Continuous Retention and Viral Suppression Provide Further Insights Into the HIV Care Continuum Compared to the Cross-sectional HIV Care Cascade

Abstract Background It is estimated that 1,295 per 100,000 are people living with HIV (PLWH) in New Haven, which is the second highest rate of HIV prevalence in Connecticut. Since 2009, New Haven has established the Ryan White (RW) HIV Care Continuum. The main goals of HIV care are early linkage to care, ART initiation, and HIV viral suppression. This study is designed to understand the trends and outcomes in newly diagnosed PLWH in New Haven County. Methods This study is a retrospective medical record review of all newly diagnosed RW eligible PLWH from January 1, 2009 to December 31, 2018. The data were collected in REDCap database and included demographics, HIV risk factor, presence of mental health and/or substance abuse disorder, date of diagnosis, date of initial visit, and ART initiation. Health outcomes such as AIDS at diagnosis and rate of viral suppression were evaluated. The data were then analyzed to show the trends over 10 years. Results From January 1, 2009 to December 31, 2018 there were 420 newly diagnosed RW PLWH. Sixty-seven percent of those were male, 56% were non-white, 47% self-identified as Men who have Sex with Men (MSM), and 41% were heterosexual. Twenty-nine percent had AIDS-defining condition at the time of the diagnosis. Thirty-four percent of the 420 patients had a mental health and/or substance use disorder; 53% of those were MSM and 51% were non-white. Over the 10-year period, it was noted that the duration between date of HIV diagnosis and linkage to care as well as ART initiation decreased. This decline was associated with a substantial increase in viral suppression. The average time between the dates of HIV diagnosis and initial visit decreased from 269 days in 2009 to 13 days in 2018. Moreover, the average time between the dates of diagnosis and ART initiation dropped from 308 days in 2009 to 15 days in 2018. The 1-year HIV viral suppression rate subsequently doubled from 44% in 2009 to 87% in 2018 (P < 0.01). Conclusion The Ryan White HIV Care Continuum Model with emphasis on early linkage to care and ART initiation can have a significant impact on HIV viral suppression at a community level for newly diagnosed patients. Another important observation in this study was the alarming high rate of AIDS at diagnosis, which highlights the need for universal HIV testing, and early diagnosis. Disclosures All authors: No reported disclosures.

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High Rates of Retention and Viral Suppression in the US HIV Safety Net System: HIV Care Continuum in the Ryan White HIV/AIDS Program, 2011

Clinical Infectious Diseases ◽

10.1093/cid/ciu722 ◽

2014 ◽

Vol 60 (1) ◽

pp. 117-125 ◽

Cited By ~ 66

Author(s):

R. K. Doshi ◽

J. Milberg ◽

D. Isenberg ◽

T. Matthews ◽

F. Malitz ◽

...

Keyword(s):

Viral Suppression ◽

Safety Net ◽

Hiv Care ◽

Hiv Care Continuum ◽

Care Continuum ◽

Ryan White ◽

The Us ◽

Aids Program ◽

Hiv Aids

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1322. A Mobile Technology-Based Intervention Improves HIV Care Continuum for Young People Living with HIV

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1185 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S478-S478

Author(s):

Ping Du ◽

John Zurlo ◽

Tarek Eshak ◽

Tonya Crook ◽

Cynthia Whitener

Keyword(s):

Mobile Technology ◽

Viral Suppression ◽

Retention In Care ◽

Hiv Care ◽

People Living With Hiv ◽

Hiv Care Continuum ◽

Care Continuum ◽

Hiv Viral Suppression ◽

Study Participants ◽

Living With Hiv

Abstract Background Young people living with HIV (YPLWH) have lower rates of retention in care and HIV viral suppression. Multiple barriers exist to engage YPLWH in care. As nearly all YPLWH use their mobile phones to access health information and to communicate with other people, we implemented a mobile technology-based intervention with the goal to improve HIV care continuum in YPLWH. Methods YPLWH were eligible for this study if they were: (1) aged 18–34 years; (2) newly diagnosed with HIV; (3) having a history of being out of care; or (4) not virally suppressed. We recruited YPLWH during January 2017-May 2018 and followed them every 6 months. We developed a HIPAA-compliant mobile application, “OPT-In For Life,” and let participants use this app to manage their HIV care. The app integrated multiple features that enabled users to communicate with the HIV treatment team via a secure messaging function, to access laboratory results and HIV prevention resources, and to set up appointment or medication reminders. We obtained participants’ demographics, app-usage data, and medical records to evaluate if this mobile technology-based intervention would improve HIV care continuum among YPLWH. We used a quasi-experiment study design to compare the rates of retention in care and HIV viral suppression every 6 months between study participants and YPLWH who were eligible but not enrolled in the study. Results 92 YPLWH participated in this study (70% male, 56% Hispanics or Blacks, 54% retained in care, and 66% virally suppressed at baseline). On average study participants used the app 1–2 times/week to discuss various health issues and supportive services with HIV providers, to access HIV-related health information, and to manage their HIV care. At the 6-month evaluation, compared with 88 eligible YPLWH who were not enrolled in this intervention, study participants had increased rates of retention in care (baseline-to-6-month between participants and nonparticipants: 54%–84% vs. 26%–25%) and HIV viral suppression (66%–80% vs. 56%–60%). Conclusion Our study demonstrates using a HIPAA-compliant mobile app as an effective intervention to engage YPLWH in care. This intervention can be adapted by other HIV programs to improve HIV care continuum for YPLWH or broader HIV populations. Disclosures All authors: No reported disclosures.

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The HIV care cascade for adolescents initiated on antiretroviral therapy in a health district of South Africa: a retrospective cohort study

BMC Infectious Diseases ◽

10.1186/s12879-020-05742-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Roxanna Haghighat ◽

Elona Toska ◽

Nontuthuzelo Bungane ◽

Lucie Cluver

Keyword(s):

South Africa ◽

Viral Load ◽

Antiretroviral Therapy ◽

Viral Suppression ◽

Hiv Care ◽

Loss To Follow Up ◽

Hiv Care Cascade ◽

Care Cascade ◽

Clinical Records

Abstract Background Little evidence exists to comprehensively estimate adolescent viral suppression after initiation on antiretroviral therapy in sub-Saharan Africa. This study examines adolescent progression along the HIV care cascade to viral suppression for adolescents initiated on antiretroviral therapy in South Africa. Methods All adolescents ever initiated on antiretroviral therapy (n=1080) by 2015 in a health district of the Eastern Cape, South Africa, were interviewed in 2014–2015. Clinical records were extracted from 52 healthcare facilities through January 2018 (including records in multiple facilities). Mortality and loss to follow-up rates were corrected for transfers. Predictors of progression through the HIV care cascade were tested using sequential multivariable logistic regressions. Predicted probabilities for the effects of significant predictors were estimated by sex and mode of infection. Results Corrected mortality and loss to follow-up rates were 3.3 and 16.9%, respectively. Among adolescents with clinical records, 92.3% had ≥1 viral load, but only 51.1% of viral loads were from the past 12 months. Adolescents on ART for ≥2 years (AOR 3.42 [95%CI 2.14–5.47], p< 0.001) and who experienced decentralised care (AOR 1.39 [95%CI 1.06–1.83], p=0.018) were more likely to have a recent viral load. The average effect of decentralised care on recent viral load was greater for female (AOR 2.39 [95%CI 1.29–4.43], p=0.006) and sexually infected adolescents (AOR 3.48 [95%CI 1.04–11.65], p=0.043). Of the total cohort, 47.5% were recorded as fully virally suppressed at most recent test. Only 23.2% were recorded as fully virally suppressed within the past 12 months. Younger adolescents (AOR 1.39 [95%CI 1.06–1.82], p=0.017) and those on ART for ≥2 years (AOR 1.70 [95%CI 1.12–2.58], p=0.013) were more likely to be fully viral suppressed. Conclusions Viral load recording and viral suppression rates remain low for ART-initiated adolescents in South Africa. Improved outcomes for this population require stronger engagement in care and viral load monitoring.

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Everything counts - a method to determine viral suppression among people living with HIV using longitudinal data for the HIV care continuum - results of two large, German, multi-center real-life cohort studies over 20 years (1999–2018)

BMC Public Health ◽

10.1186/s12889-020-10088-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Daniel Schmidt ◽

◽

Christian Kollan ◽

Matthias Stoll ◽

Osamah Hamouda ◽

...

Keyword(s):

Cohort Studies ◽

Viral Suppression ◽

Real Life ◽

Hiv Care ◽

People Living With Hiv ◽

Hiv Care Continuum ◽

Care Continuum ◽

Low Level ◽

Art Initiation ◽

Gap Time

Abstract Background The aim of this study was to develop a standardized method to reconstruct persons’ individual viral load (VL) courses to determine viral suppression and duration of viremia for the HIV care continuum in Germany using longitudinal cohort data. Methods We analyzed data from two large, multi-center German cohort studies under the direction of the Robert Koch Institute. We included data from 1999 to 2018 of all diagnosed people and of people who initiated antiretroviral treatment (ART). We developed a model generating virtual VL values and an individual VL course corresponding to real VL measurements with a maximum distance of 180 days, considering ART status and VL dynamics. If the distance between VL measurements was > 180 days, the time between was defined as gap time. Additionally, we considered blips, which we defined as a single detectable VL < 1000 copies/ml within 180 days. Results A total of 22,120 people (164,691 person-years, PY) after ART initiation were included in the analyses. The proportion of people with viral suppression (VL < 50 copies/ml) increased from 34% in 1999 to 93% in 2018. The proportion of people with VL < 200 copies/ml increased from 47% in 1999 to 96% in 2018. The proportion of people with viremia > 1000 copies/ml decreased from 37% in 1999 to 3% in 2018. The proportion of people with gap time fluctuated and ranged between 18 and 28%. An analysis of the first VL after gap time showed that 90% showed viral suppression, 5% VL between 50- < 1000 copies/ml and 5% VL > 1000 copies/ml. Conclusion We provide a method for estimating viral suppression and duration of viremia using longitudinal VL data. We observed a continuous and remarkable increase of viral suppression. Furthermore, a notable proportion of those with viremia showed low-level viremia and were therefore unlikely to transmit HIV. Individual health risks and HIV drug resistance among those with low-level viremia are problematic, and viral suppression remains the goal. In 2018, 93 and 96% of people after ART initiation showed VL < 50 copies/ml and VL < 200 copies/ml, respectively. Therefore, using the threshold of VL < 200 copies/ml, Germany reached the UNAIDS 95 target of viral suppression since 2017.

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District-level strategies to control the HIV epidemic in Zimbabwe: a practical example of precision public health

10.21203/rs.2.22644/v4 ◽

2020 ◽

Author(s):

Richard Makurumidze ◽

Tom Decroo ◽

Lutgarde Lynen ◽

Zororo Kudzaishe Chinwadzimba ◽

Wim Van Damme ◽

...

Keyword(s):

Hiv Testing ◽

Cross Sectional Study ◽

District Level ◽

Hiv Care ◽

Cross Sectional ◽

Hiv Care Cascade ◽

Hiv Epidemic ◽

Care Cascade ◽

Remediation Strategies ◽

Level Performance

Abstract Objective We conducted a descriptive cross-sectional study using survey and programme data to assess district-level performance along the HIV care cascade (HIV testing target achievement, linkage to ART and ART coverage) in order to formulate district-specific recommendations, taking into consideration prevalence and yield of testing. Results Data from 60 districts were analysed. Forty-eight districts (80.0%) surpassed 90% of their 2018 HIV testing targets. Linkage to ART was less than 90% in 40 districts (83.3%). Thirty districts (50.0%) had ART coverage above 90%. Of the 30 districts with suboptimal (<90%) ART coverage, 18 districts had achieved high HIV testing target but with suboptimal linkage to ART, 6 had achieved high HIV testing targets and high linkage to ART, 4 had both suboptimal HIV testing target achievement and linkage to ART and 2 had suboptimal HIV testing target achievement and high linkage to ART. Priority should be given to districts with suboptimal ART coverage. Remediation strategies should be tailored to address the poorly performing stage of the cascade in each of the districts.

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Identifying Spatial Variation Along the HIV Care Continuum: The Role of Distance to Care on Retention and Viral Suppression

AIDS and Behavior ◽

10.1007/s10461-018-2103-8 ◽

2018 ◽

Vol 22 (9) ◽

pp. 3009-3023 ◽

Cited By ~ 8

Author(s):

A. S. Terzian ◽

◽

N. Younes ◽

A. E. Greenberg ◽

J. Opoku ◽

...

Keyword(s):

Spatial Variation ◽

Viral Suppression ◽

Hiv Care ◽

Hiv Care Continuum ◽

Care Continuum ◽

Distance To Care

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Assessing the HIV Care Continuum in Latin America: progress in clinical retention, cART use and viral suppression

Journal of the International AIDS Society ◽

10.7448/ias.19.1.20636 ◽

2016 ◽

Vol 19 (1) ◽

pp. 20636 ◽

Cited By ~ 7

Author(s):

Peter F Rebeiro ◽

Carina Cesar ◽

Bryan E Shepherd ◽

Raquel B De Boni ◽

Claudia P Cortés ◽

...

Keyword(s):

Latin America ◽

Viral Suppression ◽

Hiv Care ◽

Hiv Care Continuum ◽

Care Continuum

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District-level strategies to control the HIV epidemic in Zimbabwe: a practical example of precision public health.

10.21203/rs.2.22644/v2 ◽

2020 ◽

Author(s):

Richard Makurumidze ◽

Tom Decroo ◽

Lutgarde Lynen ◽

Zororo Kudzaishe Chinwadzimba ◽

Wim Van Damme ◽

...

Keyword(s):

Hiv Testing ◽

Cross Sectional Study ◽

District Level ◽

Hiv Care ◽

Cross Sectional ◽

Hiv Care Cascade ◽

Hiv Epidemic ◽

Care Cascade ◽

Remediation Strategies ◽

Level Performance

Abstract Objective We conducted a descriptive cross-sectional study using survey and programme data to asses district-level performance along the HIV care cascade (HIV testing target achievement, linkage to ART, ART coverage) in order to formulate district-specific recommendations, taking into consideration prevalence and yield of testing.Results Data from 60 districts were analysed. Most 48 (80.0%) of districts surpassed 90% of their 2018 HIV testing targets. Linkage to ART was less than 90% in 40 (83.3%) of districts. Half (30) of districts had an ART coverage above 90%. Of 30 districts with suboptimal(<90%) ART coverage, 18 had achieved high HIV testing target achievement but suboptimal linkage to ART, 6 had achieved high HIV testing targets and high linkage to ART, 4 had both suboptimal HIV testing target achievement and linkage to ART and 2 had suboptimal HIV testing target achievement and high linkage to ART. Priority should be given to districts with suboptimal ART coverage. Remediation strategies should be tailored to address the poorly performing stage of the cascade in each district.

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Challenges Across the HIV Care Continuum for Patients With HIV/TB Co-infection in Atlanta, GA

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy063 ◽

2018 ◽

Vol 5 (4) ◽

Cited By ~ 2

Author(s):

Marcos C Schechter ◽

Destani Bizune ◽

Michelle Kagei ◽

David P Holland ◽

Carlos del Rio ◽

...

Keyword(s):

Inner City ◽

Viral Suppression ◽

Retention In Care ◽

The United States ◽

Hiv Care ◽

City Hospital ◽

Hiv Care Continuum ◽

Sequential Art ◽

Care Continuum ◽

Tb Treatment

Abstract Background Antiretroviral therapy (ART) for persons with HIV infection prevents tuberculosis (TB) disease. Additionally, sequential ART after initiation of TB treatment improves outcomes. We examined ART use, retention in care, and viral suppression (VS) before, during, and 3 years following TB treatment for an inner-city cohort in the United States. Methods Retrospective cohort study among persons treated for culture-confirmed TB between 2008 and 2015 at an inner-city hospital. Results Among 274 persons with culture-confirmed TB, 96 (35%) had HIV co-infection, including 23 (24%) new HIV diagnoses and 73 (76%) previous diagnoses. Among those with known HIV prior to TB, the median time of known HIV was 6 years, and only 10 (14%) were on ART at the time of TB diagnosis. The median CD4 at TB diagnosis was 87 cells/uL. Seventy-four (81%) patients received ART during treatment for TB, and 47 (52%) has VS at the end of TB treatment. Only 32% of patients had continuous VS 3 years after completing TB treatment. There were 3 TB recurrences and 3 deaths post–TB treatment; none of these patients had retention or VS after TB treatment. Conclusions Among persons with active TB co-infected with HIV, we found that the majority had known HIV and were not on ART prior to TB diagnosis, and retention in care and VS post–TB treatment were very low. Strengthening the HIV care continuum is needed to improve HIV outcomes and further reduce rates of active TB/HIV co-infection in our and similar settings.

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