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Black Americans Living With HIV Less Likely to Achieve Viral Suppression

Black patients enrolled in an LA Medical Care Coordination program were less likely to achieve viral suppression than HIV-positive people of other races.

In the US, HIV incidence disproportionately occurs among Black and Latinx people. One study, set to be presented this afternoon during the 2022 Annual Conference on Retroviruses and Opportunistic Infection (CROI), noted that in Los Angeles County in California, Black and Latinx people living with HIV receive little care and viral suppression (<200 c/mL), despite high rates of infection.

The study, presented virtually by lead author Michael J. Li, PhD, analyzed viral suppression by gender and race, while also stratifying by psychosocial issues. Li and fellow investigators examined whether people living with HIV were more likely to achieve viral suppression after enrolling in the LA County Department of Health’s Medical Care Coordination (MCC) program.

The study included 10455 people living with HIV from 12 months prior to MCC enrollment to 18 months after enrollment. The investigators gathered data on housing need, socioeconomic status, social environment, mental health, substance use and risky sexual activity. They used higher scores to indicate greater psychosocial needs. Utilizing Bayesian longitudinal modeling, the investigators predicted the change over time in the likelihood of viral suppression. Viral suppression was analyzed in conjunction with race and ethnicity (White, Latinx, Black, Asian American/Pacific Islander), gender (cisgender male, cisgender female, transgender female), and baseline psychosocial acuity.

The investigators found that people living with HIV were more likely to achieve viral suppression after enrolling in the MCC program. By 6-18 months after enrollment, 82% of participants were virally suppressed, compared to rates of 43-62% in the 12 months prior to enrollment. The results showed cisgender male, cisgender female, and transgender female MCC participants all had similar probabilities of viral suppression in the 6-18 months after enrolling.

At 6 months after enrolling in MCC, an average of 72% of Black patients were virally suppressed, compared to rates of 79-85% among White, Latinx, and AAPI patients. At 18 months post-enrollment, 74% of Black patients achieved viral suppression, while other racial groups had rates of 83-87%.

Accounting for viral suppression by high psychosocial need, patients of all races had similar levels (50-55%) at 18 months after MCC enrollment. On the other end of the spectrum, among patients with low psychosocial need, Black patients had lower rates of viral suppression (79%) than other racial groups (88-95%).

The investigators recommended further study into the structural and social factors that may be preventing Black people living with HIV from having successful viral suppression comparable to other racial groups. They specifically suggested examining discrimination, medical mistrust, and other clinical conditions as factors affecting successful HIV treatment among Black Americans.

The study, “Psychosocial Factors Interact with Race During Countywide Personalized HIV Care,” was presented virtually during the 2022 Annual Conference on Retroviruses and Opportunistic Infection (CROI).