Racial Disparities in HIV Care Extend to Common Comorbidities: Implications for Implementation of Interventions to Reduce Disparities in HIV Care

Kelly K Richardson; Barbara Bokhour; D. Keith McInnes; Vera Yakovchenko; Leonore Okwara; Amanda M Midboe; Avy Skolnik; Mary Vaughan-Sarrazin; Steven M Asch; Allen L Gifford; Michael E Ohl

doi:10.1016/j.jnma.2016.08.001

Journal article

Racial Disparities in HIV Care Extend to Common Comorbidities: Implications for Implementation of Interventions to Reduce Disparities in HIV Care

Kelly K Richardson, Barbara Bokhour, D. Keith McInnes, Vera Yakovchenko, Leonore Okwara, Amanda M Midboe, Avy Skolnik, Mary Vaughan-Sarrazin, Steven M Asch, Allen L Gifford, …

Journal of the National Medical Association, Vol.108(4), pp.201-210.e3

2016

DOI: 10.1016/j.jnma.2016.08.001

PMID: 27979005

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Abstract

Prior studies have described racial disparities in the quality of care for persons with HIV infection, but it is unknown if these disparities extend to common comorbid conditions. To inform implementation of interventions to reduce disparities in HIV care, we examined racial variation in a set of quality measures for common comorbid conditions among Veterans in care for HIV in the United States. The cohort included 23,974 Veterans in care for HIV in 2013 (53.4% black; 46.6% white). Measures extracted from electronic health record and administrative data were receipt of combination antiretroviral therapy (cART), HIV viral control (serum RNA < 200 copies/ml among those on cART), hypertension control (blood pressure < 140/90 mm Hg among those with hypertension), diabetes control (hemoglobin A1C < 9% among those with diabetes), lipid monitoring, guideline-concordant antidepressant prescribing, and initiation and engagement in substance use disorder (SUD) treatment. Black persons were less likely than their white counterparts to receive cART (90.2% vs. 93.2%, p<.001), and experience viral control (84.6% vs. 91.3%, p<.001), hypertension control (61.9% vs. 68.3%, p<.001), diabetes control (85.5% vs. 89.5%, p<.001), and lipid monitoring (81.5% vs. 85.2%, p<.001). Initiation and engagement in SUD treatment were similar among blacks and whites. Differences remained after adjusting for age, comorbidity, retention in HIV care, and a measure of neighborhood social disadvantage created from census data. Implementation of interventions to reduce racial disparities in HIV care should comprehensively address and monitor processes and outcomes of care for key comorbidities.

HIV

Racial disparities

Vet

Comorbidity

Details

Title: Subtitle: Racial Disparities in HIV Care Extend to Common Comorbidities: Implications for Implementation of Interventions to Reduce Disparities in HIV Care
Creators: Kelly K Richardson - Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, 601 Hwy 6 West, Iowa City, IA 52246, USA
Barbara Bokhour - Center for Healthcare Organization & Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Healthcare System, 200 Springs Road, Bedford, MA 01730, USA
D. Keith McInnes - Center for Healthcare Organization & Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Healthcare System, 200 Springs Road, Bedford, MA 01730, USA
Vera Yakovchenko - Center for Healthcare Organization & Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Healthcare System, 200 Springs Road, Bedford, MA 01730, USA
Leonore Okwara - Center for Innovation to Implementation, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
Amanda M Midboe - Center for Innovation to Implementation, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
Avy Skolnik - Center for Healthcare Organization & Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Healthcare System, 200 Springs Road, Bedford, MA 01730, USA
Mary Vaughan-Sarrazin - Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, 601 Hwy 6 West, Iowa City, IA 52246, USA
Steven M Asch - Center for Innovation to Implementation, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
Allen L Gifford - Center for Healthcare Organization & Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Healthcare System, 200 Springs Road, Bedford, MA 01730, USA
Michael E Ohl - Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, 601 Hwy 6 West, Iowa City, IA 52246, USA
Resource Type: Journal article
Publication Details: Journal of the National Medical Association, Vol.108(4), pp.201-210.e3
Publisher: Elsevier Inc
DOI: 10.1016/j.jnma.2016.08.001
PMID: 27979005
ISSN: 0027-9684
eISSN: 1943-4693
Grant note: name: Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development
Language: English
Date published: 2016
Academic Unit: Psychiatry; Health Management and Policy; General Internal Medicine; Internal Medicine
Record Identifier: 9984063201502771

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