scholarly journals The Relationship Between the Human Immunodeficiency Virus-1 Transmission Network and the HIV Care Continuum in Los Angeles County

2020 ◽  
Author(s):  
Adiba Hassan ◽  
Victor De Gruttola ◽  
Yunyin W Hu ◽  
Zhijuan Sheng ◽  
Kathleen Poortinga ◽  
...  
Keyword(s):  
Public Health ◽  
Human Immunodeficiency Virus ◽  
Los Angeles ◽  
Molecular Epidemiology ◽  
Los Angeles County ◽  
Hiv Care ◽  
Hiv Care Continuum ◽  
Genetic Transmission ◽  
Care Continuum ◽  
Immunodeficiency Virus

Abstract Background Public health action combating human immunodeficiency virus (HIV) includes facilitating navigation through the HIV continuum of care: timely diagnosis followed by linkage to care and initiation of antiretroviral therapy to suppress viral replication. Molecular epidemiology can identify rapidly growing HIV genetic transmission clusters. How progression through the care continuum relates to transmission clusters has not been previously characterized. Methods We performed a retrospective study on HIV surveillance data from 5226 adult cases in Los Angeles County diagnosed from 2010 through 2014. Genetic transmission clusters were constructed using HIV-TRACE. Cox proportional hazard models were used to estimate the impact of transmission cluster growth on the time intervals between care continuum events. Gamma frailty models incorporated the effect of heterogeneity associated with genetic transmission clusters. Results In contrast to our expectations, there were no differences in time to the care continuum events among individuals in clusters with different growth dynamics. However, upon achieving viral suppression, individuals in high growth clusters were slower to experience viral rebound (hazard ratio 0.83, P = .011) compared with individuals in low growth clusters. Heterogeneity associated with cluster membership in the timing to each event in the care continuum was highly significant (P < .001), with and without adjustment for transmission risk and demographics. Conclusions Individuals within the same transmission cluster have more similar trajectories through the HIV care continuum than those across transmission clusters. These findings suggest molecular epidemiology can assist public health officials in identifying clusters of individuals who may benefit from assistance in navigating the HIV care continuum.

Adaptation of the HIV Care Continuum as a Method for Evaluating Syphilis and Gonorrhea Disease Control Activities in Los Angeles County

2015 ◽  
Vol 42 (12) ◽  
pp. 686-690 ◽  
Author(s):  
Ryan Daniel Murphy ◽  
Amy Rock Wohl ◽  
Yingbo Ma ◽  
Loulou Kobeissi ◽  
Odutoyosi Oduyemi ◽  
...  
Keyword(s):  
Los Angeles ◽  
Disease Control ◽  
Los Angeles County ◽  
Hiv Care ◽  
Hiv Care Continuum ◽  
Care Continuum

scholarly journals Characterizing the Human Immunodeficiency Virus Care Continuum Among Transgender Women and Cisgender Women and Men in Clinical Care: A Retrospective Time-series Analysis

2019 ◽  
Vol 70 (6) ◽  
pp. 1131-1138 ◽  
Author(s):  
Tonia Poteat ◽  
David B Hanna ◽  
Peter F Rebeiro ◽  
Marina Klein ◽  
Michael J Silverberg ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Risk ◽  
Viral Suppression ◽  
Risk Group ◽  
Retention In Care ◽  
Hiv Care ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Immunodeficiency Virus ◽  
Over Time

Abstract Background Prior studies suggest that transgender women (TW) with human immunodeficiency virus (HIV) are less likely to be virally suppressed than cisgender women (CW) and cisgender men (CM). However, prior data are limited by small sample sizes and cross-sectional designs. We sought to characterize the HIV care continuum comparing TW to CW and CM in the United States and Canada. Methods We analyzed annual HIV care continuum outcomes by gender status from January 2001 through December 2015 among adults (aged ≥18 years) in 15 clinical cohorts. Outcomes were retention in care and viral suppression. Results The study population included TW (n = 396), CW (n = 14 094), and CM (n = 101 667). TW had lower proportions retained in care than CW and CM (P < .01). Estimates of retention in care were consistently lower in TW, with little change over time within each group. TW and CW had similar proportions virally suppressed over time (TW, 36% in 2001 and 80% in 2015; CW, 35% in 2001 and 83% in 2015) and were lower than CM (41% in 2001 and 87% in 2015). These differences did not reach statistical significance after adjusting for age, race, HIV risk group, and cohort. Conclusions TW experience challenges with retention in HIV care. However, TW who are engaged in care achieve viral suppression that is comparable to that of CW and CM of similar age, race, and HIV risk group. Further research is needed to understand care engagement disparities.

scholarly journals High Mortality Among Human Immunodeficiency Virus (HIV)-Infected Individuals Before Accessing or Linking to HIV Care: A Missing Outcome in the Cascade of Care?

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Hartmut B. Krentz ◽  
Judy MacDonald ◽  
M. John Gill
Keyword(s):  
Public Health ◽  
Human Immunodeficiency Virus ◽  
Mortality Rate ◽  
Performance Metrics ◽  
Hiv Infections ◽  
Hiv Care ◽  
Hiv Mortality ◽  
Immunodeficiency Virus ◽  
Cascade Of Care ◽  
Public Health Performance

Abstract Background.  The “cascade of care” displays the proportion of individuals who are infected with human immunodeficiency virus (HIV), diagnosed, linked, retained, on antiretroviral treatment, and HIV suppressed. We examined the implications of including death in the use of this cascade for program and public health performance metrics. Methods.  Individuals newly diagnosed with HIV and living in Calgary between 2006 and 2013 were included. Through linkage with Public Health and death registries, the deaths (ie, all-cause mortality) and their distribution within the cascade were determined. Mortality rates are reported per 100 person-years. Results.  Estimated new HIV infections were 680 (543 confirmed and 137 unknown cases). Forty-three individuals, after diagnosis, were never referred for HIV care. Despite referral(s), 88 individuals (18%) never attended the clinic for HIV care. Of individuals retained in care, 87% received antiretroviral therapy and 76% achieved viral suppression. Thirty-six deaths were reported (mortality rate, 1.50/100 person-years). One diagnosis was made posthumously. Deaths (20 of 35; 57%) occurred for individuals linked but not retained in care (6.93/100 person-years), and 70% were HIV-related. Mortality rate for patients in care was 0.79/100 person-years. Retained patients with detectable viremia had a death rate of 2.49/100, which contrasted with 0.28/100 person-years in those with suppressed viremia. Eight of these 15 deaths (53%) were HIV-related. Conclusions.  Over half of deaths occurred in those referred but not effectively linked or retained in HIV care, and these cases may be easily overlooked in standard HIV mortality studies. Inclusion of deaths into the cascade may further enhance its value as a public health metric.

scholarly journals Measuring the HIV Care Continuum Using Public Health Surveillance Data in the United States

2015 ◽  
Vol 70 (5) ◽  
pp. 489-494 ◽  
Author(s):  
Catherine R. Lesko ◽  
Lynne A. Sampson ◽  
William C. Miller ◽  
Jacquelyn Clymore ◽  
Peter A. Leone ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Public Health Surveillance ◽  
The United States ◽  
Health Surveillance ◽  
Surveillance Data ◽  
Hiv Care ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Health Surveillance Data
Sign in / Sign up

Export Citation Format

Share Document