title: Cascade of care for people living with HIV infection in the Wellington region.
abstract: OBJECTIVE
  Antiretroviral therapy (ART) is highly effective in providing better outcomes for people living with HIV infection (PLHIV) and reducing the risk of transmission to others. The 'cascade of care' describes steps in delivering care: diagnosis, linkage and retention in care, and the provision and success of ART.
  
  
  METHODS
  The cascade of care for PLHIV in the Wellington region was reviewed during 2015. An estimate of 20% undiagnosed HIV infection was used from past New Zealand research. 'Suppression of HIV infection' by ART was defined as a viral load less than 200 RNA copies/mL as commonly used in other cascade of care studies.
  
  
  RESULTS
  There were 307 people identified with HIV infection. The median age was 48 years, and 54 (18%) were women. At the time of the audit, each of the 307 PLHIV were accounted for and not lost to follow-up. ART was being taken by 272 (89%). Those with a CD4 count >500 x 10^6/L accounted for 26/35 not on ART. Of those on ART 254/272 (93.3%) had a suppressed viral load, including 252/259 (97.3%) of those established on treatment >6 months. Overall, 254/384 (66.1%) were estimated to have a suppressed viral load.
  
  
  CONCLUSIONS
  The study indicated a high level of retention in care, and of effective HIV suppression, with ART. The main gaps in the cascade of care were the people with undiagnosed HIV infection and those in whom treatment had not yet been initiated because their CD4 count was above 500 cells/10^6/L.
authors.affiliation: Infectious Diseases, Wellington Hospital, Wellington. Nigel.Raymond@ccdhb.org.nz.
authors.forename: Nigel
authors.initials: N
authors.lastname: Raymond
authors.forename: Kelly
authors.initials: K
authors.lastname: Bargh
authors.forename: Kyi Lai Lai
authors.initials: KL
authors.lastname: Aung
authors.forename: James
authors.initials: J
authors.lastname: Rice
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D003266:Continuity of Patient Care; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents