August 10, 2015 – Racial Disparity in the HIV Continuum of Care: HIV Care Updates for the Indianapolis-Carmel Metropolitan Statistical Area

Marion County Public Health Department, Epidemiology Request DR2370
Prepared by: Tammie L. Nelson, MPH, CPH

The Marion County Public Health Department’s Ryan White Services Program oversees Ryan White Part A, C, and Minority AIDS Initiative grants in the Indianapolis-Carmel Metropolitan Statistical Area (MSA). These programs serve the needs of persons newly infected or living with HIV and out of care and/or uninsured or medically underserved.

HIV Continuum of Care: Engagement in the continuum of care is important in the prevention of secondary transmission and for improving health outcomes and quality of life among people living with HIV (PLWH).1,2,3 While engagement in care in the MSA is similar to the U.S. overall (see the April 2015 Quality Matters article), disparities are experienced by racial minorities (Figure 1).4

Figure 1: HIV Continuum of Care by Race/Ethnicity, Indianapolis-Carmel MSA: 2014

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HIV Diagnosis: Overall, about 14% of HIV-positive U.S. residents are undiagnosed and unaware of their status.5 When evaluated by race/ethnicity, a higher percentage of minorities are undiagnosed.5 Among White PLWH, about 12% are thought to be undiagnosed while the estimate among Blacks and Latinos is 15%. The percentage of undiagnosed PLWH is even higher among other racial/ethnic minorities.

Linkage to Care: Among MSA residents living with HIV, the largest racial disparity is in linkage to care, defined as having attended one’s first HIV primary care visit within 90 days of diagnosis. Of MSA residents newly diagnosed with HIV during 2014, only 68% of Blacks and 78% of Latinos were linked to care within 90 days as compared to 87% of Whites and 100% of other races/ethnicities.

Retention in Care: Although less likely to be linked to care within 90 days of their diagnoses, Blacks and Latinos were more likely to be retained in care, defined by having attended at least one HIV medical visit in each six month period of 2013 and 2014 with at least 60 days between one visit in each period. About 51% of Blacks and 54% of Latinos were retained in care throughout 2013-2014; whereas only 47% of Whites and 46% of others were retained in care.

Prescription of HIV Antiretroviral Medications (ART): Because reporting prescriptions for ART is not mandated in Indiana, and because the percentage of PLWH having suppressed viral loads is much higher than the percentage of ART prescriptions reported, it is assumed that ART prescriptions are grossly under reported. For this reason, disparities in this measure cannot be verified.

Suppressed Viral Load: Among White PLWH in the MSA who received at least one viral load test during 2014, 86% had suppressed viral loads (below 200 copies/mL). Suppressed viral loads were found among 83% of Latinos and those of other races/ethnicities. Among Blacks, however, only 76% had suppressed viral loads.

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Sources:

1 Branson, et al. (2006) Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings.

2 Gardner, et al. (2011). The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection.

3 CDC. (2015). Vital signs: HIV prevention through care and treatment – United States.

4 CDC. (2015). Enhanced HIV/AIDS reporting system (eHARS) (as provided by the Indiana State Department of Health).

5 CDC. (2014). Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas—2012.

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