title: Continuous Retention and Viral Suppression Provide Further Insights Into the HIV Care Continuum Compared to the Cross-sectional HIV Care Cascade.
abstract: BACKGROUND
  The human immunodeficiency virus (HIV) care continuum has become an important tool for evaluating HIV care. Current depictions of the care continuum are often cross-sectional and evaluate retention and viral suppression (VS) in a single year, yet the National HIV/AIDS Strategy calls for programs with long-lasting outcomes.
  
  
  METHODS
  Retrospective chart review of HIV-infected patients enrolled in a large, urban clinic in 2010 followed longitudinally for 36 months. McNemar comparisons and logistic regression analyses were conducted to evaluate covariate association with continuous retention and VS. Generalized estimating equation log-linear models were used to integrate time into the model.
  
  
  RESULTS
  Among 655 patients (77% male, 83% black, 54% men who have sex with men (MSM), 78% uninsured) continuous retention/VS at 12 months (84%/64%), 24 months (60%/48%), and 36 months (49%/39%) showed significant attrition (P < .0001) over time. Continuous retention was associated with prevalent VS at the end of 36 months (adjusted prevalence ratio 3.12; 95% confidence interval [CI], 2.40, 4.07). 12-month retention for black (84%) and nonblack (85%) patients was equivalent, yet fewer blacks (46%) than nonblacks (63%) achieved 36-month continuous retention due to a significant interaction between race and time (aOR 0.75, 95% CI, .59, .95).
  
  
  CONCLUSIONS
  Continuous retention is a critically important measure of long-term success in HIV treatment and the crucial component of successful treatment-as-prevention but is infrequently evaluated. Single cross-sections may overestimate successful retention and virologic outcomes. A longitudinal HIV care continuum provides greater insight into long-term outcomes and exposes disparities not evident with traditional cross-sectional care continua.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine.|Infectious Diseases Program, Grady Health System.|Hubert Department of Global Health, Rollins School of Public Health, Emory University.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Colasanti
authors.affiliation: HIV/AIDS Epidemiology Section, Georgia Department of Public Health.
authors.forename: Jane
authors.initials: J
authors.lastname: Kelly
authors.affiliation: HIV/AIDS Epidemiology Section, Georgia Department of Public Health.
authors.forename: Eugene
authors.initials: E
authors.lastname: Pennisi
authors.affiliation: Department of Biostatistics and Bioinformatics, Rollins School of Public Health.
authors.forename: Yi-Juan
authors.initials: YJ
authors.lastname: Hu
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University.
authors.forename: Christin
authors.initials: C
authors.lastname: Root
authors.affiliation: HIV/AIDS Epidemiology Section, Georgia Department of Public Health.
authors.forename: Denise
authors.initials: D
authors.lastname: Hughes
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine.|Hubert Department of Global Health, Rollins School of Public Health, Emory University.|Center for AIDS Research, Emory University, Atlanta, Georgia.
authors.forename: Carlos
authors.initials: C
authors.lastname: Del Rio
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine.|Infectious Diseases Program, Grady Health System.|Center for AIDS Research, Emory University, Atlanta, Georgia.
authors.forename: Wendy S
authors.initials: WS
authors.lastname: Armstrong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003266:Continuity of Patient Care; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000628:therapy* / Q000821:virology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019562:Viral Load; D055815:Young Adult
keywords: HIV; care continuum; continuous retention; disparity; viral suppression