Date of Defense:
July 20, 2015
Background: In 2013, President Obama launched the HIV Care Continuum Initiative as part of the National HIV/AIDS Strategy to curb the HIV/AIDS epidemic across the United States. In line with this Initiative, the CDC developed the HIV care continuum model to track the efficacy of state and national measures supporting essential steps towards viral suppression: a necessary outcome for all HIV positive patients to achieve the best quality of life. 1 The care continuum is applied to individuals 13 years and older and is comprised of five key stages: Diagnosis of HIV, linkage to care, retention in care, prescribed antiretroviral therapy (ART) and viral suppression. 1
Objective: Adapt and apply the CDC’s HIV care continuum model to the pediatric HIV population who received care at Children’s Hospitals and Clinics of Minnesota (CHC) between 1994 and 2014 to determine how specific subsets have fared in terms of the care continuum outcomes of retention in care and viral suppression across time. Additionally, identify factors that are predictive of these outcomes. These results will inform steps for targeted interventions in the future to achieve maximum viral suppression in CHC’s HIV positive population, and improve their quality and length of life.
Methods: A retrospective serial cross sectional study design was employed to create a primary dataset utilizing pediatric HIV patient data available in CHC’s electronic medical database between 2006 and 2 014. Predictor and outcome variables were selected and defined based on pre – determined criteria. The HIV care continuum was applied to the completed dataset, followed by a multivariate logistic regression analysis to identify significant predictors of viral suppression.
Results: There was an increase in the proportion of patients retained in care and virally suppressed across time. Time, age group, insurance type, sex and country of birth were non – significant ( p >0.05) predictors of viral suppression across time. After adjustment, race/ethnicity ( p =0.0124) and adoption status ( p= 0.0001) were significantly associated with viral suppression. Black/African Americans have 84% lower odds of viral suppression compared with white/Caucasians/other (OR=0.16 (0.049 – 0 .548), p =0.003). Compared with biological children, international adoptees had 7.49 times higher odds of viral suppression (OR=7.49 (2.88 – 19.5), p <0.0001) and domestic adoptees/other had 5.5 times higher odds of viral suppression (OR=5.5 (1.45 – 20.8) , p =0.012).