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The HIV Care Continuum at the Jurisdiction Level

Summary and Comment |
February 5, 2014

The HIV Care Continuum at the Jurisdiction Level

  1. Jonathan Colasanti, MD, MSPH and
  2. Dr. Carlos del Rio

Across 19 jurisdictions in the U.S. representing 37% of HIV diagnoses nationwide, half of the patients were not receiving ongoing care, and even fewer achieved virologic suppression.

  1. Jonathan Colasanti, MD, MSPH and
  2. Dr. Carlos del Rio

Mapping each step along the HIV care continuum has quickly become the gold standard for understanding the path to HIV viral suppression. Using CDC surveillance data, investigators assessed engagement in this continuum among HIV patients in 19 U.S. jurisdictions (18 states and the District of Columbia), where HIV diagnoses in 2011 represented 37% of the nationwide total.

Among the 15,449 persons with a new HIV diagnosis in 2011 in these 19 jurisdictions, 79.8% were linked to care (i.e., had ≥1 CD4-cell or viral load [VL] result within 3 months of diagnosis). The proportion ranged from 71.6% in Georgia (where 1834 cases were diagnosed) to 100% in North Dakota (13 cases). Among 338,959 persons living with HIV (PLWH) in 2010, 63.4% were classified as in care (i.e., having any CD4-cell or VL results during the year) and 50.9% as retained in continuous care (i.e., having ≥2 CD4 or VL results ≥3 months apart during the year); 43.4% showed viral suppression (i.e., having VL ≤200 copies/mL on the most recent test in 2010). The proportions of PLWH in care ranged from 41.2% in Illinois to 74.5% in Iowa; of those retained in continuous care, from 24.6% in Illinois to 58.8% in Iowa; and of those achieving viral suppression, from 14.3% in Delaware to 55.7% in California.

Comment

The completeness of surveillance data at the jurisdiction level remains suboptimal, and the study did not include individuals with as-yet-undiagnosed HIV infection. Nonetheless, the findings reflect a cautiously optimistic view of the care process for HIV in the U.S. Linkage to care after diagnosis appears to be around 80%, with 7 of the 19 jurisdictions now meeting or surpassing the 85% National HIV/AIDS Strategy (NHAS) goal. However, it is concerning that in 2010, only 63.4% of persons living with HIV were in care and 50.9% were retained in care, and that all jurisdictions included in this study fell short of the NHAS goal of 80% receiving continuous care. More important, fewer than half of all PLWH achieved viral suppression. A greater understanding of the disparities and social determinants driving suboptimal HIV care-continuum outcomes within jurisdictions is critical for implementing informed interventions at the local level. More-complete data reporting from these 19 jurisdictions (and others) is expected in the coming years.

Dr. Colasanti is an infectious diseases fellow at Emory University School of Medicine. He reports no conflicts of interest.

  • Disclosures for Dr. Carlos del Rio at time of publication Grant / research support NIH Editorial boards AIDS Research and Human Retroviruses; Journal of AIDS; Globe Public Health Leadership positions in professional societies HIV Medicine Association (Board of Directors); International AIDS Society-USA (Board of Directors)

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