title: A picture is worth a thousand words: maps of HIV indicators to inform research, programs, and policy from NA-ACCORD and CCASAnet clinical cohorts.
abstract: BACKGROUND
  Maps are powerful tools for visualization of differences in health indicators by geographical region, but multi-country maps of HIV indicators do not exist, perhaps due to lack of consistent data across countries. Our objective was to create maps of four HIV indicators in North, Central, and South American countries.
  
  
  METHODS
  Using data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) and the Caribbean, Central, and South America network for HIV epidemiology (CCASAnet), we mapped median CD4 at presentation for HIV clinical care, proportion retained in HIV primary care, proportion prescribed antiretroviral therapy (ART), and the proportion with suppressed plasma HIV viral load (VL) from 2010 to 2012 for North, Central, and South America. The 15 Canadian and US clinical cohorts and 7 clinical cohorts in Argentina, Brazil, Chile, Haiti, Honduras, Mexico, and Peru represented approximately 2-7% of persons known to be living with HIV in these countries.
  
  
  RESULTS
  Study populations were selected for each indicator: median CD4 at presentation for care was estimated among 14,811 adults; retention was estimated among 87,979 adults; ART use was estimated among 84,757 adults; and suppressed VL was estimated among 51,118 adults. Only three US states and the District of Columbia had a median CD4 at presentation >350 cells/mm(3). Haiti, Mexico, and several states had >85% retention in care; lower (50-74%) retention in care was observed in the US West, South, and Mid-Atlantic, and in Argentina, Brazil, and Peru. ART use was highest (90%) in Mexico. The percentages of patients with suppressed VL in the US South and Northeast were lower than in most of Central and South America.
  
  
  CONCLUSIONS
  These maps provide visualization of gaps in the quality of HIV care and allow for comparison between and within countries as well as monitoring policy and programme goals within geographical boundaries.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; kalthoff@jhu.edu.
authors.forename: Keri N
authors.initials: KN
authors.lastname: Althoff
authors.affiliation: Department of Medicine, Vanderbilt University, Nashville, TN, USA.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Rebeiro
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Hanna
authors.affiliation: Department of Internal Medicine, Infectious Disease Service, Instituto Hondureño de Seguridad Social, Tegucigalpa, Honduras.
authors.forename: Denis
authors.initials: D
authors.lastname: Padgett
authors.affiliation: Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Horberg
authors.affiliation: Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brasil.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Grinsztejn
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Alison G
authors.initials: AG
authors.lastname: Abraham
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Hogg
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: M John
authors.initials: MJ
authors.lastname: Gill
authors.affiliation: Departamento de Medicina, Facultad de Medicina, Universidad de Chile and Fundación Arriarán, Santiago, Chile.
authors.forename: Marcelo J
authors.initials: MJ
authors.lastname: Wolff
authors.affiliation: Department of Internal Medicine, Universidad Central del Caribe, Bayamón, Puerto Rico, USA.
authors.forename: Angel
authors.initials: A
authors.lastname: Mayor
authors.affiliation: Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Anita
authors.initials: A
authors.lastname: Rachlis
authors.affiliation: Epidemiology, Basic Science Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Williams
authors.affiliation: Department of Medicine, Vanderbilt University, Nashville, TN, USA.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Sterling
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Mari M
authors.initials: MM
authors.lastname: Kitahata
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Kate
authors.initials: K
authors.lastname: Buchacz
authors.affiliation: Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.|Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Thorne
authors.affiliation: Investigaciones Clínicas, Fundación Huésped, Buenos Aires, Argentina, USA.
authors.forename: Carina
authors.initials: C
authors.lastname: Cesar
authors.affiliation: HIV Research Group, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú
authors.forename: Fernando M
authors.initials: FM
authors.lastname: Cordero
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sean B
authors.initials: SB
authors.lastname: Rourke
authors.affiliation: Departamento de Infectología, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico DF, Mexico.
authors.forename: Juan
authors.initials: J
authors.lastname: Sierra-Madero
authors.affiliation: Le Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti and Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Jean W
authors.initials: JW
authors.lastname: Pape
authors.affiliation: Investigaciones Clínicas, Fundación Huésped, Buenos Aires, Argentina, USA.
authors.forename: Pedro
authors.initials: P
authors.lastname: Cahn
authors.affiliation: Department of Medicine, Vanderbilt University, Nashville, TN, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: McGowan
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D006291:Health Policy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012107:Research Design
keywords: CD4 T-lymphocyte count; Central America; HIV RNA suppression; HIV indicators; Map; North America; South America; antiretroviral therapy; implementation science; retention in care