title: HIV care visits and time to viral suppression, 19 U.S. jurisdictions, and implications for treatment, prevention and the national HIV/AIDS strategy.
abstract: OBJECTIVE
  Early and regular care and treatment for human immunodeficiency virus (HIV) infection are associated with viral suppression, reductions in transmission risk and improved health outcomes for persons with HIV. We determined, on a population level, the association of care visits with time from HIV diagnosis to viral suppression.
  
  
  METHODS
  Using data from 19 areas reporting HIV-related tests to national HIV surveillance, we determined time from diagnosis to viral suppression among 17,028 persons diagnosed with HIV during 2009, followed through December 2011, using data reported through December 2012. Using Cox proportional hazards models, we assessed factors associated with viral suppression, including linkage to care within 3 months of diagnosis, a goal set forth by the National HIV/AIDS Strategy, and number of HIV care visits as determined by CD4 and viral load test results, while controlling for demographic, clinical, and risk characteristics.
  
  
  RESULTS
  Of 17,028 persons diagnosed with HIV during 2009 in the 19 areas, 76.6% were linked to care within 3 months of diagnosis and 57.0% had a suppressed viral load during the observation period. Median time from diagnosis to viral suppression was 19 months overall, and 8 months among persons with an initial CD4 count ≤ 350 cells/µL. During the first 12 months after diagnosis, persons linked to care within 3 months experienced shorter times to viral suppression (higher rate of viral suppression per unit time, hazard ratio [HR] = 4.84 versus not linked within 3 months; 95% confidence interval [CI] 4.27, 5.48). Persons with a higher number of time-updated care visits also experienced a shorter time to viral suppression (HR = 1.51 per additional visit, 95% CI 1.49, 1.52).
  
  
  CONCLUSIONS
  Timely linkage to care and greater frequency of care visits were associated with faster time to viral suppression with implications for individual health outcomes and for secondary prevention.
authors.affiliation: Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: H Irene
authors.initials: HI
authors.lastname: Hall
authors.affiliation: ICF International, Atlanta, Georgia, United States of America.
authors.forename: Tian
authors.initials: T
authors.lastname: Tang
authors.affiliation: Center for AIDS Research, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
authors.forename: Andrew O
authors.initials: AO
authors.lastname: Westfall
authors.affiliation: Center for AIDS Research, University of Alabama at Birmingham, Birmingham, Alabama, United States of America ; Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology* / Q000517:prevention & control*; D006792:House Calls / Q000706:statistics & numerical data*; D006801:Humans; D011159:Population Surveillance; D016016:Proportional Hazards Models; D015980:Public Health Practice; D013997:Time Factors; D014481:United States / Q000453:epidemiology