title: Linkage and retention in care and the time to HIV viral suppression and viral rebound - New York City.
abstract: The success of antiretroviral therapy (ART) as treatment for the individual patient and as prevention requires the achievment and maintenance of human immunodeficiency virus (HIV) viral suppression. Linkage to and retention in care are required for access to ART. We describe the impact of care on viral suppression using routinely reported surveillance data. We included New York City residents ≥13 years of age, diagnosed with HIV/AIDS from 1 July 2005 to 30 June 2009 with a viral load (VL) or CD4 reported within six months of diagnosis and ≥1 VL reported from 1 July 2005 to 30 June 2011. To examine viral rebound, we restricted the analysis to those who achieved viral suppression and had a subsequent VL measure reported by 30 June 2011. Cox proportional hazards models were used to evaluate factors associated with time to viral suppression (VL ≤ 400 copies/mL) and rebound (VL > 1000 copies/mL). Initiation of care within three months of diagnosis (CD4/VL report within three months of diagnosis), female sex, and an initial CD4 < 350 (cells/mm(3)) at diagnosis significantly increased the likelihood of viral suppression. Irregular care (no CD4/VL reported every six months), younger age, non-white race/ethnicity, having an initial CD4 ≥ 350 at diagnosis, and AIDS diagnosis by 2010 increased the likelihood of rebound. These findings lend support to interventions for improving linkage to and maintenance in regular care as a way to achieve and maintain suppression. Surveillance data represent an ideal means for monitoring engagement in care and viral suppression at the population level.
authors.affiliation: a New York City Department of Health and Mental Hygiene , New York , NY , USA.
authors.forename: McKaylee
authors.initials: M
authors.lastname: Robertson
authors.forename: Fabienne
authors.initials: F
authors.lastname: Laraque
authors.forename: Heather
authors.initials: H
authors.lastname: Mavronicolas
authors.forename: Sarah
authors.initials: S
authors.lastname: Braunstein
authors.forename: Lucia
authors.initials: L
authors.lastname: Torian
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D011159:Population Surveillance; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents
keywords: HIV viral load; HIV viral rebound; HIV viral suppression; initiation of care; linkage to care; retention in care