Wiewel Ellen W, Borrell Luisa N, Jones Heidi E, Maroko Andrew R, Torian Lucia V
Division of Disease Control, New York City Department of Health and Mental Hygiene , Long Island City , NY , USA.
Epidemiology and Biostatistics, City University of New York (CUNY) Graduate School of Public Health and Health Policy , New York , NY , USA.
AIDS Care. 2019 Dec;31(12):1484-1493. doi: 10.1080/09540121.2019.1595517. Epub 2019 Mar 25.
Health care facility characteristics have been shown to influence intermediary health outcomes among persons with HIV, but few longitudinal studies of suppression have included these characteristics. We studied the association of these characteristics with the achievement and maintenance of HIV viral suppression among New York City (NYC) residents aged 13 years and older newly diagnosed with HIV between 2006 and 2012. The NYC HIV surveillance registry provided individual and facility data ( = 12,547 persons). Multivariable proportional hazards models estimated the likelihood of individual achievement and maintenance of suppression by type of facility, patient volume, and distance from residence, accounting for facility clustering and for individual-level confounders. Viral suppression was achieved within 12 months by 44% and at a later point by another 29%. Viral suppression occurred at a lower rate in facilities with low HIV patient volume (e.g., 10-24 diagnoses per year vs. ≥75, adjusted hazard ratio [AHR] = 0.87, 95% confidence interval [CI] 0.79-0.95) and in screening/diagnosis sites (vs. hospitals, AHR = 0.86, 95% CI 0.80-0.92). Among persons achieving viral suppression, 18% experienced virologic failure within 12 months and 24% later. Those receiving care at large outpatient facilities or large private practices had a lower rate of virologic failure (e.g., large outpatient facilities vs. large hospitals, AHR = 0.63, 95% CI 0.53-0.75). Achievement and maintenance of viral suppression were associated with facilities with higher HIV-positive caseloads. Some facilities with small caseloads and screening/diagnosis sites may need stronger care or referral systems to help persons with HIV achieve and maintain viral suppression.
医疗保健机构的特征已被证明会影响艾滋病毒感染者的中间健康结果，但很少有关于病毒抑制的纵向研究纳入这些特征。我们研究了这些特征与2006年至2012年间新诊断出感染艾滋病毒的13岁及以上纽约市居民实现并维持艾滋病毒病毒抑制之间的关联。纽约市艾滋病毒监测登记处提供了个人和机构数据（n = 12547人）。多变量比例风险模型估计了按机构类型、患者数量和住所距离实现并维持病毒抑制的个体可能性，同时考虑了机构聚类和个体层面的混杂因素。44%的患者在12个月内实现了病毒抑制，另有29%在之后实现。在艾滋病毒患者数量较少的机构中，病毒抑制发生率较低（例如，每年10 - 24例诊断与≥75例相比，调整后风险比[AHR] = 0.87，95%置信区间[CI] 0.79 - 0.95），在筛查/诊断地点也是如此（与医院相比，AHR = 0.86，95% CI 0.80 - 0.92）。在实现病毒抑制的人群中，18%在12个月内经历了病毒学失败，24%在之后经历了病毒学失败。在大型门诊机构或大型私人诊所接受治疗的患者病毒学失败率较低（例如，大型门诊机构与大型医院相比，AHR = 0.63，95% CI 0.53 - 0.75）。病毒抑制的实现和维持与艾滋病毒阳性病例数较高的机构有关。一些病例数较少的机构和筛查/诊断地点可能需要更强有力的护理或转诊系统，以帮助艾滋病毒感染者实现并维持病毒抑制。
