title: "Out of Care" HIV Case Investigations: A Collaborative Analysis Across 6 States in the Northwest US.
abstract: BACKGROUND
  HIV care continuum estimates derived from laboratory surveillance typically assume that persons without recently reported CD4 count or viral load results are out of care.
  
  
  METHODS
  We conducted a multistate project (Alaska, Idaho, Montana, Oregon, Washington, and Wyoming) to ascertain the status of HIV cases that appeared to be out of care during a 12-month period. We used laboratory surveillance to identify cases in all states but Idaho, where viral load reporting is not mandatory, requiring us to rely on clinic records. After complete investigation, we assigned each case one of the following dispositions: moved out of state, died, in HIV care, no evidence of HIV care, or data error.
  
  
  RESULTS
  We identified 3866 cases with no CD4 count or viral load result in a ≥12-month period during 2012-2014, most (85%) of which were in Washington or Oregon. A median of 43% (range: 20%-67%) of cases investigated in each state had moved, 9% (0%-16%) had died, and 11% (8%-33%) were in care during the 12-month surveillance period. Only 28% of investigated cases in the region and a median of 30% (10%-57%) of investigated cases in each state had no evidence of care, migration, or death after investigation.
  
  
  CONCLUSIONS
  Most persons living with HIV in the Northwest United States who appear to be out of care based on laboratory surveillance are not truly out of care. Our findings highlight the importance of improving state surveillance systems to ensure accurate care continuum estimates and guide Data to Care efforts.
authors.affiliation: *University of Washington, Seattle, Washington; †Public Health-Seattle & King County, Seattle, Washington; ‡HIV Services, Family Medicine Residency of Idaho, Boise, Idaho; §Alaska Department of Health and Social Services, Anchorage, Alaska; ‖Oregon Health Authority, Salem, Oregon; ¶Multnomah County Health Department, Portland, Oregon; #Washington State Department of Health, Olympia, Washington; **Montana Department of Public Health and Human Services, Helena, Montana; and ††Wyoming Department of Health, Cheyenne, Wyoming.
authors.forename: Julia C
authors.initials: JC
authors.lastname: Dombrowski
authors.forename: Joanna
authors.initials: J
authors.lastname: Bove
authors.forename: James C
authors.initials: JC
authors.lastname: Roscoe
authors.forename: Jessica
authors.initials: J
authors.lastname: Harvill
authors.forename: Caislin L
authors.initials: CL
authors.lastname: Firth
authors.forename: Shireen
authors.initials: S
authors.lastname: Khormooji
authors.forename: Jason
authors.initials: J
authors.lastname: Carr
authors.forename: Peter
authors.initials: P
authors.lastname: Choi
authors.forename: Courtney
authors.initials: C
authors.lastname: Smith
authors.forename: Sean D
authors.initials: SD
authors.lastname: Schafer
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Golden
mesh_terms: D018791:CD4 Lymphocyte Count; D019411:Clinical Laboratory Techniques; D003266:Continuity of Patient Care / Q000458:organization & administration*; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D006302:Health Services Research; D006801:Humans; D015205:Northwestern United States / Q000453:epidemiology; D019562:Viral Load