The DC Cohort: A Longitudinal Population-Based Cohort Study of People Living with HIV in Washington, DC

George Washington University, Washington DC

Investigators

Linked publications, trials & patents

Abstract

Washington, DC is an HIV “hotspot,” as it is one of the 50 jurisdictions in the US that accounts for more than 50% of new diagnoses. With 11,904 people with HIV (PWH) residing in DC, the epidemic disproportionately impacts certain populations and reflects an aging epidemic. As we strive to end the HIV epidemic, it is critically important to characterize persons who are at risk for HIV, monitor the use of novel prevention tools, identify persons newly diagnosed with HIV, and effectively direct HIV treatment efforts. The DC Cohort, a longitudinal cohort study of over 12,800 PWH receiving care at 14 clinical sites in DC, is uniquely positioned to help end the HIV epidemic. Launched in 2011 with the goal of bending the trajectory of the HIV epidemic in DC by improving the quality of care, the Cohort was established as an R24 research platform in 2019. The Cohort engages academic and community-based clinics, links to DC Health Department databases, and provides near real-time performance feedback to clinics on HIV outcomes using a data visualization Clinical Dashboard. All of this is achieved through automated data extraction and harmonization of electronic medical records data from varied clinical settings and across age groups. In this renewal application, we aim to enhance our existing population-level database to improve the longitudinal characterization of care and outcomes using a status neutral approach by enrolling both people at risk for and living with HIV. We will continue our DC Health data linkages to improve our ability to describe and monitor HIV and co-morbidities outcomes to help inform local and national efforts to end the HIV epidemic. Our second aim is to use cutting edge research to identify factors and strategies to monitor and improve HIV prevention for people at risk for HIV and care and treatment for those living with HIV in DC and beyond. By continuing to triangulate data from the core database, patient reported outcomes surveys, and our various data linkages, we will describe status neutral care outcomes aligned with local and national research priorities. New data on those at risk will be used to monitor and describe pre-exposure prophylaxis use, demographics, and persistence as well as HIV incidence. We will expand the clinical Dashboard to monitor key programmatic and clinical indicators and identify strategies to improve the quality of care. Finally, we will leverage the DC Cohort as a valuable and dynamic population- based resource to support the development and testing of pioneering interventions to optimize HIV prevention, clinical care, and treatment. The goals of the Cohort align with OAR and NIAID priorities that focus on reducing HIV incidence, achieving viral suppression among PWH, and improving the management of HIV-related clinical outcomes. The DC Cohort is an unparalleled clinical, research, and public health resource that enables us to monitor care in a high prevalence city. Lessons learned will produce generalizable knowledge that can be applied in other urban hotspots across the US.