African American race and HIV virological suppression: beyond disparities in clinic attendance.

Academic Article

Abstract

  • Racial disparities in clinic attendance may contribute to racial disparities in plasma human immunodeficiency virus type 1 : HIV-1) RNA levels among HIV-positive patients in care. Data from 946 African American and 535 Caucasian patients receiving HIV care at the University of North Carolina Center for AIDS Research HIV clinic between January 1, 1999, and August 1, 2012, were used to estimate the association between African American race and HIV virological suppression (i.e., undetectable HIV-1 RNA) when racial disparities in clinic attendance were lessened. Clinic attendance was measured as the proportion of scheduled clinic appointments attended (i.e., visit adherence) or the proportion of six 4-month intervals with at least 1 attended scheduled clinic appointment (i.e., visit constancy). In analyses accounting for patient characteristics, the risk ratio for achieving suppression when comparing African Americans with Caucasians was 0.91 (95% confidence interval: 0.85, 0.98). Lessening disparities in adherence or constancy lowered disparities in virological suppression by up to 44.4% and 11.1%, respectively. Interventions that lessen disparities in adherence may be more effective in eliminating disparities in suppression than interventions that lessen disparities in constancy. Given that gaps in care were limited to be no more than 2 years for both attendance measures, the impact of lessening disparities in adherence may be overstated.
  • Published In

    Keywords

  • clinic visits, cohort studies, health status disparities, human immunodeficiency virus, viral load, Adult, African Americans, Ambulatory Care Facilities, European Continental Ancestry Group, Female, HIV Infections, HIV-1, Health Status Disparities, Humans, Male, Middle Aged, Patient Compliance, RNA, Viral, Viral Load
  • Digital Object Identifier (doi)

    Author List

  • Howe CJ; Napravnik S; Cole SR; Kaufman JS; Adimora AA; Elston B; Eron JJ; Mugavero MJ
  • Start Page

  • 1484
  • End Page

  • 1492
  • Volume

  • 179
  • Issue

  • 12