New data shows that the majority of patients receiving medical care funded by the Federal Ryan White HIV/AIDS Program (RW) are virally suppressed. The Health Resources and Services
Administration's (HRSA) HIV/AIDS Bureau (HAB) presented the data on the continuum of HIV care in the Ryan White HIV/AIDS Program at the 20th Conference on Retroviruses and Opportunistic Infections this week in Atlanta.
Engagement in HIV care reduces morbidity and mortality among people living with HIV. The continuum of HIV care focuses attention on health care services delivery at critical points in engagement in HIV care, with viral load suppression as a key goal to improve individual health outcomes and reduce HIV transmission. The continuum of engagement in HIV care is an important framework for understanding the status of HIV care and treatment in the United States.
Beginning in 2009, RW grantees began annual reporting of demographic, service, and clinical data into the Ryan White Services Report (RSR) using encrypted unique client identifiers. The RSR 2010 data set was cleaned, de-duplicated using probabilistic records linkage techniques, and merged to create a single record for each client. Using this data, HAB calculated the total number of RW clients served, and the numbers of clients who were HIV+ and received RW-funded medical care or case management, received medical care and had visit dates available, were retained in medical care (>2 visits >90 days apart), were prescribed antiretroviral therapy (ART), and had their viral load suppressed (HIV RNA <200 copies/ml) at the most recent test.
- An estimated 546,156 individual clients received RW services in 2010.
- Of these, 429,881 (79%) received any RW-funded outpatient ambulatory medical care or case management.
- 307,562 (56% of RW clients) received RW-funded medical care.
- Of the 291,449 individuals who received RW-funded medical care and had visit dates available, 220,645 were retained in medical care (76%).
- Among subpopulations, retention was highest in those <13 years, ?65 years, individuals with multiple forms of health insurance, and females.
- Of the 261,865 individuals who received RW-funded medical care and had ART data and visit date available, 208,808 (80%) were prescribed ART.
- Of the 250,344 individuals who received RW-funded medical care and had viral load data available, 174,114 (70%) had viral load suppressed (see chart to the right).
- Viral load suppression was higher in retained patients (75%) compared with patients who were not retained (50%).
These rates of retention, ART prescription, and viral load suppression among RW clients are high compared to CDC's nationwide estimates of the continuum of care for all people living with HIV; but they also demonstrate room for improvement. These improvements will help to achieve the goals of the National HIV/AIDS Strategy and improve individual and public health.
For more information on Ryan White Program continuum of care data, visit http://hab.hrsa.gov/data/reports/continuumofcare/.
Rupali K. Doshi, M.D., M.S., is a medical officer in the HIV/AIDS Bureau of the Health Resources and Services Administration at the U.S. Department of Health and Human Services and Laura W. Cheever, M.D., Sc.M., is acting associate administrator in the HIV/AIDS Bureau of the Health Resources and Services Administration at the U.S. Department of Health and Human Services.