Chartbook on Effective Treatment

• Since inception, the Ryan White HIV/AIDS Program (RWHAP) has provided funds for primary care and support services for people living with and affected by HIV.
• Working with States, cities, and local community organizations, the RWHAP works to improve the quality of HIV-related care for those who lack sufficient health care coverage or financial resources to cope with HIV.
• For a second year, we present data from the RWHAP:
  • Data presented are limited to those who received care through the RWHAP.
  • Data are not representative of the entire HIV population, which is estimated to be about 1.2 million people in the United States.
• For more information, go to http://hab.hrsa.gov/abouthab/aboutprogram.html.

Ryan White Program Patients With Viral Load Below 200

Ryan White program HIV patients with at least one HIV care visit and most recent viral load <200 during the year, 2011

Source: Health Resources and Services Administration, HIV/AIDS Bureau, 2011.

• Overall Rate:
  • The number of HIV-positive clients with at least one HIV medical care visit and at least one viral load available was 264,595; 72.6% were virally suppressed (defined as most recent HIV RNA <200 copies/mL in the calendar year). It is important that RWHAP providers and grantees focus on improving viral load suppression rates in their States, as well as comparing their performance with other States.
• Differences by State:
  • Quartile ranges were as follows:
    • 1^st quartile (lowest): 53.7%-69.9% (AR, FL, IN, LA, MD, MS, MO, NJ, NY, TX, UT, VI, WY).
    • 2^nd quartile: 70.0%-74.8% (AL, AK, CT, DE, GA, IL, KY, MI, NV, NC, OH, OK, PR, SC, TN, WI).
    • 3^rd quartile: 75.0%-79.7% (CA, CO, DC, HI, IA, KS, MN, NE, NM, OR, PA, SD, VA).
    • 4^th quartile (Highest): 80.4%-97.4% (AZ, ID, MA, ME, MT, ND, NH, RI, VT, WA, WV).
  • In 2011, most of the New England States were in the highest quartile for the percentage of Ryan White program patients with at least one HIV care visit and most recent viral load of less than 200 during the year. Most of the West South Central states were in the lowest quartile.

Ryan White Program Patients Retained in HIV Care

Ryan White program HIV patients who were retained in HIV care (at least 2 ambulatory visit dates at least 90 days apart) by race/ethnicity, income, insurance, and sex

Key: NHOPI = Native Hawaiian or Other Pacific Islander; AI/AN = American Indian or Alaska Native.
Source: Health Resources and Services Administration, HIV/AIDS Bureau, 2010-2011.
Note: Retained in care is defined as having at least two HIV medical care visit dates that were at least 90 days apart in the calendar year, with the first visit occurring before September 1. White, Black, Asian, NHOPI, and AI/AN are non-Hispanic. Hispanic includes all races. Poor refers to household incomes below the Federal poverty line; low income, from the poverty line to just below 200% of the poverty line; middle income, 200% to just below 300% of the poverty line; and high, 300% of the poverty line and over.

• Overall Rate: The number of HIV-positive clients with at least one HIV medical care service and at least one HIV medical care visit date available during 2011 was 276,067. In 2011, 82.2% of Ryan White program HIV patients were retained in care.
• Groups With Disparities:
  • In both years, Black and AI/AN HIV-positive clients were less likely to be retained in care than White HIV-positive clients.
  • In both years, HIV-positive clients from low and middle income households were more likely to be retained in care compared with those from high income households.
  • In both years, HIV-positive clients with Medicaid and those without insurance were less likely to be retained in care compared with those with private insurance.
  • In both years, transgender HIV-positive clients were less likely to be retained in care compared with nontransgender male HIV-positive clients.
  • The HIV/AIDS Bureau does not ask the sexual orientation of clients, but it collects variables that portray aspects of sexual orientation, including gender, transgender status, sex at birth, and client risk factors, such as men who have sex with men. For more information, go to https://careacttarget.org/sites/default/files/file-upload/resources/2014RSRManual508_0.pdf [4.7 MB].

References

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Branch AD, Van Natta ML, Vachon ML, et al. Studies of the Ocular Complications of AIDS Research Group. Mortality in hepatitis C virus-infected patients with a diagnosis of AIDS in the era of combination antiretroviral therapy. Clin Infect Dis 2012 Jul;55(1):137-44. Epub 2012 Apr 24. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3369565/.

Buchacz K, Baker RK, Palella Jr FJ, et al. AIDS-defining opportunistic illnesses in US patients, 1994-2007: a cohort study. AIDS 2010;24:1549-59.

Centers for Disease Control and Prevention. Gay and Bisexual Men. July 2015a. http://www.cdc.gov/hiv/group/msm/index.html. Accessed July 13, 2015.

Centers for Disease Control and Prevention. HIV Among Transgender People. April 2015b. http://www.cdc.gov/hiv/group/gender/transgender/index.html. Accessed July 13, 2015.

Centers for Disease Control and Prevention. HIV and Viral Hepatitis. March 2014. http://www.cdc.gov/hiv/pdf/library_factsheets_hiv_and_viral_hepatitis.pdf [329 KB]. Accessed June 30, 2015.

Centers for Disease Control and Prevention. HIV in the United States: At A Glance. July 2015c. http://www.cdc.gov/hiv/statistics/basics/ataglance.html. Accessed June 30, 2015.

Centers for Disease Control and Prevention. Diagnoses of HIV infection in the United States and dependent areas, 2013. HIV Surveillance Report, Volume 25. http://www.cdc.gov/hiv/library/reports/surveillance/. February 2015d. Accessed June 27, 2015.

Herbst JH, Jacobs ED, Finlayson TJ, et al. Estimating the HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behav 2008 Jan;12(1):1-17. Epub 2007 Aug 13. PMID: 17694429.

Ingle SM, May MT, Gill MJ, et al. Impact of risk factors for specific causes of death in the first and subsequent years of antiretroviral therapy among HIV-infected patients. Clin Infect Dis 2014 Jul 15;59(2):287-97. Epub 2014 Apr 24. PMID: 24771333. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4073781/. Accessed July 14, 2015.

Moore R. Epidemiology of HIV infection in the United States: implications for linkage to care. Clin Infect Dis 2011;52(S2):S208-13. PMID: 21342909. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3106255/. Accessed July 14, 2015.

Office of National AIDS Policy. National HIV/AIDS strategy for the United States. Washington, DC: The White House; July. https://www.whitehouse.gov/administration/eop/onap/nhas/. Accessed July 29, 2015.

Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Washington, DC: U.S. Department of Health and Human Services. http://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.pdf [4.2 MB]. Accessed June 26, 2015.

Stephens SC, Bernstein KT, Philip SS. Male to female transgender person have different sexual risk behaviors yet similar rates of STDs and HIV. AIDS Behav 2011 Apr;15(3):683-6. PMID: 20694509.

Yangco BG, Buchacz K, Baker R, et al. Is primary Mycobacterium avium complex prophylaxis necessary in patients with CD4 <50 cells/uL who are virologically suppressed on cART? AIDS Patient Care STDs 2014;28(6):280-3.

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