Wohl Amy Rock, Benbow Nanette, Tejero Judith, Johnson Christopher, Scheer Susan, Brady Kathleen, Gagner Alexandra, Hughes Alison, Eberhart Michael, Mattson Christine, Skarbinski Jacek
*Division of HIV and STD Programs, Los Angeles County Department of Public Health; †HIV/STI Services Division, Chicago Department of Public Health; ‡Clinical Outcomes Team, Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention; §Applied Research, Community Health, Epidemiology and Surveillance Branch, San Francisco Department of Public Health; and ‖AIDS Activities Coordinating Unit, Philadelphia Department of Public Health.
J Acquir Immune Defic Syndr. 2017 Oct 1;76(2):158-170. doi: 10.1097/QAI.0000000000001482.
Comparisons of antiretroviral therapy (ART) prescription and viral suppression among people in HIV care across US metropolitan areas are limited. Medical Monitoring Project, 2011-2013, data were used to describe and compare associations between sociodemographics and ART prescription and viral suppression for persons receiving HIV care.
Chicago, Los Angeles County (LAC), Philadelphia, and San Francisco in the United States.
Bivariate and multivariable methods were used.
The proportion of patients prescribed ART (91%-93%) and virally suppressed (79%-88%) was consistent although more persons were virally suppressed in San Francisco compared with the other areas, and a smaller proportion was virally suppressed in Philadelphia compared with Chicago. In the combined cohort, persons aged 30-49 years were less likely than persons 50+ (adjusted prevalence ratio (aPR) -0.97, confidence interval (CI): 0.94 to 0.99); persons reporting non-injection drug use were less likely than non-users (aPR = 0.94, CI: 0.90 to 0.98); and Hispanics were more likely than whites (aPR - 1.04, CI: 1.01 to 1.08) to be prescribed ART. Blacks (aPR = 0.93; CI: 0.87 to 0.99) and homeless persons (aPR = 0.87; CI: 0.80 to 0.95) were less likely to be virally suppressed in the combined cohort. In LAC, persons aged 30-49 years were less likely than those 50+ to be prescribed ART (aPR = 0.94, CI: 0.90 to 0.98). Younger persons (18-29) (aPR = 0.77; CI: 0.60 to 0.99) and persons with less than a high school education (aPR = 0.80; CI: 0.67 to 0.95) in Philadelphia, blacks (aPR = 0.90; CI: 0.83 to 0.99) and men who have sex with women only (aPR = 0.89; CI: 0.80 to 0.99) in Chicago, and homeless individuals in LAC (aPR = 0.80; CI: 0.67 to 0.94) were less likely to be virally suppressed.
Data highlight the need to increase ART prescription to achieve viral suppression among younger persons, noninjection drug users, blacks, and homeless persons in US metropolitan areas and underscores the importance of region-specific strategies for affected subgroups.
美国各大都市区接受艾滋病病毒治疗（ART）的人群中，抗逆转录病毒疗法处方和病毒抑制情况的比较有限。利用2011 - 2013年医疗监测项目的数据来描述和比较接受艾滋病病毒治疗者的社会人口统计学特征与ART处方及病毒抑制之间的关联。
美国的芝加哥、洛杉矶县（LAC）、费城和旧金山。
采用双变量和多变量方法。
接受ART治疗的患者比例（91% - 93%）和病毒得到抑制的比例（79% - 88%）较为一致，不过与其他地区相比，旧金山病毒得到抑制的人数更多，而费城病毒得到抑制的比例低于芝加哥。在合并队列中，30 - 49岁的人群接受ART治疗的可能性低于50岁及以上人群（调整患病率比（aPR）为 - 0.97，置信区间（CI）：0.94至0.99）；报告非注射吸毒的人群接受ART治疗的可能性低于非吸毒者（aPR = 0.94，CI：0.90至0.98）；西班牙裔接受ART治疗的可能性高于白人（aPR - 1.04，CI：1.01至1.08）。在合并队列中，黑人（aPR = 0.93；CI：0.87至0.99）和无家可归者（aPR = 0.87；CI：0.80至0.95）病毒得到抑制的可能性较低。在洛杉矶县，30 - 49岁的人群接受ART治疗的可能性低于50岁及以上人群（aPR = 0.94，CI：0.90至0.98）。在费城，年龄较小者（18 - 29岁）（aPR = 0.77；CI：0.60至0.99）和高中以下学历者（aPR = 0.80；CI：0.67至0.95），在芝加哥，黑人（aPR = 0.90；CI：0.83至0.99）和仅与女性发生性行为的男性（aPR = 0.89；CI：0.80至0.99），以及在洛杉矶县的无家可归者（aPR = 0.80；CI：0.67至0.94）病毒得到抑制的可能性较低。
数据表明，在美国各大都市区，需要增加ART处方以实现年轻人群、非注射吸毒者、黑人及无家可归者的病毒抑制，并强调针对受影响亚组采取因地制宜策略的重要性。
