title: The 2013 HIV Continuum of Care in Tennessee: Progress Made, but Disparities Persist.
abstract: We measured patient engagement in the human immunodeficiency virus (HIV) continuum of care in Tennessee after implementation of enhanced surveillance activities to assess progress toward 2015 statewide goals. We also examined subgroup disparities to identify groups at risk for poor outcomes.
  
  
  
  We estimated linkage to care, retention in care, and viral suppression among HIV-infected people in Tennessee in 2013, overall and by subgroup, after implementation of enhanced laboratory reporting, address verification, and death-matching procedures.
  
  
  
  Of 792 people newly diagnosed with HIV infection in 2013, 632 (79.8%) were linked to care, close to the 2015 goal of ≥80%. Of 15 473 people living and diagnosed with HIV infection before 2013, 8458 (54.7%) were retained in care, approaching the 2015 goal of ≥64.0%. A total of 8640 (55.8%) were virally suppressed, surpassing the 2015 goal of ≥51.0%. Compared with people living and diagnosed with HIV infection before 2013, newly diagnosed people were more likely to be younger, male, non-Hispanic black, and men who have sex with men (MSM). For linkage to care, retention in care, and viral suppression, younger and non-Hispanic black people fared worse, whereas females and those enrolled in the Ryan White program fared better. For retention in care and viral suppression, Hispanic people, injection drug users, and East Tennessee residents fared worse than those in Memphis, whereas MSM fared better. Nashville residents fared worse in retention in care than Memphis residents.
  
  
  
  Tennessee's HIV continuum of care in 2013 showed progress toward 2015 goals. Future efforts to improve the HIV continuum of care should be directed toward vulnerable groups and regions, particularly young, non-Hispanic black, and Hispanic people; injection drug users; and residents of the East Tennessee and Nashville regions.
authors.affiliation: Tennessee Department of Health, HIV/ STD Program, Nashville, TN, USA.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Wester
authors.affiliation: Department of Medicine, School of Medicine, Vanderbilt University, Nashville, TN, USA.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Rebeiro
authors.affiliation: Tennessee Department of Health, HIV/ STD Program, Nashville, TN, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Shavor
authors.affiliation: Department of Biostatistics, School of Medicine, Vanderbilt University, Nashville, TN, USA.
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Shepherd
authors.affiliation: Tennessee Department of Health, HIV/ STD Program, Nashville, TN, USA.
authors.forename: Shanell L
authors.initials: SL
authors.lastname: McGoy
authors.affiliation: Tennessee Department of Health, HIV/ STD Program, Nashville, TN, USA.
authors.forename: Benn
authors.initials: B
authors.lastname: Daley
authors.affiliation: Tennessee Department of Health, HIV/ STD Program, Nashville, TN, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Morrison
authors.affiliation: Department of Pediatrics, School of Medicine, Vanderbilt University, Nashville, TN, USA.
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
authors.affiliation: Department of Medicine, School of Medicine, Vanderbilt University, Nashville, TN, USA.
authors.forename: April C
authors.initials: AC
authors.lastname: Pettit
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000367:Age Factors; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology*; D006297:Health Services Accessibility / Q000458:organization & administration; D054625:Healthcare Disparities / Q000208:ethnology*; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous / Q000208:ethnology; D013714:Tennessee; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV care cascade; HIV continuum of care; HIV surveillance