Wayne
Cabell
Mingo
Mason
Lincoln
Putnam
Logan
Jackson
Boone
Wood
Kanawha
Wyoming
McDowell
Wirt Gilmer
Calhoun
Roane
Fayette
Raleigh
Clay
Braxton
Nicholas
Summers
Lewis
Greenbrier
Monroe
Coverage area for Ryan White site in Morgantown shown in yellow . A sister site at the Charleston Area Medical Center in Charleston , WV , covers areas shown in blue .
gion-wide high degree of viral suppression and patient engagement in HIV treatment services , the risk of new infection remains high . In addition , there may be other risk factors that could be contributory to new HIV infection . These factors could include transient migration to areas outside the service region where new infection could occur as well as transient migration into the service region of patients that receive care outside of WV without adequate viral suppression . In addition , patients engaged in high-risk behavior such as IDU may remain undiagnosed , thus contributing to further spread of infection .
In our patient cohort , 10.2 % of patients had a reported diagnosis of Hepatitis C infection , which is at the lower end of reported rates within the US , where the percentage of reported co-infection with HIV ranges from 10-30 %. 9 , 10 Similarly , our reported rate of Hepatitis B infection was 5.9 %, which is at the lower range of reported epidemiology in the US , where the percentage of reported co-infection with HIV
FIGURE 1
Marion Tyler
Pleasants Taylor
Doddridge Harrison
Ritchie Barbour
Mercer
Hancock
Brooke
Ohio
Marshall
Wetzel
Webster
Monongalia
Upshur
Pocahontas
Randolph
Preston
Tucker
Grant
Pendleton
Mineral
Hardy
Hampshire
Morgan Berkeley
Jefferson
ranges from 5-15 %. 11 The rate of Hepatitis B infection is lower than expected given the high reported prevalence of IDU in the service region in this study and may potentially be secondary to differences in sampling and reporting techniques in prior literature .
Our patient cohort reported a high prevalence of mood disorders of 19 %. The reported high prevalence is in line with prior reported literature and serves to underscore the high prevalence of psychiatric
12 , 13
comorbid conditions in HIV infection . Hypertension was the next most commonly reported comorbid conditions at 18 %, which is within range of previously published estimates of 13-45 %. 14
Our study reports a significantly shorter duration between diagnosis and linkage to care for patients diagnosed within WV , compared to patients diagnosed outside of WV . Similarly , patients diagnosed in the service area had a significantly shorter duration to cART initiation . The shorter duration to linkage of care is likely the reason for patients diagnosed within WV having a significantly lower CD4 count at the time of establishment with HIV clinical services , as these patients were more likely to have been treatment-naïve at the time of linkage to care .
We acknowledge some limitations in our study . Our study was limited to a single RW program in the service region and so did not take into account data from all HIV providers in the area . Our reported data was also limited to new infections diagnosed and managed by RW services in the region and so may not accurately represent all HIV infections diagnosed within this time period . We also relied on retrospective patient-provided social history to determine the likely location of HIV infection .
CONCLUSION
RW services remain an essential component of provision of clinical services to underserved patients with HIV . However , the maintenance of a high viral suppression rate and retention of care within a single RW program itself does not decrease transmission of new HIV infection within the state . Additional studies are needed to determine if maintaining high engagement in clinical services and sustained viral suppression across all HIV providers in a service region can reduce spread of in-state HIV infection .
REFERENCES
1 . Health Resources and Services Administration , HIV / AIDS Programs . Accessed March 3 , 2020 . http :// hab . hrsa . gov /.
2 . Doshi RK , Milberg J , Isenberg D , et al . High rates of retention and viral suppression in the US HIV safety net system : HIV care continuum in the Ryan White HIV / AIDS Program , 2011 . Clin Infect Dis . 2015 ; 60 ( 1 ): 117-125 . doi : 10.1093 / cid / ciu722 .
3 . Crowley JS , Kates J . Updating the Ryan White HIV / AIDS Program for a New Era : Key Issues & Questions for the Future .
West Virginia Medical Journal • June 2022 • 27