New Indicator Recommended for HIV Care Progress Monitoring

The percentage of newly diagnosed patients who achieve viral suppression within 3 months of diagnosis should be included as an outcome indicator in monitoring the progress of HIV care among people newly diagnosed with the virus, researchers say in a new report.

The outcome indicator would be an addition to the 1 process indicator the US National HIV/AIDS Strategy currently uses in monitoring those who have been newly diagnosed with HIV.

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The researchers made the recommendation after analyzing data from the NYC HIV surveillance registry, which included 32,775 participants who were diagnosed with HIV between January 1, 2007, and December 31, 2016, and reported to the NYC Department of Health and Mental Hygiene by September 30, 2017. After excluding some participants due to factors such as age or residency, the researchers evaluated data on 27,520 participants.

The participants were followed for 3 months after their HIV diagnosis to see if they had achieved viral suppression, which was defined as a viral load of less than 200 copies/mL during the first 3 months of diagnosis.

The outcome indicator increased from 9% in 2007 to 37% in 2016. “This increase reflects the improvement in timely linkage of newly diagnosed persons to care, the 2011 change in treatment recommendations to offer ART to any person living with HIV regardless of CD4 count, and the availability of more potent medications in recent years that result in quicker time to viral suppression,” the researchers wrote.

The likelihood of men and women achieving viral suppression in 2016 was about the same (37.0% vs 38.9%). However, this was a significant increase from the rates in 2007 (7.6% in men vs 13.3% in women).

Looking at race, whites (40%), Hispanics (39.5%), and blacks (33.6%) had achieved the highest rates of viral suppression in 2016. Participants who were diagnosed at age 65 years or older had the highest percentage of suppression in 2016 at 58.3%.

“…[We] recommend that the Centers for Disease Control and Prevention and local health agencies use this new indicator along with the existing process indicator to monitor the progress in HIV care among persons newly diagnosed with HIV in the United States,” the researchers concluded.

—Colleen Murphy

Reference:

Xia Q, Coeytaux K, Braunstein SL, Torian LV, Daskalakis DC. Proposing a new indicator for the National Human Immunodeficiency Virus/AIDS Strategy: percentage of newly diagnosed persons achieving viral suppression within 3 months of diagnosis [published online October 10, 2018].  J Infect Dis. https://doi.org/10.1093/infdis/jiy538.