title: Disparities and Trends in Viral Suppression During a Transition to a "Test and Treat" Approach to the HIV Epidemic, San Francisco, 2008-2012.
abstract: BACKGROUND
  In 2010, 2 years before national recommendations to provide antiretroviral therapy for HIV-infected persons regardless of CD4 count, the San Francisco Department of Public Health (SFDPH) implemented a "test and treat" strategy that expanded HIV testing and offered antiretroviral therapy to persons at all publicly funded HIV clinics. We used the SFDPH registry of HIV-infected persons to measure trends in the time to viral suppression of persons suppressed.
  
  
  METHODS
  The Kaplan-Meier product limit method was used to assess trends in time from HIV diagnosis to viral suppression (HIV RNA <200 copies/mL) among persons diagnosed from 2008 to 2012. The annual proportion of persons living with HIV who were virally suppressed was measured for the years 2008 to 2012. Independent predictors of viral suppression were determined using proportional hazards regression for newly diagnosed cases and Poisson regression for living cases.
  
  
  RESULTS
  Of the 2349 persons newly diagnosed, the median time from diagnosis to suppression decreased from 13 months in 2008 to 5 months in 2012 (P < 0.0001). Among the 11,787 persons living with HIV, the annual proportion suppressed increased from 69% in 2008 to 78% in 2012. African Americans, persons who inject drugs, persons without private insurance, and persons with nadir CD4 counts above 350 cells per cubic millimeter, were less likely to be virally suppressed.
  
  
  CONCLUSIONS
  We found a decrease in time and overall population-level increases in viral suppression under a test and treat strategy and highlight sociodemographic disparities that may hamper the full benefit of this approach.
authors.affiliation: *San Francisco Department of Public Health; and †Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.
authors.forename: Sandra
authors.initials: S
authors.lastname: Schwarcz
authors.forename: Ling Chin
authors.initials: LC
authors.lastname: Hsu
authors.forename: Susan
authors.initials: S
authors.lastname: Scheer
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012307:Risk Factors; D012495:San Francisco / Q000453:epidemiology; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents