Room for Improvement: The HIV-Diabetes Care Continuum Over 15 Years in the Women's Interagency HIV Study

• Authors: Jonathan Arthur Colasanti, Emory University; Karla Galaviz Arredondo, Emory University; Christina Mehta, Emory University; Kartika Palar, University of California San Francisco; Michael F. Schneider, Johns Hopkins University; Phyllis Tien, University of California San Francisco; Adaora A. Adimora, University of North Carolina; Maria Alcaide, University of Miami; Mardge H. Cohen, Rush University; Deborah Gustafson, Suny Downstate Medical Center; Roksana Karim, University of Southern California; Daniel Merenstein, Georgetown University; Anjali Sharma, Albert Einstein College of Medicine; Gina Wingood, Columbia University; Vincent Marconi, Emory University; Ighovwerha Ofotokun, Emory University; Mohammed K Ali, Emory University
• Journal Title: Open Forum Infectious Diseases
• Volume: Volume 5, Number 6
• Publisher: Oxford University Press (OUP) | 2018-06-01, Pages ofy121-ofy121
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1093/ofid/ofy121
• Subjects: Health Sciences, Epidemiology; Health Sciences, Pathology; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Infectious Diseases; care continuum; diabetes; HIV; quality; UNITED-STATES; ANTIRETROVIRAL THERAPY; ASSOCIATION; MELLITUS; QUALITY; MANAGEMENT; RETENTION; TRENDS; COHORT; SUPPRESSION

Abstract

Background: Gains in life expectancy through optimal control of HIV infection with antiretroviral therapy (ART) may be threatened if other comorbidities, such as diabetes, are not optimally managed. Methods: We analyzed cross-sectional data of the Women's Interagency HIV Study (WIHS) from 2001, 2006, and 2015. We estimated the proportions of HIV-positive and HIV-negative women with diabetes who were engaged in care and achieved treatment goals (hemoglobin A1c [A1c] <7.0%, blood pressure [BP] <140/90 mmHg, low-density lipoprotein [LDL] cholesterol <100 mg/dL, not smoking) and viral suppression. Repeated-measures models were used to estimate the adjusted prevalence of achieving each diabetes treatment goal at each time point, by HIV status. Results: We included 486 HIV-positive and 258 HIV-negative women with diabetes. In 2001, 91.8% visited a health care provider, 60.7% achieved the A1c target, 70.5% achieved the BP target, 38.5% achieved the LDL cholesterol target, 49.2% were nonsmokers, 23.3% achieved combined ABC targets (A1c, BP, and cholesterol), and 10.9% met combined ABC targets and did not smoke. There were no differences by HIV status, and patterns were similar in 2006 and 2015. Among HIV-positive women, viral suppression increased from 41% in 2001 to 87% in 2015 compared with 8% and 13% achieving the ABC goals and not smoking. Viral suppression was not associated with achievement of diabetes care goals. Conclusions: Successful management of HIV is outpacing that of diabetes. Future studies are needed to identify factors associated with gaps in the HIV-diabetes care continuum and design interventions to better integrate effective diabetes management into HIV care.