title: High rates of retention and viral suppression in the US HIV safety net system: HIV care continuum in the Ryan White HIV/AIDS Program, 2011.
abstract: BACKGROUND
  In the human immunodeficiency virus (HIV) care continuum, retention in HIV medical care and viral suppression are key goals to improve individual health outcomes and reduce HIV transmission. National data from clinical providers are lacking.
  
  
  METHODS
  HIV providers funded by the Ryan White HIV/AIDS Program (RWHAP) annually report demographic, service, and clinical data using encrypted unique client identifiers, and data are processed and de-duplicated to create a single record for each client. We calculated retention and viral suppression for clients who received RWHAP-funded HIV medical care in 2011. We conducted multivariate logistic regression to identify factors associated with these outcomes.
  
  
  RESULTS
  In 2011, an estimated 512 911 HIV-infected clients received at least 1 RWHAP-funded non-AIDS Drug Assistance Program service. Of these, 317 458(61.8%) were seen for at least 1 HIV medical care visit. Of these, 82.2% were retained in HIV medical care, and 72.6% achieved viral suppression. Viral suppression was higher among retained clients (77.7%) vs clients who were not retained (58.3%). The lowest levels of retention and viral suppression were among individuals aged 13-34 years.
  
  
  CONCLUSIONS
  The RWHAP provides HIV medical care and support services for more than half a million poor and underinsured individuals living with HIV in the United States. Rates of retention and viral suppression are relatively high compared with other national estimates but demonstrate room for improvement, especially among youth and racial minorities. Additional improvements in retention and viral suppression will contribute to achieving the goals of the National HIV/AIDS Strategy and improve individual and public health.
authors.affiliation: HIV/AIDS Bureau.
authors.forename: Rupali Kotwal
authors.initials: RK
authors.lastname: Doshi
authors.affiliation: HIV/AIDS Bureau.
authors.forename: John
authors.initials: J
authors.lastname: Milberg
authors.affiliation: HIV/AIDS Bureau.
authors.forename: Deborah
authors.initials: D
authors.lastname: Isenberg
authors.affiliation: HIV/AIDS Bureau.
authors.forename: Tracy
authors.initials: T
authors.lastname: Matthews
authors.affiliation: HIV/AIDS Bureau.
authors.forename: Faye
authors.initials: F
authors.lastname: Malitz
authors.affiliation: HIV/AIDS Bureau.
authors.forename: Marlene
authors.initials: M
authors.lastname: Matosky
authors.affiliation: HIV/AIDS Bureau.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Trent-Adams
authors.affiliation: Office of the Administrator, Health Resources and Services Administration, Rockville, Maryland.
authors.forename: Deborah
authors.initials: D
authors.lastname: Parham Hopson
authors.affiliation: HIV/AIDS Bureau.
authors.forename: Laura W
authors.initials: LW
authors.lastname: Cheever
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D014481:United States; D019562:Viral Load; D055815:Young Adult
keywords: HIV care continuum; HIV/AIDS; retention; safety net health system; viral suppression