Abstract and Introduction
Abstract
Background The purpose of this analysis is to compare 2 newly developed methods (a "likelihood" method and a "weighting" method) with the widely used method (the "include-all" method) to estimate the proportions of HIV-infected persons retained in care and virally suppressed in New York City (NYC).
Methods The NYC HIV registry data were used for the analysis. The include-all method included all patients in the denominator who were diagnosed and/or receiving care in NYC and not known to be dead by December 31, 2012. The likelihood method included patients in the denominator who were likely to reside in NYC in 2012 based on their length of absence from HIV care. The weighting method included patients in the denominator who were residing in NYC in 2012 by weighting each in-care patient based on their probability of receiving HIV care.
Results The include-all method estimated that 114,926 persons were diagnosed and living with HIV in NYC, 63.7% were retained in care (≥1 care visit in 2012), and 48.9% were virally suppressed (≤200 copies/mL). The likelihood method and the weighting method produced equivalent estimates with 80,074 and 80,509 persons diagnosed and living with HIV in NYC, 91.5% and 91.0% retained in care, and 70.2% and 71.7% virally suppressed, respectively.
Conclusions Using 2 newly developed methods, we were able to report more accurate estimates of the proportions of patients retained in care and virally suppressed. Other local health jurisdictions should consider using these new methods to measure care outcomes and monitor the National HIV/AIDS Strategy.
Introduction
Antiretroviral treatment (ART) can significantly improve the length and quality of life of HIV-infected individuals. Despite the wide availability of HIV treatment in the United States, many HIV-infected persons are not engaged in regular care or receiving ART.
The Centers for Disease Control and Prevention (CDC) estimated that among persons with HIV who were aware of their infection, 45% were retained in care and 31% had a suppressed viral load (VL). These proportions were significantly lower than those reported from other developed countries, for example, 92% in France were retained in care, and 64% and 71% in France and the United Kingdom, respectively, had a VL of <50 copies per milliliter. The estimated proportion of patients receiving ART in the United States among diagnosed patients was even lower than the global average: 40% in the United States versus 47% worldwide (8 million of 17 million).
One possibility is that these proportions are underestimates. The objectives of this analysis are to compare 2 new estimation methods (a "likelihood" method and a "weighting" method) with the widely used method (the "include-all" method), and use the 2 new methods to estimate the proportions of patients retained in care and virally suppressed in New York City (NYC).