207263 Viral suppression rates in New York State: How good have we gotten?

Monday, November 9, 2009: 8:30 AM

Karen L. Schneider, PhD , JSI Research & Training Institute, Inc. (JSI), Boston, MA
Bruce D. Agins, MD, MPH , NY AIDS Institute, New York, NY
Wendy Chow, MPH , JSI Research & Training Institute, Inc. (JSI), Boston, MA
Karl Heiner, PhD , School of Business, SUNY New Paltz, New Paltz, NY
Christopher G. Wells , NY AIDS Institute, New York, NY
Hugh Dai, MD , NY AIDS Institute, New York, NY
Lisa R. Hirschhorn, MD, MPH , Global Health Delivery Project, Harvard University, Boston, MA
Background: Advances in antiretroviral therapy (ART) have resulted in greater chances of viral suppression (VS) for patients. However, limited data exist on population rates of VS. NY State HIV/AIDS quality improvement program data were used to examine population rates of ART-related VS.

Methods: 101 NY HIV care centers submitted data on 5,417 patients seen in 2007. Eligible patients had ≥2 visits and viral loads (VL) in 2007 and were on ART in all trimesters seen. Outcomes included: VL≤50 and ≤400 on every VL (always suppressed, AVS) and on >1 VL (ever suppressed, EVS). VS disparities were examined using bivariate and multivariate logistic regression.

Results: 87% were EVS at ≤400 (56%, VL≤50) and 63% AVS at ≤400 (31%, VL≤50). Significantly (p<0.001) lower AVS rates (≤400) were found for younger patients, minorities, non- MSM risk, current substance users, patients less engaged in care, and patients with CD4 counts always ≤200. AVS≤50 showed similar results. While rates of EVS were higher than AVS, similar disparities were seen. In multivariate models, significantly (p<0.05) lower rates of AVS<400 was seen in younger patients, Blacks, Hispanics, IDU risk, HET and CD4<200. For EVS<400, lower rates were seen in younger patients, minorities, IDU risk, HET, patients less engaged in care and patients with CD4<200. Results were similar for VL<50.

Conclusions: VS rates in this statewide sample were higher than in earlier population studies, regardless of VL measure used. However, disparities exist. Further evaluation is needed to explore other factors for non-suppression (adherence, resistance) and quality of care.

Learning Objectives:
Analyze patient data from NY HIV care sites to estimate rates of viral suppression. Evaluate the extent to which disparities exist in viral suppression rates.

Keywords: HIV/AIDS, Treatment Outcomes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Dr. Schneider has a PhD in epidemiology and has been working with the NY AIDS Institute on an evaluation of the HIVQUAL-US quality improvement program for the past year. The NY AIDS Institute provided the data, and Dr. Schneider and Ms. Chow analyzed the data for this abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.