High retention in care and durable viral suppression in an urban HIV housing services client population

Background: The federal Housing Opportunities for Persons with AIDS (HOPWA) program addresses housing needs of low-income HIV-infected persons. The New York City (NYC) Department of Health and Mental Hygiene oversees NYC HOPWA and manages NYC surveillance data from the HIV Surveillance Registry (HSR). This analysis examined viral suppression and care retention in NYC HOPWA. Methods: HOPWA 2010 enrollees were matched with the HSR (N=2,535). Viral load (VL) and CD4 test events served as proxies for care. Based on the National HIV/AIDS Strategy (NHAS) indicator, retention was defined ≥2 tests per year ≥3 months apart. Durable suppression was defined as no VL >400 copies/mL, among clients with ≥2 VL ≥2 weeks apart in 2010. Results: 2,427 clients (96%) had a 2010 VL or CD4 test. The sample was largely male (62%), black or Hispanic (95%), and aged 40+ (71%). Approximately one-quarter of clients resided in each of Brooklyn, Manhattan and the Bronx. Reported transmission risks included MSM (27%), heterosexual (27%), unknown (23%), injection drug (22%), and perinatal (under 2%). Eight-six percent met the NHAS retention definition. Of 1,967 clients with ≥2 eligible VL results, 998 (51%) showed durable suppression. Durable suppression was less likely among Bronx clients, those under 30, and those with injection drug or perinatal transmission history. Conclusions: Half of NYC HOPWA clients achieved durable viral suppression. The groups less likely to succeed resembled those with suboptimal care engagement in the larger NYC population with HIV. Integrated analysis of surveillance and programmatic data offers a powerful tool for monitoring progress toward NHAS goals.