title: Ongoing HIV Transmission and the HIV Care Continuum in North Carolina.
abstract: OBJECTIVE
  HIV transmission is influenced by status awareness and receipt of care and treatment. We analyzed these attributes of named partners of persons with acute HIV infection (index AHI cases) to characterize the transmission landscape in North Carolina (NC).
  
  
  METHODS
  Secondary analysis of programmatic data.
  
  
  METHODS
  We used data from the NC Screening and Tracing of Active Transmission Program (2002-2013) to determine HIV status (uninfected, AHI, or chronic HIV infection [CHI]), diagnosis status (new or previously-diagnosed), and care and treatment status (not in care, in care and not on treatment, in care and on treatment) of index AHI cases' named partners. We developed an algorithm identifying the most likely transmission source among known HIV-infected partners to estimate the proportion of transmissions arising from contact with persons at different HIV continuum stages. We conducted a complementary analysis among a subset of index AHI cases and partners with phylogenetically-linked viruses.
  
  
  RESULTS
  Overall, 358 index AHI cases named 932 partners, of which 218 were found to be HIV-infected (162 (74.3%) previously-diagnosed, 11 (5.0%) new AHI, 45 (20.6%) new CHI). Most transmission events appeared attributable to previously-diagnosed partners (77.4%, 95% confidence interval 69.4-85.3%). Among these previously-diagnosed partners, 23.2% (14.0-32.3%) were reported as in care and on treatment near the index AHI case diagnosis date. In the subset study of 33 phylogenetically-linked cases and partners, 60.6% of partners were previously diagnosed (43.9-77.3%).
  
  
  CONCLUSIONS
  A substantial proportion of HIV transmission in this setting appears attributable to contact with previously-diagnosed partners, reinforcing the need for improved engagement in care after diagnosis.
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Anna B
authors.initials: AB
authors.lastname: Cope
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Powers
authors.affiliation: Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: JoAnn D
authors.initials: JD
authors.lastname: Kuruc
authors.affiliation: Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Leone
authors.affiliation: Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America; Bristol-Myers Squibb, Lawrenceville, New Jersey, United States of America.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Anderson
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina, United States of America.
authors.forename: Li-Hua
authors.initials: LH
authors.lastname: Ping
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina, United States of America.
authors.forename: Laura P
authors.initials: LP
authors.lastname: Kincer
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina, United States of America; Department of Biochemistry and Biophysics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America; UNC Center for AIDS Research, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina, United States of America.
authors.forename: Ronald
authors.initials: R
authors.lastname: Swanstrom
authors.affiliation: North Carolina Department of Health and Human Services, Division of Public Health, Raleigh, North Carolina, United States of America.
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Mobley
authors.affiliation: North Carolina Department of Health and Human Services, Division of Public Health, Raleigh, North Carolina, United States of America.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Foust
authors.affiliation: Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Gay
authors.affiliation: Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America; UNC Center for AIDS Research, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina, United States of America.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Eron
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America; Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America; UNC Center for AIDS Research, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina, United States of America.
authors.forename: Myron S
authors.initials: MS
authors.lastname: Cohen
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America; Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
mesh_terms: D000208:Acute Disease; D003266:Continuity of Patient Care; D003710:Demography; D015658:HIV Infections / Q000175:diagnosis / Q000635:transmission* / Q000821:virology; D006801:Humans; D009657:North Carolina; D012747:Sexual Partners; D019562:Viral Load