Study Identifies Racial Disparities in HIV Quality of Care that Extend to Common Comorbid Conditions

BACKGROUND:
Prior studies have described racial disparities in the quality of healthcare for persons with HIV infection. As the largest provider of HIV care in the U.S., with approximately 25,000 Veterans in care, VA provides an ideal setting to examine racial disparities in comprehensive measures of care, including those for common comorbid conditions. Thus, to more fully understand patterns of racial disparities in the quality of care for persons with HIV infection, this study examined a national cohort of Veterans (n=23,974; 53% Black) in care for HIV in the VA healthcare system during 2013. Specifically, investigators quantified racial variation in a set of widely used quality measures related to antiretroviral therapy, common medical comorbidities, depression, and substance use disorder treatment. In addition to patient demographics, investigators also examined how neighborhood social disadvantage influenced racial disparities in HIV care.

FINDINGS:

• Racial disparities were identified in quality of care specific to HIV infection – and in the care of common comorbid conditions. Blacks were less likely than whites to receive combination antiretroviral therapy (90% vs. 93%) or to experience viral control (85% vs. 91%), hypertension control (62% vs. 68%), diabetes control (86% vs. 90%), or lipid monitoring (82% vs. 85%).
• Black Veterans with HIV were more likely than white Veterans with HIV to be diagnosed with hypertension, substance abuse, Hepatitis C, and chronic kidney disease.
• Black Veterans with HIV were more likely to live in very highly socially disadvantaged neighborhoods (44% vs. 17%) and in the South (63% vs. 42%), while white Veterans with HIV were more likely than black Veterans to live in low or very low socially-disadvantaged neighborhoods (38% vs. 22%), and in the West (30% vs. 10%).

IMPLICATIONS:

• Although performance on quality measures was generally high, racial disparities in HIV care for Veterans remain problematic and extend to comorbid conditions. Implementation of interventions to reduce racial disparities in HIV care should comprehensively address and monitor processes and outcomes of care for key comorbidities.

LIMITATIONS:

• Race/ethnicity is sometimes unreliably measured in VA administrative data for Veterans who do not identify as black or white; thus this study did not include Veterans who self-identifed as Latino, Asian/Pacific Islander, or Native American.
• Potential residual confounding in associations between race and quality measures due to socioeconomic status is possible.

AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D. Dr. Richardson is part of HSR&D's Center for Comprehensive Access and Delivery Research and Evaluation (CADRE). Drs. Bokhour and McInnes are part of HSR&D's Center for Healthcare Organization & Implementation Research (CHOIR).

Richardson K, Bokhour B, McInnes D, et al. Racial Disparities in HIV Care Extend to Common Comorbidities: Implications for Implementation of Interventions to Reduce Disparities in HIV Care. Journal of the National Medical Association. Winter 2016;108(4):201-210.