Sustained Virologic Response

Non-Hispanic blacks/African Americans (blacks) represent 12% of the U.S.Population* However, in 2014 an estimated 43% (471,500) of persons living with diagnosed and undiagnosed human immunodeficiency virus (HIV) infection were blacks (1). In 2016, blacks accounted for 44% of all new HIV diagnoses (2). Although antiretroviral therapy (ART) prescriptions among persons in HIV care increased overall from 89% in 2009 to 94% in 2013, fewer blacks than Hispanics or Latinos (Hispanics) and non-Hispanic whites (whites) were on ART and had a suppressed viral load (1,500 HIV RNA copies/mL, a level that increases the risk for transmitting HIV (4-7). National HIV Surveillance System (NHSS) data are among those used to monitor progress toward reaching the national goal of reducing health disparities. CDC analyzed NHSS data to describe sustained viral suppression and transmission risk potential by race/ethnicity. Among 651,811 persons with HIV infection diagnosed through 2013 and who were alive through 2014 in 38 jurisdictions with complete laboratory reporting, a lower percentage of blacks had sustained viral suppression (40.8%), than had Hispanics (50.1%) and whites (56.3%). Among persons who were in care (i.e., had at least one viral load test in 2014) and had not achieved sustained viral suppression in 2014, blacks experienced longer periods (52.1% of the 12-month period) with viral loads >1,500 copies/mL, than did Hispanics (47.2%) and white (40.8%). Blacks aged 13-24 years had the lowest prevalence of sustained viral suppression, a circumstance that might increase transmission risk potential. Strengthening interventions that improve access to ART, promote adherence, and address barriers to clinical care and supportive services for all persons with diagnosed HIV infection is important for achieving the national goal of reducing health disparities.

BackgroundDifferentiated antiretroviral therapy (ART) delivery models, in which patients are provided with care relevant to their current status (e.g., newly initiating, stable on treatment, or unstable on treatment) has become an essential part of patient-centered health systems. In 2015, the South African government implemented Chronic Disease Adherence Guidelines (AGLs), which involved five interventions: Fast Track Initiation Counseling for newly initiating patients, Enhanced Adherence Counseling for patients with an unsuppressed viral load, Early Tracing of patients who miss visits, and Adherence Clubs (ACs) and Decentralized Medication Delivery (DMD) for stable patients. We evaluated two of these interventions in 24 South African facilities: ACs, in which patients meet in groups outside usual clinic procedures and receive medication; and DMD, in which patients pick up their medication outside usual pharmacy queues.Methods and findingsWe compared those participating in ACs or receiving DMD at intervention sites to those eligible for ACs or DMD at control sites. Outcomes were retention and sustained viral suppression (ConclusionsIn this study, we found comparable DMD outcomes versus standard of care at facilities, a benefit for retention of patients in care with ACs, and apparent benefits in terms of retention (for AC patients) and sustained viral suppression (for DMD patients) among men. This suggests the importance of alternative service delivery models for men and of community-based strategies to decongest primary healthcare facilities. Because these strategies also reduce patient inconvenience and decongest clinics, comparable outcomes are a potential success. The cost of all five AGL interventions and possible effects on reducing clinic congestion should be investigated.Clinical trial registrationNCT02536768.

BackgroundAlcohol consumption has been associated with poor antiretroviral therapy (ART) adherence but less is known about its relationship to HIV viral suppression, or whether certain drinking patterns have a stronger association than others. The objectives of this study were to determine the association of different patterns of alcohol consumption to HIV viral suppression and ART adherence, and to determine whether any associations of alcohol with HIV viral suppression were mediated by poor ART adherence.MethodsThis observational study used baseline data from 619 HIV+ participants, recruited across 8 clinical and community settings across Florida as part of the Florida Cohort from 2014 to 2016. Alcohol consumption was measured by self-report, and grouped into four categories: heavy drinking (>7/week for women or >14 drinks/week for men); binge, but not heavy drinking (≥4 or >5 drinks/occasion for women and men, respectively), low level drinking (neither heavy nor binge), and abstinence. Serum HIV RNA measurements were obtained from statewide HIV surveillance data, and durable viral suppression was defined as achieving HIV viral suppression (ResultsThe majority of the 619 participants were male (63%) and aged 45 or greater (65%). The proportion of participants with heavy, binge, low-level drinking and abstinence was 9, 25, 37 and 30%, respectively. Optimal ART adherence (≥95%) was reported by 68%, and 60% achieved durable viral suppression. In multivariable analysis controlling for demographic factors, drug use, and homelessness, heavy drinking (compared to abstinence) was associated with increased odds of failing to achieve durable viral suppression (OR 2.16, 95% CI 1.08-4.32) whereas binge drinking alone was not significantly associated with this outcome (OR 1.04, 95% CI 0.64-1.70). Both heavy drinking and binge drinking were significantly associated with suboptimal ART adherence. Mediation analyses suggested that only a small proportion of the relationship between heavy drinking and suboptimal viral suppression was due to poor ART adherence.ConclusionsExceeding weekly recommended levels of alcohol consumption (heavy drinking) was significantly associated with poor HIV viral suppression and ART non-adherence, while binge drinking was associated with suboptimal ART adherence in this sample. Clinicians should attempt to address heavy drinking in their patients with HIV.

BackgroundAIDS Drug Assistance Programs (ADAPs), a key part of the federally funded Ryan White HIV/AIDS Program, provide antiretroviral therapy (ART) to low-income and uninsured or underinsured people with HIV. As long as they meet federal regulations, jurisdictions maintain flexibility in implementing ADAPs, allowing for a range of operational and programmatic options, including eligibility criteria, formulary design for ART (and non-ART) drugs, and the nature and character of insurance support. These programmatic and policy decisions ultimately impact ADAP client outcomes, including engagement in care, differences in the populations benefiting from ADAP, and viral suppression rates. Despite ADAPs achieving an 85% national average viral suppression rate, this falls short of the 90% goal needed to end the HIV epidemic, and no formal evaluation has examined how specific operational or policy factors drive success across states.ObjectiveThis qualitative study aims to examine how operational, organizational, and contextual factors shape the ability of ADAPs to improve viral suppression rates among people with HIV enrolled in ADAPs, specifically by identifying the mechanisms that facilitate high performance and viral suppression for all people with HIV. Results will inform how viral suppression outcomes could be improved through policy, program, operational, and organizational changes in ADAP design and implementation.MethodsUsing a qualitative descriptive approach guided by the Consolidated Framework for Implementation Research, we conducted semistructured interviews with state-level ADAP leaders, operational and programmatic decision-makers, and staff. Interview questions covered 5 domains: leadership and staffing; operations, integration, and collaboration; formulary design and treatment; eligibility and enrollment; and innovation and implementation. Qualitative data from the interviews will be analyzed using deductive and inductive approaches along with situational mapping.ResultsThis study was funded in April 2023. In total, 33 individuals from 16 states have participated in this qualitative study, resulting in a participation rate of 31.4% (16/51). States from all 4 US census regions were represented. Interviews were conducted between February 12, 2025, and March 20, 2025. As of March 2026, data analysis is underway.ConclusionsWe anticipate that the study will highlight features, organizational practices, and operational norms that contribute to the successes of ADAPs with high rates of viral suppression. Successful completion of this analysis will provide evidence to inform state and federal regulations, program development, resource allocation, and prioritization to advance the goal of helping people achieve viral suppression and interrupt HIV transmission, which is a vital public health objective. Using other data alongside our qualitative findings, we can provide context for the environment in which these programs or policies impact ADAP clients and the broader public health objectives of the Ryan White HIV/AIDS Program. Ultimately, we expect that disseminating these results will support improvements in viral suppression, enhancing both individual health outcomes and public health.International registered report identifier (irrid)DERR1-10.2196/90008.