Project Abstract
Washington, DC has approximately 13,000 people living with HIV (PLWH) and is one of the HIV “hotspots” in
the US that collectively contribute to 50% of new HIV diagnoses. As we strive to end the HIV epidemic, the
ability to characterize persons who are newly diagnosed with HIV, effectively direct treatment efforts for HIV
and its co-occurring conditions, and use novel prevention tools to avert further transmissions, are of critical
importance. The DC Cohort, a longitudinal cohort study of over 10,000 PLWH receiving care at 15 clinical sites
in DC, is uniquely positioned to help end the HIV epidemic. The Cohort was launched in 2011 with the goal of
bending the trajectory of the HIV epidemic in DC by improving the quality of care. The Cohort engages
academic and community-based clinics, links to DC Health Department (DOH) 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 all age groups. The Cohort provides a representative, population-level and
scientifically productive research resource that does not exist in most urban high prevalence cities. Building off
the Cohort’s infrastructure and achievements, we will expand this robust population-level data repository to
comprehensively and longitudinally track outcomes among PLWH in a high prevalence city. We will incorporate
new data sources into the Cohort including administrative, service, pharmacy, additional co-morbidity and
patient-reported outcomes data. Access to multi-level data will enhance the monitoring of HIV and co-
morbidities outcomes. Next, we propose to use the Cohort to monitor the impact and effectiveness of Ending
the HIV Epidemic (EHE) initiatives in DC and contribute lessons learned to national EHE efforts. The
Dashboard will monitor key EHE indicators: retention in care; viral suppression (VS); availability, initiation and
efficacy of new ARV therapeutics; and reductions in health disparities. With this tool, local HIV providers and
the DC DOH can support those at greatest risk for suboptimal outcomes. Finally, we will use the Cohort to
develop pioneering interventions to improve the quality of care among PLWH. We will partner with the DC
Center for AIDS Research, local and national HIV investigators, and community stakeholders to identify and
develop clinical, epidemiologic, socio-behavioral, basic science, and implementation science interventions to
improve care. We will use the Cohort infrastructure to identify potential participants and clinical sites for these
studies in support of NIH-funded and other research proposals. The goals of the Cohort align with OAR, NIAID,
and EHE priorities which focus on reducing health disparities, achieving VS, monitoring quality of care, and
improving the management of HIV-related clinical outcomes. The DC Cohort is an unparalleled clinical,
research, and public health resource which 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.
