title: HIV viral suppression among persons with varying levels of engagement in HIV medical care, 19 US jurisdictions.
abstract: BACKGROUND
  Ongoing HIV medical care is vital in achieving and maintaining viral suppression. We examined viral suppression applying retention in care definitions used by various federal agencies.
  
  
  METHODS
  Using National HIV Surveillance System data from 19 US jurisdictions with complete CD4 and viral load reporting, we determined viral suppression among persons who met the National HIV/AIDS Strategy retention in care definition (≥2 visits ≥3 months apart; "retained in continuous care") and among those who had evidence of care but did not meet the definition ("engaged in care"). We also examined viral suppression among persons who met the Health and Human Services Core Indicator definition for retention.
  
  
  RESULTS
  Of 338,959 persons living with diagnosed HIV infection in 19 areas in 2010, 63.7% received any care; of these, 19.7% were "engaged in care" and 80.3% were "retained in continuous care." Of those "engaged in care," 47.7% achieved viral suppression compared with 73.6% of persons "retained in continuous care." Significant differences were evident for all subpopulations within each care category; younger persons and blacks/African Americans had lower levels of viral suppression than their counterparts. Persons "engaged in care," regardless of sex, age, race/ethnicity, and transmission category, had significantly lower percentages of viral suppression than persons "retained in continuous care." Similar patterns of viral suppression were found for persons meeting the Health and Human Services definition compared with persons "retained in continuous care."
  
  
  CONCLUSIONS
  Higher levels of engagement in care, including more frequent monitoring of CD4 and viral load, were associated with viral suppression.
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, GA.
authors.forename: Stacy M
authors.initials: SM
authors.lastname: Cohen
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Hu
authors.forename: Patricia
authors.initials: P
authors.lastname: Sweeney
authors.forename: Anna Satcher
authors.initials: AS
authors.lastname: Johnson
authors.forename: H Irene
authors.initials: HI
authors.lastname: Hall
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D016903:Drug Monitoring / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000821:virology*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D016896:Treatment Outcome; D014481:United States; D019562:Viral Load; D055815:Young Adult