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. 2020 Aug 14;185(7-8):e1147-e1154.
doi: 10.1093/milmed/usaa021.

HIV Care Continuum and Meeting 90-90-90 Targets: Cascade of Care Analyses of a U.S. Military Cohort

Andrew Anglemyer  1   2 , Noah Haber  3   4 , Adi Noiman  5   6 , George Rutherford  7 , Anuradha Ganesan  5   8 , Jason Blaylock  8 , Jason Okulicz  9 , Ryan C Maves  10 , Tahaniyat Lalani  5   11 , Christina Schofield  12 , James Mancuso  13 , Brian K Agan  5   6 ; Infectious Disease Clinical Research Program HIV Working Group
Affiliations

HIV Care Continuum and Meeting 90-90-90 Targets: Cascade of Care Analyses of a U.S. Military Cohort

Andrew Anglemyer et al. Mil Med. .

Abstract

Introduction: The new initiative by the Department of Health and Human Services (DHHS) aims to decrease new HIV infections in the U.S. by 75% within 5 years and 90% within 10 years. Our objective was to evaluate whether the U.S. military provides a good example of the benefits of such policies.

Materials and methods: We conducted an analysis of a cohort of 1,405 active duty military personnel with HIV enrolled in the Natural History Study who were diagnosed between 2003 and 2015 at six U.S. military medical centers. The study was approved by institutional review boards at the Uniformed Services University of the Health Sciences and each of the sites. We evaluated the impact of Department of Defense (DoD) HIV care policies, including screening, linkage to care, treatment eligibility, and combined antiretroviral therapy (cART) initiation on achieving viral suppression (VS) within 3 years of diagnosis. As a secondary outcome, we evaluated the DoD's achievement of UNAIDS 90-90-90 targets.

Results: Nearly all (99%) were linked to care within 60 days. Among patients diagnosed in 2003-2009, 77.5% (95% confidence intervals (CI) 73.9-80.6%) became eligible for cART within 3 years of diagnosis, 70.6% (95% CI 66.6-74.1%) overall initiated cART, and 64.2% (95% CI 60.1-68.0%) overall achieved VS. Among patients diagnosed in 2010-2015, 98.7% (95% CI 96.7-99.5%) became eligible for cART within 3 years of diagnosis, 98.5% (95% CI 96.4-99.4%) overall initiated cART, and 89.8% (95% CI 86.0-92.5%) overall achieved VS.

Conclusions: U.S. military HIV policies have been highly successful in achieving VS goals, exceeding the UNAIDS 90-90-90 targets. In spite of limitations, including generalizability, this example demonstrates the feasibility of the DHHS initiative to decrease new infections through testing, early treatment, and retention in care.

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Figures

Figure 1
Figure 1
a. Cross-sectional cascade of HIV care trends over time by year of diagnosis contrasted with longitudinal Kaplan-Meier estimates, U.S. Military HIV Natural History Study Cohort, 2003–2015(n = 1405). Note: Kaplan-Meier estimates with 95% confidence intervals from the longitudinal cascade analysis displayed for reference in 2003–2009 and 2010–2015 time periods. b. Longitudinal cascade of HIV Care Trends Since Diagnosis Among U.S. Military HIV Natural History Study Cohort (n = 1405). Note: The curves represent Kaplan-Meier estimates of time to event from the start time of diagnosis, censoring at time of discharge and last date of data collection for the cohort. Each color represents the cumulative incidence of reaching a particular cascade stage following the identification.
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Comment in

References

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    1. Department of Defense Instruction on medical standards for appointment, enlistment, or induction into the military services. 2018. Available at https://www.med.navy.mil/sites/nmotc/nami/arwg/Documents/WaiverGuide/DOD...; accessed March 4, 2020.
    1. Department of Defense Department of defense instruction on HIV screening. 2013. Available at http://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodi/648501p.pdf. ; accessed March 4, 2020.
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