HIV Care Interventions Crucial to Reducing Life Expectancy Disparities Between White and Black MSM with HIV
AT A GLANCE
- New simulation modeling research finds that the life expectancy of non-Hispanic Black men who have sex with men and who acquire HIV is 6.3 years shorter compared with White MSM with HIV in the United States.
- Improving engagement in care would lead to larger life expectancy gains compared with strategies of earlier HIV diagnosis and improved ART adherence, especially among Black MSM; improving time to diagnosis, engagement in care and ART adherence would have the greatest impact.
- Equity-focused solutions including increasing engagement in care are essential to reduce racial disparities in HIV care outcomes in the United States.
The life expectancy of non-Hispanic Black men who have sex with men and who acquire HIV is 6.3 years shorter than their White counterparts when receiving status quo HIV care in the United States, according to simulation modeling findings presented at IDWeek.
In addition to identifying the impact of racial disparities, researchers examined how evidence-based interventions such as annual testing and keeping patients connected to their providers, otherwise known as engagement in care, could improve life expectancy for men with HIV — especially Black MSM.
“Improving engagement in care had the largest impact in reducing disparities,” said Katherine Rich, MPH, a student at Harvard Medical School and the study’s lead author. “Our analysis emphasizes that maintaining engagement in care is paramount to improving life expectancy and clinical outcomes among people living with HIV.”
Simulation modeling results show that improving engagement in care would result in a gain of 1.4 life-years for Black MSM and 1.0 life-years for White MSM, while annual testing would result in a gain of 0.6 life-years for Black MSM and 0.3 life-years for White MSM compared with status quo care. Achieving annual testing, 95% engagement in care and 95% virologic suppression would result in a gain of 3.4 life-years for Black MSM and 1.6 life-years for White MSM.
“There are significant and unacceptable disparities in HIV care,” said the study’s senior author, Emily P. Hyle, MD, MSc, Associate Professor of Medicine at Harvard Medical School and infectious diseases physician at Massachusetts General Hospital. “Black MSM in the United States do not experience the same health outcomes as White MSM. Equity-focused solutions combatting structural barriers to care are essential to reduce disparities and improve outcomes.”
This research provides a framework to guide the development of interventions focused on mitigating disparities in care, especially among key populations. “The findings underscore the need to identify and implement novel strategies that specifically meet the health care needs of Black MSM in ways that our current structures and systems do not,” emphasizes Aimalohi Ahonkhai, MD, MPH, a study co-author and Assistant Professor of Medicine at Vanderbilt University School of Medicine. “Such change is imperative to ensure both equitable access to and outcomes in HIV care.”
In addition to Katherine Rich, Dr. Ahonkhai, and Dr. Hyle, study co-authors included: Krishna Reddy, MD, MS; Aimalohi Ahonkhai, MD, MPH; Fatma Shebl, MD, PhD, MS; Ankur Pandya, PhD; Elena Losina, PhD; and Kenneth Freedberg, MD, MSc.
IDWeek is the joint annual meeting of the Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, the HIV Medicine Association, the Pediatric Infectious Diseases Society and the Society of Infectious Diseases Pharmacists. IDWeek is a recognized forum for peer-reviewed presentations of new research on scientific advances and bench-to-bedside approaches in prevention, diagnosis, treatment and epidemiology of infectious diseases, including HIV, across the lifespan. For more information, visit www.idweek.org.