Our experiences may have practical implications for researchers who seek to merge data from diverse clinical databases, and are applicable to the study of health-related issues beyond HIV.

Background Using the results of a site assessment survey performed at clinics throughout Washington DC, we studied the impact of clinic-level factors on antiretroviral therapy (ART) initiation and viral suppression (VS) among people living with HIV (PLWH). Methods This was a retrospective analysis from the DC Cohort, an observational clinical cohort of PLWH from 2011-2018. We included data from PLWH not on ART and not virally suppressed at enrollment. Outcomes were ART initiation and VS (HIV RNA <200 copies/mL). A clinic survey captured information on care delivery (clinical services, adherence services, patient monitoring services, e.g.) and clinic characteristics (types of providers, availability of evenings/weekends sessions, e.g.). Multivariate marginal Cox regression models were generated to identify factors associated with time to ART initiation and VS. Results Multiple clinic-level factors were associated with ART initiation, including retention in care monitoring and medication dispensing review (aHR = 1.34 to 1.40, p<0.05 for both). Furthermore, multiple factors were associated with VS, including retention in HIV care monitoring, medication dispensing review, presence of a peer interventionist (aHR ranging from 1.35 to 1.72, p<0.05 for all). In multivariable models evaluating different combinations of clinic-level factors, enhanced adherence services (aHR 1.37 (95% CI 1.18, 1.58), medication dispensing review (aHR 1.22, 95% CI 1,10, 1.36), and availability of opioid treatment (aHR 1.26 (95% CI 1.01, 1.57) were all associated with time to VS. Conclusions The observed association between clinic-level factors and ART initiation/VS suggests that the presence of specific clinic services may facilitate achievement of HIV treatment goals.

Introduction Prior studies found renal disease was common among HIV-infected outpatients. We updated incident renal disease estimates in this population, comparing those with and without tenofovir exposure. Methods We conducted a retrospective analysis of the DC Cohort, a longitudinal study of HIV patients in Washington, DC, from 2011 to 2015. We included adults prescribed antiretroviral therapy (ART) with baseline glomerular filtration rate (GFR) ≥15 ml/min per 1.73 m 2 . We defined renal disease as 50% decrease in GFR or doubled serum creatinine (Cr) within 3 months. We defined cumulative viral load as area under the curve (AUC) of log 10 transformed longitudinal HIV RNA viral load (VL). Correlates of time to incident renal disease were identified using Cox proportional hazard regression models, adjusted for demographics and known risk factors for kidney disease. Results Among 6068 adults, 77% were Black and median age was 48 years. Incident renal disease rate was 0.77 per 100 person-years (95% confidence interval [CI]: 0.65–0.9). Factors associated with renal disease were age (adjusted hazard ratio [aHR]: 1.4; CI 1.1–1.7 per 10 years), public non-Medicaid, non-Medicare insurance (aHR: 3.4; CI: 1.9–6.4), AUC VL (aHR: 1.1; CI: 1.1–1.2), diabetes mellitus (aHR: 1.6; CI: 1.0–2.4), and mildly reduced GFR (60–89 ml/min per 1.73 m 2 ) (aHR: 1.5; CI: 1.0–2.3); recent tenofovir exposure was not associated with renal disease (aHR: 0.7; CI: 0.5–1.1). Conclusion Our study revealed a substantial burden of renal disease among HIV patients. Cumulative VL was associated with renal disease, suggesting that early VL suppression may decrease its incidence.