Baligh R. Yehia|Alisa J. Stephens?Shields|John A. Fleishman|Stephen A. Berry|Allison L. Agwu|Joshua P. Metlay|Richard D. Moore|W. Christopher Mathews|Ank E. Nijhawan|Richard M. Rutstein|Aditya H. Gaur|Kelly A. Gebo
The HIV Care Continuum: Changes over Time in Retention in Care and Viral Suppression
University of Pennsylvania|Agency for Healthcare Research and Quality|Johns Hopkins Medicine|Johns Hopkins University|Johns Hopkins Medicine|Johns Hopkins University|Massachusetts General Hospital|Johns Hopkins Medicine|Johns Hopkins University|University of California, San Diego|The University of Texas Southwestern Medical Center|Children's Hospital of Philadelphia|St. Jude Children's Research Hospital|Johns Hopkins Medicine|Johns Hopkins University
background hiv care continuum diagnosis linkage care retention care receipt antiretroviral therapy art viral suppression used identify opportunities improving delivery hiv care continuum steps typically calculated conditional manner number persons completing prior step serving base population next step approach may underestimate prevalence viral suppression excluding patients suppressed meet standard definitions retention care understanding retention care viral suppression interact change time may improve ability intervene steps continuum methods followed 17140 patients 11 us hiv clinics 20102012 calendar year patients classified one five categories 1 retainedsuppressed 2 retainednotsuppressed 3 notretainedsuppressed 4 notretainednotsuppressed 5 lost followup calendar years 2011 2012 retained individuals completing 2 hiv medical visits separated 90 days year persons retained completed 1 hiv medical visit year meet retention definition persons lost followup hiv medical visits year hiv viral suppression defined hiv1 rna 200 copiesml last measure year multinomial logistic regression used determine probability patients transitioning retentionsuppression categories 2010 2011 2010 2012 adjusting age sex raceethnicity hiv risk factor insurance status cd4 count use art results overall 658 patients retainedsuppressed 174 retainednotsuppressed 100 notretainedsuppressed 68 notretainednotsuppressed 2010 595 patients maintained status 2011 kappa0458 533 maintained status 2012 kappa0437 conclusions counting patients notretainedsuppressed virally suppressed commonly done hiv care continuum underestimated proportion suppressed 13 applying care continuum longitudinal manner enhance utility