1. Evaluating Clinic-Based Interventions to Reduce Racial Differences in Mortality Among People With Human Immunodeficiency Virus in the United States.
- Author
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Zalla LC, Cole SR, Eron JJ, Adimora AA, Vines AI, Althoff KN, Marconi VC, Gill MJ, Horberg MA, Silverberg MJ, Rebeiro PF, Lang R, Kasaie P, Moore RD, and Edwards JK
- Subjects
- Adult, Humans, Race Factors, United States epidemiology, White, Black or African American, HIV, HIV Infections drug therapy, HIV Infections mortality, Healthcare Disparities
- 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., Competing Interests: Potential conflicts of interest. L. C. Z. reports grants from NIH, predoctoral fellowship funding from ViiV Healthcare, and consulting fees and travel support from Carelon. S. R. C. reports grants from NIH. J. J. E. reports grants from NIH, ViiV Healthcare, Gilead Sciences, and Janssen; consulting fees from ViiV Healthcare, Gilead Sciences, and Merck & Co; and participation in a data and safety and monitoring board (DSMB) for TAIMED. A. A. A. reports grants from NIH, Merck & Co, and Gilead Sciences; consulting fees from Merck & Co and Gilead Sciences; participation in DSMBs for ACTIV 6 and RECOVER; and a leadership role in the Infectious Diseases Society of America. K. N. A. reports grants from NIH, royalties from Coursera, consulting fees from TrioHealth Inc and the All of Us Research Program, and travel support from the International Workshop on HIV and Hepatitis Observational Databases. V. C. M. reports grants from NIH, Emory University, Lilly, Gilead Sciences, ViiV Healthcare, CDC, and the Department of Veterans Affairs; honoraria from Medscape/WebMD/ViiV, Integritas, and Lilly; travel support from NIH; and service as Study Section Chair and participation in a DSMB for NIH. M. J. G. reports grants from NIH and participation on advisory boards for Merck & Co, Gilead Sciences, and ViiV Healthcare. M. A. H. reports grants from NIH, Gilead Sciences, and CDC. P. F. R. reports consulting fees from Gilead Sciences and Janssen. P. K. reports grants from NIH. RDM reports grants from NIH. J. K. E. reports grants from NIH and travel support from and a leadership position in the Society for Epidemiologic Research. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2023
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