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Observational Study
. 2016 Sep 10;30(14):2227-34.
doi: 10.1097/QAD.0000000000001183.

A longitudinal, HIV care continuum: 10-year restricted mean time in each care continuum stage after enrollment in care, by history of IDU

Catherine R Lesko  1 , Jessie K Edwards, Richard D Moore, Bryan Lau
Affiliations
Observational Study

A longitudinal, HIV care continuum: 10-year restricted mean time in each care continuum stage after enrollment in care, by history of IDU

Catherine R Lesko et al. AIDS. .

Abstract

Objectives: We present a novel, patient-centric, longitudinal summary of patient progress through the HIV care continuum. Using this new approach, we compare person-time spent alive, in care, on antiretroviral therapy (ART), and virally suppressed among people who inject drugs (PWID) and those who do not (non-IDU).

Design: Prospective clinical observational cohort study.

Methods: We followed ART-naive patients with detectable HIV viral loads who enrolled in the Johns Hopkins HIV Clinical Cohort from enrollment until the occurrence of several care continuum-related milestones, including ART initiation and viral suppression, and until several care continuum-related failures, including loss to clinic and death. We added and subtracted cumulative incidence curves to estimate the proportion of the cohort in each of seven continuum stages across the 10 years following enrollment in clinical care.

Results: PWID composed 32% of the study sample (n = 1443). Over 10 years following enrollment in care, PWID and non-IDU spent only 23 and 37%, respectively, of person-time in care, on ART, and virally suppressed. PWID lost 8.9 more months of life compared with non-IDU and spent an additional 5.0 months on ART but not virally suppressed, and an additional 5.5 months in care but not on ART. There were not meaningful improvements in the 5-year restricted mean person-time differences comparing PWID to non-IDU across enrollment cohorts (2000-2003, 2004-2007, 2008-2014).

Conclusion: Efforts to increase viral suppression among PWID should focus on increasing ART initiation and improving adherence to therapy.

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Figures

Appendix Figure 1
Appendix Figure 1
HIV care continuum states and allowable movement through the continuum under the proposed model * Note that individuals were allowed to move directly from being lost-to-clinic prior to ART initiation or in care, not on ART initiation into being on ART and virally suppressed; this could have occurred if observation of ART initiation and viral suppression occurred simultaneously, e.g. if person was virally suppressed on mono- or dual- therapy and then initiated ART, or if viral suppression occurred in the same month as ART initiation among ART-naïve persons.
Figure 1
Figure 1
Proportion of N=1443 ART-naïve, virally unsuppressed, HIV-infected PWID and non-IDU in each compartment of the HIV care continuum following enrollment in the Johns Hopkins HIV Clinical Cohort to 10 years follow-up
Figure 2
Figure 2
Proportion of ART-naïve, virally unsuppressed, HIV-infected PWID and non-IDU in each compartment of the HIV care continuum following enrollment in the Johns Hopkins HIV Clinical Cohort to 5 years follow-up, stratified by enrollment cohort
See this image and copyright information in PMC

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