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

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.

Figure 1.

Care continuum for HIV-positive and HIV-negative adult women with diabetes, Women’s Interagency HIV Study (A, 2001; B, 2006; C, 2015). Data are presented as a percentage of the prevalent cases of diabetes in each cross-section. In columns with dark and light shading, the column represents those at goal. The lighter shading represents the proportion of patients not on medications, and the darker shading represents patients who self-report taking medications for that diagnosis. Seen HCP: defined by self-report of visiting a health care provider in the prior 12 months. Viral suppression: defined by last viral load of the year being <200 copies/mL. Glycemic control: defined by hemoglobin A_1c target of <7.0%. BP control: defined by systolic BP <140 mmHg and Diastolic BP <90 mmHg. Cholesterol control: defined by low-density lipoprotein (LDL) <100 mg/dL. Nonsmoker: defined by self-report of not smoking. ABC control: combined control of hemoglobin A_1c level, blood pressure, LDL cholesterol level. ABC + nonsmoker: ABC control plus being nonsmoker. Abbreviations: ABC, A1c, BP, and cholesterol; BP, blood pressure; HCP, health care provider.