title: HIV Care Continuum Applied to the US Department of Veterans Affairs: HIV Virologic Outcomes in an Integrated Health Care System.
abstract: BACKGROUND
  The Department of Veterans Affairs (VA), the largest integrated HIV care provider in the United States (US), used the HIV Care Continuum to compare clinical care within the VA HIV population with the general US HIV population and to identify areas for improvement.
  
  
  METHODS
  National data from the VA's HIV Clinical Case Registry were used to construct measures along the Continuum for Veterans in VA care diagnosed with HIV by June 2013 and alive by December 31, 2013. Comparisons were made to recent estimates for the same measures for the US HIV population. Additional comparisons were performed for demographic subgroups of sex, race/ethnicity, and age.
  
  
  RESULTS
  Of 25,480 Veterans diagnosed with HIV, 77.4% were engaged in care compared with 46.3% in the US population diagnosed with HIV (P < 0.001). Seventy-three percent of Veterans diagnosed with HIV received antiretroviral therapy compared with 43% of the US population diagnosed with HIV (P < 0.001). Nearly two-thirds (65.3%) of HIV-diagnosed Veterans had suppressed HIV viral loads compared with 35.0% of the US population diagnosed with HIV (P < 0.001).
  
  
  CONCLUSIONS
  The VA health care system performed better at every stage of the HIV Care Continuum compared with the general US estimates. Comparable high rates with some variation were noted among the demographic groups in the VA cohort. The high viral suppression rate in VA, which was almost double the estimate for the HIV-diagnosed US population, demonstrates that improved outcomes along the HIV Care Continuum can be achieved in a comprehensive integrated health care system.
authors.affiliation: *Department of Veterans Affairs; †Office of Public Health/Population Health, Veterans Health Administration, Palo Alto, CA; ‡Department of Medicine, VA Palo Alto Health Care System, Veterans Health Administration, Palo Alto, CA; §Patient Care Services/Women's Health Services, Veterans Health Administration, Washington, DC; and ‖Office of Public Health/Clinical Public Health, Veterans Health Administration, Washington, DC.
authors.forename: Lisa
authors.initials: L
authors.lastname: Backus
authors.forename: Maggie
authors.initials: M
authors.lastname: Czarnogorski
authors.forename: Gale
authors.initials: G
authors.lastname: Yip
authors.forename: Brittani P
authors.initials: BP
authors.lastname: Thomas
authors.forename: Marisa
authors.initials: M
authors.lastname: Torres
authors.forename: Tierney
authors.initials: T
authors.lastname: Bell
authors.forename: David
authors.initials: D
authors.lastname: Ross
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D044469:Racial Groups; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents