title: Assessing the HIV Care Continuum in Latin America: progress in clinical retention, cART use and viral suppression.
abstract: BACKGROUND
  We assessed trends in HIV Care Continuum outcomes associated with delayed disease progression and reduced transmission within a large Latin American cohort over a decade: clinical retention, combination antiretroviral therapy (cART) use and viral suppression (VS).
  
  
  METHODS
  Adults from Caribbean, Central and South America network for HIV epidemiology clinical cohorts in seven countries contributed data between 2003 and 2012. Retention was defined as two or more HIV care visits annually, >90 days apart. cART was defined as prescription of three or more antiretroviral agents annually. VS was defined as HIV-1 RNA <200 copies/mL at last measurement annually. cART and VS denominators were subjects with at least one visit annually. Multivariable modified Poisson regression was used to assess temporal trends and examine associations between age, sex, HIV transmission mode, cohort, calendar year and time in care.
  
  
  RESULTS
  Among 18,799 individuals in retention analyses, 14,380 in cART analyses and 13,330 in VS analyses, differences existed between those meeting indicator definitions versus those not by most characteristics. Retention, cART and VS significantly improved from 2003 to 2012 (63 to 77%, 74 to 91% and 53 to 82%, respectively; p<0.05, each). Female sex (risk ratio (RR)=0.97 vs. males) and injection drug use as HIV transmission mode (RR=0.83 vs. male sexual contact with males (MSM)) were significantly associated with lower retention, but unrelated with cART or VS. MSM (RR=0.96) significantly decreased the probability of cART compared with heterosexual transmission.
  
  
  CONCLUSIONS
  HIV Care Continuum outcomes improved over time in Latin America, though disparities for vulnerable groups remain. Efforts must be made to increase retention, cART and VS, while engaging in additional research to sustain progress in these settings.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN, USA; p.rebeiro@vanderbilt.edu.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Rebeiro
authors.affiliation: Fundación Huésped, Buenos Aires, Argentina.
authors.forename: Carina
authors.initials: C
authors.lastname: Cesar
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Shepherd
authors.affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Raquel B
authors.initials: RB
authors.lastname: De Boni
authors.affiliation: Fundación Arriarán, Universidad de Chile, Santiago, Chile.
authors.forename: Claudia P
authors.initials: CP
authors.lastname: Cortés
authors.affiliation: Fundación Arriarán, Universidad de Chile, Santiago, Chile.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Rodriguez
authors.affiliation: Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
authors.forename: Pablo
authors.initials: P
authors.lastname: Belaunzarán-Zamudio
authors.affiliation: Le Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti.
authors.forename: Jean W
authors.initials: JW
authors.lastname: Pape
authors.affiliation: Instituto Hondureño de Seguridad Social and Hospital Escuela, Tegucigalpa, Honduras.
authors.forename: Denis
authors.initials: D
authors.lastname: Padgett
authors.affiliation: Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hoces
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Catherine C
authors.initials: CC
authors.lastname: McGowan
authors.affiliation: Fundación Huésped, Buenos Aires, Argentina.
authors.forename: Pedro
authors.initials: P
authors.lastname: Cahn
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D003266:Continuity of Patient Care; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission / Q000821:virology; D006801:Humans; D007843:Latin America; D008297:Male; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: HIV Care Continuum; Latin America; cART use; cohort studies; retention; viral suppression