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Open Forum Infect Dis. 2018 May 22;5(6):ofy121. doi: 10.1093/ofid/ofy121. eCollection 2018 Jun 1.

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

Author information

1
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
2
Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.
3
Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia.
4
Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California.
5
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
6
Divison of Infectious Diseases, Department of Medicine, University of California-San Francisco and the Department of Veterans Affairs, San Francisco, California.
7
Division of Infectious Disease, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
8
Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida.
9
Department of Medicine, Stroger Hospital and Rush University, Chicago, Illinois.
10
Department of Neurology, SUNY-Downstate Medical Center, Brooklyn, New York.
11
Department Preventive Medicine, University of Southern California, Los Angeles, California.
12
Department of Family Medicine, Georgetown University Medical Center, Washington, DC.
13
Department of Medicine, Albert Einstein College of Medicine, Bronx, New York.
14
Department of Sociomedical Sciences, Lerner Center for Public Health Promotion, Mailman School of Public Health at Columbia University, New York, New York.

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.

KEYWORDS:

HIV; care continuum; diabetes; quality

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