Use of national standards to monitor HIV care and treatment in a high prevalence city-Washington, DC

Amanda D Castel, Arpi Terzian, Rachel Hart, Nabil Rayeed, Mariah M Kalmin, Heather Young, Alan E Greenberg, DC Cohort Executive Committee, Amanda D Castel, Arpi Terzian, Rachel Hart, Nabil Rayeed, Mariah M Kalmin, Heather Young, Alan E Greenberg, DC Cohort Executive Committee

Abstract

We sought to benchmark the quality of HIV care being received by persons living with HIV in care in Washington, DC and identify individual-level and structural-level differences. Data from the DC Cohort, an observational HIV cohort of persons receiving outpatient care in DC, were used to estimate the Institute of Medicine (IOM) and Department of Health and Human Services (HHS) quality of care measures. Differences in care by demographics and clinic type were assessed using χ2 tests and multivariable regression models. Among 8,047 participants, by HHS standards, 69% of participants were retained in care (RIC), 95% were prescribed antiretroviral therapy (ART), and 84% were virally suppressed (VS). By IOM standards, 84% were in continuous care; and 78% and 80% underwent regular CD4 and VL monitoring, respectively. Screening for syphilis, chlamydia, and gonorrhea was 51%, 31%, and 26%, respectively. Older participants were 1.5 times more likely to be RIC compared to younger participants (OR: 1.5; 95% CI: 1.3, 1.8). Participants enrolled in community-based clinics were more likely to be RIC (OR: 1.7; 95% CI: 1.4, 2.0) versus those enrolled at hospital-based clinics. Older participants were more likely to achieve VS than younger participants (OR: 1.8; 95% CI: 1.5, 2.2) while Black participants were less likely compared to white participants (OR: 0.4; 95% CI: 0.3, 0.5). Despite high measures of quality of care, disparities remain. Continued monitoring of the quality of HIV care and treatment can inform the development of public health programs and interventions to optimize care delivery.

Conflict of interest statement

Competing Interests: Despite the role of Cerner Corporation in the design and conduct of the DC Cohort study and analysis, this commercial affiliation does not alter our adherence to PLOS one policies on sharing data and materials.

Figures

Fig 1. Proportion of DC cohort participants…
Fig 1. Proportion of DC cohort participants meeting criteria for selected HHS and IOM indicators for quality of care, DC cohort, 2011–2016.
This figure represents individuals who were enrolled in the DC Cohort as of September 30, 2016 and met the criteria for selected Department of Health and Human Services and Institute of Medicine HIV quality of care indicators. While high proportions of participants met the HIV-related indicators (69%-95%), screening for sexually transmitted infections was relatively low (26%-51%).

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