BACKGROUND: The achievement of sustained viral suppression is the goal of HIV treatment. Viral suppression is associated with lower morbidity, mortality and decreased risk of HIV transmission. Barriers to achieving viral suppression are higher for certain demographic groups, resulting in disparities in viral suppression. The objective of this analysis was to compare the magnitude of the disparities seen among those with recent viral suppression (RVS), and among those with sustained viral suppression (SVS).
METHODS: Data were collected from 2009 to 2014 from 988 Georgia Medical Monitoring Project (MMP) respondents. MMP is a surveillance system that produces nationally representative estimates of behavioral and clinical characteristics of HIV-infected adults receiving medical care in the United States. Rao-Scott chi-square tests were performed to identify significant bivariate differences in factors associated with RVS (<200 copies/ml at last test within past 12 months) and SVS (<200 copies/ml at all tests within past 12 months). Relative disparity (RD), or percent difference, was calculated to evaluate changes in disparities within the group for RVS and SVS.
RESULTS: RVS was achieved in 772 participants (77.6%, 95% CI: 74.2-80.9). SVS was achieved in 626 participants (62.7%, 95% CI: 57.8-67.6). Disparities were larger for SVS than RVS by race (White (ref) vs. Black: SVS-RD=14.9%, RVS-RD=11.1%), age (≥40 years (ref) vs.<40 years: SVS-RD= 19.9%, RVS-RD=16.3%), poverty level (above (ref) vs. below: SVS-RD=6.0%, RVS-RD=3.1%), years since HIV diagnosis (≥10 years (ref) vs.< 5 years: SVS-RD=18.5%, RVS-RD=3.4% to), and HIV care facility type (non-Ryan White (ref) vs. Ryan White: SVS-RD=18.0%, RVS-RD=11.7%). The disparity by depression status was less for SVS than for RVS (major depression (ref) vs. no depression: SVS RD=0%, RVS-RD=5.4%).
CONCLUSIONS: Viral suppression disparities are generally larger for the achievement of sustained viral suppression than for recent viral suppression, the measure commonly used for the HIV care continuum. It is essential that these differences are highlighted and addressed. Targeted intervention efforts are needed to improve adherence, retention in care, and ultimately sustained viral suppression. These improvements will contribute to reducing disparities in morbidity, mortality, and HIV incidence.