Use of national standards to monitor HIV care and treatment in a high prevalence city-Washington, DC.

Amanda D Castel,Alan E Greenberg,Mariah M Kalmin,Heather Young,Arpi Terzian,Rachel Hart,Nabil Rayeed,Dc Cohort Executive Committee

doi:10.1371/journal.pone.0186036

Amanda D Castel, Alan E Greenberg + Show 6 more

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https://doi.org/10.1371/journal.pone.0186036

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Abstract

We sought to benchmark the quality of HIV care being received by persons living with HIV in care in Washington, DC and identify individual-level and structural-level differences. Data from the DC Cohort, an observational HIV cohort of persons receiving outpatient care in DC, were used to estimate the Institute of Medicine (IOM) and Department of Health and Human Services (HHS) quality of care measures. Differences in care by demographics and clinic type were assessed using χ2 tests and multivariable regression models. Among 8,047 participants, by HHS standards, 69% of participants were retained in care (RIC), 95% were prescribed antiretroviral therapy (ART), and 84% were virally suppressed (VS). By IOM standards, 84% were in continuous care; and 78% and 80% underwent regular CD4 and VL monitoring, respectively. Screening for syphilis, chlamydia, and gonorrhea was 51%, 31%, and 26%, respectively. Older participants were 1.5 times more likely to be RIC compared to younger participants (OR: 1.5; 95% CI: 1.3, 1.8). Participants enrolled in community-based clinics were more likely to be RIC (OR: 1.7; 95% CI: 1.4, 2.0) versus those enrolled at hospital-based clinics. Older participants were more likely to achieve VS than younger participants (OR: 1.8; 95% CI: 1.5, 2.2) while Black participants were less likely compared to white participants (OR: 0.4; 95% CI: 0.3, 0.5). Despite high measures of quality of care, disparities remain. Continued monitoring of the quality of HIV care and treatment can inform the development of public health programs and interventions to optimize care delivery.

Highlights

The US National HIV/AIDS Strategy has established specific targets for persons living with HIV/AIDS (PLWHA) which include having 90% of people living with HIV diagnosed, 90% retained in HIV medical care, 80% achieving viral suppression, and ensuring 95% of PLWHA have stable housing [1]
When comparing our Health and Human Services (HHS)-defined retention-in-care estimate to other published estimates, we found that retention among DC Cohort participants was slightly lower than participants in NA-ACCORD (71–75%) but higher than that reported by the HIV Research Network and others (59%-65%) [4, 14,15,16,17,18,19,20,21]
The DC Cohort Institute of Medicine (IOM) continuity of care estimate was relatively high at 84% and higher than local surveillance estimates of 69%; this measure only relies on 12 months of follow-up [22]

Summary

Introduction

The US National HIV/AIDS Strategy has established specific targets for persons living with HIV/AIDS (PLWHA) which include having 90% of people living with HIV diagnosed, 90% retained in HIV medical care, 80% achieving viral suppression, and ensuring 95% of PLWHA have stable housing [1]. In order to measure progress in achieving those targets, established HIV clinical cohorts and federally-funded HIV/AIDS programs are able to measure the quality. Monitoring the quality of HIV care in DC

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