 (19%) Hispanic or Latino. The percentages of females diagnosed, linked to care, retained in care, and prescribed ART were slightly higher than for males but there were no substantial differences in viral suppression. The percentages were lower in each stage of the continuum for blacks/African Americans and Hispanics/Latinos compared with whites. Overall, 857,276 persons with HIV were not virally suppressed, including 75% of males, 79% of blacks/ African Americans, 74% of Hispanics/Latinos, and 70% of whites. Numbers were too small to present for other races.
Conclusions: Disparities exist in each step of the continuum for blacks/African Americans and Hispanics/Latinos. Additional efforts are needed to ensure that all persons with HIV get optimal care, reduce disparities, and ultimately reduce HIV transmission.


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