Outcomes Along the HIV Care Continuum among Undocumented Immigrants in Clinical Care

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Abstract

HIV-infected undocumented immigrants face unique barriers to care yet little is known about their clinical outcomes. We performed a retrospective cohort study of HIV-infected adults in clinical care from 2006 to 2014 at a large academic medical center in a setting where medical insurance is available to HIV-infected undocumented immigrants. Undocumented status was assessed based on Social Security number and insurance status and verified through medical chart review. Using Poisson regression models, we compared undocumented and documented patients with respect to retention in care (≥2 HIV-related laboratory tests ≥90 days apart), antiretroviral therapy (ART) prescription (≥3 active antiretroviral agents prescribed in a year), and viral suppression (HIV RNA <200 copies/ml for the last measured viral load) for each year in care. Of 7,551 patients included in the analysis, we classified 173 (2.3%) as undocumented. For each year of the analysis, higher proportions of undocumented patients were retained in care, prescribed ART, and virally suppressed. In adjusted models, undocumented status was associated with increased probability of retention in care [risk ratio (RR) 1.05, confidence interval (95% CI) 1.01-1.09], ART prescription (RR 1.05, 95% CI 1.01-1.08), and viral suppression (RR 1.13, 95% CI 1.08-1.19) compared to documented status. Undocumented patients achieved clinical outcomes at modestly higher rates than documented patients, despite entering care with more advanced disease. In a setting where insurance is available to undocumented patients, similar outcomes along the HIV care continuum may be achieved regardless of immigration status.

Original languageEnglish (US)
Pages (from-to)1038-1044
Number of pages7
JournalAIDS Research and Human Retroviruses
Volume33
Issue number10
DOIs
StatePublished - Oct 1 2017

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Continuity of Patient Care
HIV
Social Security
Odds Ratio
Insurance
Prescriptions
Anti-Retroviral Agents
HIV-2
Insurance Coverage
Emigration and Immigration
Viral Load
Undocumented Immigrants
Cohort Studies
Therapeutics
Retrospective Studies
RNA
Confidence Intervals

Keywords

  • HIV care continuum
  • immigrants
  • retention in care
  • undocumented immigrants
  • viral suppression

ASJC Scopus subject areas

  • Immunology
  • Virology
  • Infectious Diseases

Cite this

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title = "Outcomes Along the HIV Care Continuum among Undocumented Immigrants in Clinical Care",
abstract = "HIV-infected undocumented immigrants face unique barriers to care yet little is known about their clinical outcomes. We performed a retrospective cohort study of HIV-infected adults in clinical care from 2006 to 2014 at a large academic medical center in a setting where medical insurance is available to HIV-infected undocumented immigrants. Undocumented status was assessed based on Social Security number and insurance status and verified through medical chart review. Using Poisson regression models, we compared undocumented and documented patients with respect to retention in care (≥2 HIV-related laboratory tests ≥90 days apart), antiretroviral therapy (ART) prescription (≥3 active antiretroviral agents prescribed in a year), and viral suppression (HIV RNA <200 copies/ml for the last measured viral load) for each year in care. Of 7,551 patients included in the analysis, we classified 173 (2.3{\%}) as undocumented. For each year of the analysis, higher proportions of undocumented patients were retained in care, prescribed ART, and virally suppressed. In adjusted models, undocumented status was associated with increased probability of retention in care [risk ratio (RR) 1.05, confidence interval (95{\%} CI) 1.01-1.09], ART prescription (RR 1.05, 95{\%} CI 1.01-1.08), and viral suppression (RR 1.13, 95{\%} CI 1.08-1.19) compared to documented status. Undocumented patients achieved clinical outcomes at modestly higher rates than documented patients, despite entering care with more advanced disease. In a setting where insurance is available to undocumented patients, similar outcomes along the HIV care continuum may be achieved regardless of immigration status.",
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