Jonathan Colasanti1,2,3, Jane Kelly4, Eugene Pennisi4, Yi-Juan Hu5, Christin Root3, Denise Hughes4, Carlos Del Rio1,3,6, Wendy S Armstrong1,2,6. 1. Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine. 2. Infectious Diseases Program, Grady Health System. 3. Hubert Department of Global Health, Rollins School of Public Health, Emory University. 4. HIV/AIDS Epidemiology Section, Georgia Department of Public Health. 5. Department of Biostatistics and Bioinformatics, Rollins School of Public Health. 6. Center for AIDS Research, Emory University, Atlanta, Georgia.
Abstract
BACKGROUND: The human immunodeficiency virus (HIV) care continuum has become an important tool for evaluating HIV care. Current depictions of the care continuum are often cross-sectional and evaluate retention and viral suppression (VS) in a single year, yet the National HIV/AIDS Strategy calls for programs with long-lasting outcomes. METHODS: Retrospective chart review of HIV-infected patients enrolled in a large, urban clinic in 2010 followed longitudinally for 36 months. McNemar comparisons and logistic regression analyses were conducted to evaluate covariate association with continuous retention and VS. Generalized estimating equation log-linear models were used to integrate time into the model. RESULTS: Among 655 patients (77% male, 83% black, 54% men who have sex with men (MSM), 78% uninsured) continuous retention/VS at 12 months (84%/64%), 24 months (60%/48%), and 36 months (49%/39%) showed significant attrition (P < .0001) over time. Continuous retention was associated with prevalent VS at the end of 36 months (adjusted prevalence ratio 3.12; 95% confidence interval [CI], 2.40, 4.07). 12-month retention for black (84%) and nonblack (85%) patients was equivalent, yet fewer blacks (46%) than nonblacks (63%) achieved 36-month continuous retention due to a significant interaction between race and time (aOR 0.75, 95% CI, .59, .95). CONCLUSIONS: Continuous retention is a critically important measure of long-term success in HIV treatment and the crucial component of successful treatment-as-prevention but is infrequently evaluated. Single cross-sections may overestimate successful retention and virologic outcomes. A longitudinal HIV care continuum provides greater insight into long-term outcomes and exposes disparities not evident with traditional cross-sectional care continua.
BACKGROUND: The human immunodeficiency virus (HIV) care continuum has become an important tool for evaluating HIV care. Current depictions of the care continuum are often cross-sectional and evaluate retention and viral suppression (VS) in a single year, yet the National HIV/AIDS Strategy calls for programs with long-lasting outcomes. METHODS: Retrospective chart review of HIV-infectedpatients enrolled in a large, urban clinic in 2010 followed longitudinally for 36 months. McNemar comparisons and logistic regression analyses were conducted to evaluate covariate association with continuous retention and VS. Generalized estimating equation log-linear models were used to integrate time into the model. RESULTS: Among 655 patients (77% male, 83% black, 54% men who have sex with men (MSM), 78% uninsured) continuous retention/VS at 12 months (84%/64%), 24 months (60%/48%), and 36 months (49%/39%) showed significant attrition (P < .0001) over time. Continuous retention was associated with prevalent VS at the end of 36 months (adjusted prevalence ratio 3.12; 95% confidence interval [CI], 2.40, 4.07). 12-month retention for black (84%) and nonblack (85%) patients was equivalent, yet fewer blacks (46%) than nonblacks (63%) achieved 36-month continuous retention due to a significant interaction between race and time (aOR 0.75, 95% CI, .59, .95). CONCLUSIONS: Continuous retention is a critically important measure of long-term success in HIV treatment and the crucial component of successful treatment-as-prevention but is infrequently evaluated. Single cross-sections may overestimate successful retention and virologic outcomes. A longitudinal HIV care continuum provides greater insight into long-term outcomes and exposes disparities not evident with traditional cross-sectional care continua.
Authors: Edward M Gardner; Margaret P McLees; John F Steiner; Carlos Del Rio; William J Burman Journal: Clin Infect Dis Date: 2011-03-15 Impact factor: 9.079
Authors: Michael J Mugavero; Andrew O Westfall; Anne Zinski; Jessica Davila; Mari-Lynn Drainoni; Lytt I Gardner; Jeanne C Keruly; Faye Malitz; Gary Marks; Lisa Metsch; Tracey E Wilson; Thomas P Giordano Journal: J Acquir Immune Defic Syndr Date: 2012-12-15 Impact factor: 3.731
Authors: Peter Rebeiro; Keri N Althoff; Kate Buchacz; John Gill; Michael Horberg; Hartmut Krentz; Richard Moore; Timothy R Sterling; John T Brooks; Kelly A Gebo; Robert Hogg; Marina Klein; Jeffrey Martin; Michael Mugavero; Sean Rourke; Michael J Silverberg; Jennifer Thorne; Stephen J Gange Journal: J Acquir Immune Defic Syndr Date: 2013-03-01 Impact factor: 3.731
Authors: Anna B Cope; Kimberly A Powers; JoAnn D Kuruc; Peter A Leone; Jeffrey A Anderson; Li-Hua Ping; Laura P Kincer; Ronald Swanstrom; Victoria L Mobley; Evelyn Foust; Cynthia L Gay; Joseph J Eron; Myron S Cohen; William C Miller Journal: PLoS One Date: 2015-06-04 Impact factor: 3.240
Authors: Merhawi T Gebrezgi; Kristopher P Fennie; Diana M Sheehan; Boubakari Ibrahimou; Sandra G Jones; Petra Brock; Robert A Ladner; Mary Jo Trepka Journal: AIDS Patient Care STDS Date: 2020-04 Impact factor: 5.078
Authors: Diana M Sheehan; Kristopher P Fennie; Daniel E Mauck; Lorene M Maddox; Spencer Lieb; Mary Jo Trepka Journal: AIDS Patient Care STDS Date: 2017-04 Impact factor: 5.078
Authors: Jonathan Colasanti; Natalie Stahl; Eugene W Farber; Carlos Del Rio; Wendy S Armstrong Journal: J Acquir Immune Defic Syndr Date: 2017-02-01 Impact factor: 3.731
Authors: Lisa R Metsch; Daniel J Feaster; Lauren Gooden; Tim Matheson; Maxine Stitzer; Moupali Das; Mamta K Jain; Allan E Rodriguez; Wendy S Armstrong; Gregory M Lucas; Ank E Nijhawan; Mari-Lynn Drainoni; Patricia Herrera; Pamela Vergara-Rodriguez; Jeffrey M Jacobson; Michael J Mugavero; Meg Sullivan; Eric S Daar; Deborah K McMahon; David C Ferris; Robert Lindblad; Paul VanVeldhuisen; Neal Oden; Pedro C Castellón; Susan Tross; Louise F Haynes; Antoine Douaihy; James L Sorensen; David S Metzger; Raul N Mandler; Grant N Colfax; Carlos del Rio Journal: JAMA Date: 2016-07-12 Impact factor: 56.272
Authors: Anthony T Fojo; Catherine R Lesko; Keri L Calkins; Richard D Moore; Mary E McCaul; Heidi E Hutton; William C Mathews; Heidi Crane; Katerina Christopoulos; Karen Cropsey; Michael J Mugavero; Kenneth Mayer; Brian W Pence; Bryan Lau; Geetanjali Chander Journal: AIDS Behav Date: 2019-03
Authors: David J Riedel; Kristen A Stafford; Aparna Vadlamani; Robert R Redfield Journal: AIDS Res Hum Retroviruses Date: 2016-12-13 Impact factor: 2.205
Authors: John A Sauceda; Nadra E Lisha; Samantha E Dilworth; Mallory O Johnson; Katerina A Christopoulos; Troy Wood; Kimberly A Koester; W Christopher Mathews; Richard D Moore; Sonia Napravnik; Kenneth H Mayer; Heidi M Crane; Rob J Fredericksen; Michael J Mugavero; Torsten B Neilands Journal: Health Psychol Date: 2020-04-13 Impact factor: 4.267