Viral Suppression in the United States - Medical Monitoring Project and NA-ACCORD
Bradley H,Althoff K,Buchacz K,McKenney J,Prejean J,Paz-Bailey G,Shouse R,Brooks J,Rosenberg E

Viral Suppression in the United States - Medical Monitoring Project and NA-ACCORD

Annals of Epidemiology | November 22, 2018

Purpose: To assess sampling bias in national viral suppression (VS) estimates derived from the Medical Monitoring Project (MMP) resulting from use of an abbreviated (four-month) annual sampling period. We aimed to improve VS estimates using cohort data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) and a novel cohort-adjustment method.

Methods: Using full calendar years of NA-ACCORD data, we assessed timing of HIV care attendance (inside versus exclusively outside MMP’s four-month sampling period), VS status at last test (<200 vs. ?200 copies/mL), and associated demographics. These external estimates were used to standardize MMP to NA-ACCORD data with multivariable regression models of care attendance and VS , yielding adjusted 2009–2013 VS estimates with 95% confidence intervals (CI).

Results: Weighted percentages of VS among persons in HIV care were 67% in 2009 and 77% in 2013. These estimates are slightly lower than previously published MMP estimates (72% and 80% in 2009 and 2013, respectively). The number of persons receiving HIV care was previously underestimated by 20% because patients receiving care exclusively outside the MMP sampling period did not contribute toward the weighted population estimate. 

Conclusions: Careful examination of national surveillance estimates using data triangulation and novel methodologies can improve the robustness of VS estimates.

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