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. 2012 Jan 2;26(1):77-86.
doi: 10.1097/QAD.0b013e32834dcee9.

Population-based metrics for the timing of HIV diagnosis, engagement in HIV care, and virologic suppression

Julia C Dombrowski  1 , James B Kent, Susan E Buskin, Joanne D Stekler, Matthew R Golden
Affiliations

Population-based metrics for the timing of HIV diagnosis, engagement in HIV care, and virologic suppression

Julia C Dombrowski et al. AIDS. .

Abstract

Objective: To compare population-based metrics for assessing progress toward the US National HIV/AIDS Strategy (NHAS) goals.

Design: Analysis of surveillance data from persons living with HIV/AIDS (PLWHA) in King County, Washington, USA, 2005-2009.

Methods: We examined indicators of the timing of HIV diagnosis [intertest interval, CD4 cell count at diagnosis, and AIDS ≤ 1 year of diagnosis (late diagnosis)]; linkage to initial care (CD4 or viral load report ≤3 months after diagnosis) and sustained care (a laboratory report 3-9 months after linkage); engagement in continuous care in 2009 (at least two laboratory reports ≥3 months apart); and virologic suppression.

Results: Thirty-two percent of persons had late HIV diagnoses, 31% of whom reported testing HIV negative in the 2 years preceding their HIV diagnoses. Linkage to sustained care, but not linkage to initial care, was significantly associated with subsequent virologic suppression. Among 6070 PLWHA in King County, 65% of those with at least one viral load reported in 2009 and 53% of all PLWHA had virologic suppression. Although only 66% of all PLWHA were engaged in continuous care, 81% were defined as engaged using the denominator proposed in the NHAS (at least one laboratory result reported in 2009 excluding persons establishing care in the second half of the year).

Conclusions: Proposed metrics for monitoring the HIV care continuum may not accurately measure late diagnoses or linkage to sustained care and are sensitive to assumptions about the size of the population of PLWHA. Monitoring progress toward achievement of NHAS goals will require improvements in HIV surveillance data and refinement of care metrics.

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Figures

Figure 1
Figure 1. Correlation between intertest interval (ITI) and CD4 count at diagnosis, and ITI in persons diagnosed with AIDS within one year
Box 1a. Correlation between intertest interval (ITI) and CD4 count at diagnosis among all persons diagnosed with HIV/AIDS in King County 2005–2009. Box 2a. Correlation between ITI and CD4 count at diagnosis among persons with laboratory-confirmed dates of last negative HIV test. Box 1b. Distribution of ITI in persons diagnosed with AIDS within one year among all persons diagnosed with HIV/AIDS in King County 2005–09 Box 2b. Distribution of ITI in persons diagnosed with AIDS within one year among persons with laboratory-confirmed dates of last negative HIV test. aLimited to the >95% of persons with ITI <120 months.
Figure 2
Figure 2. Virologic suppression and CD4 count distribution of persons living with HIV/AIDS (PLWHA) presumed to be residing in king County at the end of 2009
aCases determined through investigation to have died or relocated were excluded from the total population of PLWHA in King County.
Figure 3
Figure 3. Variation in estimates of engagement in continuous care and viral suppression based on differing denominator definitions
aExcludes persons who established HIV care in the second half of 2009 bAdjusted estimate based on the assumption that persons whose last lab was reported prior to 2005 have left king County. Persons determined through case investigation to have died or moved have been removed from the total denominator of PLWHA in king County. VL, viral load
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References

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