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Racial and Ethnic Differences in Viral Suppression Among HIV-Positive Women in Care

Nwangwu-Ike, Ndidi, MPH; Frazier, Emma L., PhD, MS; Crepaz, Nicole, PhD; Tie, Yunfeng, PhD; Sutton, Madeline Y., MD, MPH

JAIDS Journal of Acquired Immune Deficiency Syndromes: October 1, 2018 - Volume 79 - Issue 2 - p e56–e68
doi: 10.1097/QAI.0000000000001779
Epidemiology
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Background: Women with HIV diagnoses are less likely to be virally suppressed than men. Women of different racial/ethnic groups may be differentially affected by sociodemographic factors. We examined differences in viral suppression among women by race/ethnicity and associated variables to inform prevention interventions.

Methods: We used data from the 2010–2014 cycles of the Medical Monitoring Project, a cross-sectional survey of HIV-positive adults in care. We limited analyses to black, Hispanic, and white women. We calculated weighted prevalences of recent viral suppression (undetectable or <200 copies/mL) and sustained viral suppression (consistent viral suppression during the past 12 months) among women by race/ethnicity. We computed adjusted prevalence differences (aPDs) and 95% confidence intervals (CIs) for viral suppression by racial/ethnic group, controlling for selected variables, including available social determinants of health variables.

Results: Among women, 62.9% were black, 19.8% Hispanic, and 17.3% white. Overall, 74.3% had recent viral suppression, and 62.3% had sustained viral suppression. Compared with white women (79.7%, CI: 77.2 to 82.2), black (72.5%, CI: 70.3 to 74.7; PD: 7.2) and Hispanic (75.4%, CI: 72.6 to 78.3; PD: 4.3) women were less likely to have recent viral suppression. In multivariable analyses, after adjusting for antiretroviral therapy adherence, HIV disease stage, age, homelessness, and education, black–white aPDs remained significant for recent (aPD: 4.8, CI: 1.6 to 8.1) and sustained (aPD: 5.0, CI: 1.1 to 9.0) viral suppression.

Conclusion: Viral suppression was suboptimal for all women, but more for black and Hispanic women. Differences between black, Hispanic, and white women may be partially due to antiretroviral therapy adherence, HIV disease stage, and social determinants of health factors.

Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA.

Correspondence to: Ndidi Nwangwu-Ike, Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, DHAP/NCHHSTP/CDC, 1600 Clifton Road NE MS E-47, Atlanta, GA 30333 (e-mail: hhp9@cdc.gov).

Funding for the Medical Monitoring Project is provided by a cooperative agreement (PS09-937) from the Centers for Disease Control and Prevention.

Presented in part as an abstract at the 25th Anniversary Congress on Women's Health; April, 2017; Washington, DC.

The authors have no funding or conflicts of interest to disclose.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

Received February 13, 2018

Accepted June 13, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.