John A Nelson1,2, Anna Kinder1,3, Anna Satcher Johnson4, H Irene Hall4, Xiaohong Hu4, Donna Sweet1,5, Alyssa Guido6, Harold Katner1,7, Jennifer Janelle1,8, Maribel Gonzalez1,9, Natalia Martínez Paz1,10, Charlotte Ledonne1,11, Jason Henry1,12, Theresa Bramel1,13, Jeanne Harris1,14. 1. Rural Health Committee, AIDS Education and Training Center Program, François-Xavier Bagnoud Center, Rutgers University School of Nursing, Newark, New Jersey. 2. School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey. 3. Casper Natrona County Health Department, Casper, Wyoming. 4. Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB, Prevention; Division of HIV/AIDS Prevention, Atlanta, Georgia. 5. School of Medicine, University of Kansas, Wichita, Kansas. 6. College of Medicine, University of Arizona, Tucson, Arizona. 7. School of Medicine, Mercer University, Macon, Georgia. 8. Department of Medicine, University of Florida, Gainesville, Florida. 9. Florida Department of Health, LaBelle, Florida. 10. School of Medicine, University of Washington, Seattle, Washington. 11. San Luis Valley Area Health Education Center, Alamosa, Colorado. 12. Northeast/Caribbean AIDS Education and Training Center, St. Croix, US Virgin Islands. 13. Alaska Native Tribal Health Consortium, Anchorage, Alaska. 14. College of Medicine, University of Kentucky, Lexington, Kentucky.
Abstract
PURPOSE: The HIV care continuum is used to monitor success in HIV diagnosis and treatment among persons living with HIV in the United States. Significant differences exist along the HIV care continuum between subpopulations of people living with HIV; however, differences that may exist between residents of rural and nonrural areas have not been reported. METHODS: We analyzed the Centers for Disease Control and Prevention's National HIV Surveillance System data on adults and adolescents (≥13 years) with HIV diagnosed in 28 jurisdictions with complete reporting of HIV-related lab results. Lab data were used to assess linkage to care (≥1 CD4 or viral load test ≤3 months of diagnosis), retention in care (≥2 CD4 and/or viral load tests ≥3 months apart), and viral suppression (viral load <200 copies/mL) among persons living with HIV. Residence at diagnosis was grouped into rural (<50,000 population), urban (50,000-499,999 population), and metropolitan (≥500,000 population) categories for statistical comparison. Prevalence ratios and 95% CI were calculated to assess significant differences in linkage, retention, and viral suppression. FINDINGS: Although greater linkage to care was found for rural residents (84.3%) compared to urban residents (83.3%) and metropolitan residents (81.9%), significantly lower levels of retention in care and viral suppression were found for residents of rural (46.2% and 50.0%, respectively) and urban (50.2% and 47.2%) areas compared to residents of metropolitan areas (54.5% and 50.8%). CONCLUSIONS: Interventions are needed to increase retention in care and viral suppression among people with HIV in nonmetropolitan areas of the United States.
PURPOSE: The HIV care continuum is used to monitor success in HIV diagnosis and treatment among persons living with HIV in the United States. Significant differences exist along the HIV care continuum between subpopulations of people living with HIV; however, differences that may exist between residents of rural and nonrural areas have not been reported. METHODS: We analyzed the Centers for Disease Control and Prevention's National HIV Surveillance System data on adults and adolescents (≥13 years) with HIV diagnosed in 28 jurisdictions with complete reporting of HIV-related lab results. Lab data were used to assess linkage to care (≥1 CD4 or viral load test ≤3 months of diagnosis), retention in care (≥2 CD4 and/or viral load tests ≥3 months apart), and viral suppression (viral load <200 copies/mL) among persons living with HIV. Residence at diagnosis was grouped into rural (<50,000 population), urban (50,000-499,999 population), and metropolitan (≥500,000 population) categories for statistical comparison. Prevalence ratios and 95% CI were calculated to assess significant differences in linkage, retention, and viral suppression. FINDINGS: Although greater linkage to care was found for rural residents (84.3%) compared to urban residents (83.3%) and metropolitan residents (81.9%), significantly lower levels of retention in care and viral suppression were found for residents of rural (46.2% and 50.0%, respectively) and urban (50.2% and 47.2%) areas compared to residents of metropolitan areas (54.5% and 50.8%). CONCLUSIONS: Interventions are needed to increase retention in care and viral suppression among people with HIV in nonmetropolitan areas of the United States.
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