Retention in care of adults and adolescents living with HIV in 13 U.S. areas

Abstract

Background: Monitoring immunologic and virologic responses to antiretroviral therapy in HIV-1-infected patients is an important component of treatment in the United States. However, little population-based information is available on whether HIV-infected persons receive the recommended tests or continuous care.

Methods: Using data from 13 areas reporting relevant HIV-related tests to national HIV surveillance, we determined retention in care in persons older than 12 years living with HIV at the end of 2009. We assessed retention in care, defined as ≥2 CD4 or viral load tests at least 3 months apart in the past year, by demographic, clinical, and risk characteristics and calculated prevalence ratios and 95% confidence intervals. We also assessed the percentage established in care within 12 months after HIV diagnosis in 2008 (≥2 tests, ≥3 months apart).

Results: Among 100,375 persons living with HIV, 45% had ≥2 tests at least 3 months apart. A higher percentage of whites were retained in care (50%) compared with blacks/African Americans (41%, prevalence ratio: 0.83, 95% confidence interval: 0.82 to 0.84) and Hispanics/Latinos (40%, prevalence ratio: 0.90, 95% CI: 0.87 to 0.92). Compared with heterosexual women (50%), fewer men who have sex with men (48%), heterosexual men (45%), and male (37%) and female (43%) injection drug users had ≥2 tests. Approximately 64% established care within 12 months of diagnosis.

Conclusions: Less than half of persons living with HIV had laboratory evidence of ongoing clinical care and only two thirds established care after diagnosis. Further assessments determining modifiable barriers to accessing care could assist with achieving public health targets.