Evaluating Clinic-Based Interventions to Reduce Racial Differences in Mortality among People with Human Immunodeficiency Virus in the United States

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Citation

Zalla, Lauren C.; Cole, Stephen R.; Eron, Joseph J.; Adimora, Adaora A.; Vines, Anissa I.; Althoff, Keri N.; Marconi, Vincent C.; Gill, M. John; Horberg, Michael A.; & Silverberg, Michael J., et al. (2023). Evaluating Clinic-Based Interventions to Reduce Racial Differences in Mortality among People with Human Immunodeficiency Virus in the United States. Journal of Infectious Diseases, 228(12), 1690-1698. PMCID: PMC10733732

Abstract

BACKGROUND: Mortality remains elevated among Black versus White adults receiving human immunodeficiency virus (HIV) care in the United States. We evaluated the effects of hypothetical clinic-based interventions on this mortality gap.
METHODS: We computed 3-year mortality under observed treatment patterns among >40 000 Black and >30 000 White adults entering HIV care in the United States from 1996 to 2019. We then used inverse probability weights to impose hypothetical interventions, including immediate treatment and guideline-based follow-up. We considered 2 scenarios: "universal" delivery of interventions to all patients and "focused" delivery of interventions to Black patients while White patients continued to follow observed treatment patterns.
RESULTS: Under observed treatment patterns, 3-year mortality was 8% among White patients and 9% among Black patients, for a difference of 1 percentage point (95% confidence interval [CI], .5-1.4). The difference was reduced to 0.5% under universal immediate treatment (95% CI, -.4% to 1.3%) and to 0.2% under universal immediate treatment combined with guideline-based follow-up (95% CI, -1.0% to 1.4%). Under the focused delivery of both interventions to Black patients, the Black-White difference in 3-year mortality was -1.4% (95% CI, -2.3% to -.4%).
CONCLUSIONS: Clinical interventions, particularly those focused on enhancing the care of Black patients, could have significantly reduced the mortality gap between Black and White patients entering HIV care from 1996 to 2019.

URL

http://dx.doi.org/10.1093/infdis/jiad263

Reference Type

Journal Article

Year Published

2023

Journal Title

Journal of Infectious Diseases

Author(s)

Zalla, Lauren C.
Cole, Stephen R.
Eron, Joseph J.
Adimora, Adaora A.
Vines, Anissa I.
Althoff, Keri N.
Marconi, Vincent C.
Gill, M. John
Horberg, Michael A.
Silverberg, Michael J.
Rebeiro, Peter F.
Lang, Raynell
Kasaie, Parastu
Moore, Richard D.
Edwards, Jessie K.

Article Type

Regular

PMCID

PMC10733732

Data Set/Study

North American AIDS Cohort
Collaboration on Research and Design (NA-ACCORD)

Continent/Country

North America

Race/Ethnicity

Black
White

ORCiD

Edwards, J -0000-0002-1741-335X