Frequent Participation in Ryan White Services Improves Time to HIV Viral Suppression Among Persons with HIV Monoinfection and Persons with HCV Coinfection in Philadelphia

Background Hepatitis C virus (HCV) coinfection is associated with poor health outcomes for persons with HIV (PWH). Although higher HIV viral suppression rates have been reported among PWH who participate in Ryan White services, studies have not assessed effects on HCV coinfection. Methods We used Philadelphia’s routine HIV and hepatitis surveillance data to identify new HIV diagnoses during November 2018–October 2021 in a retrospective cohort analysis. We plotted Kaplan-Meier curves and performed Cox regressions to understand effects of HCV coinfection and receipt of Ryan White support services on time to reach HIV viral suppression, adjusting for linkage to HIV care, retention in HIV care, race and ethnicity, gender, age at time of HIV diagnosis, and injection drug use history. Results Kaplan-Meier plots revealed that median time to HIV viral suppression was shorter among persons with HIV monoinfection, compared with HIV and HCV coinfection (80 days vs 235 days; P <.001). When adjusted for covariates, persons with HCV coinfection remained less likely to reach HIV viral suppression than persons without HCV coinfection for each day of follow-up (hazard ratio 0.53; 95% CI 0.39–0.72). Compared with persons who received no support services, persons who received ≥1 service weekly and persons who received ≥2 services weekly were 60% (95% CI 27%–101%) and 117% (95% CI 36%– 223%) more likely to achieve viral suppression, respectively, for each day of follow-up. Conclusions Addressing social determinants of health through federally sponsored Ryan White services can improve health for persons with HIV monoinfection and HCV coinfection.