HIV continuum of care: bridging cross-sectional and longitudinal analyses.
AIDS
; 36(4): 583-591, 2022 03 15.
Article
em En
| MEDLINE
| ID: mdl-34772850
ABSTRACT
OBJECTIVE:
The aim of this study was to propose a unified continuum-of-care (CoC) analysis combining cross-sectional and longitudinal elements, incorporating time spent between stages.DESIGN:
The established 90-90-90 target follows a cross-sectional four-stage CoC analysis, lacking information on timing of diagnosis, antiretroviral therapy (ART) initiation, and viral suppression durability.METHODS:
Data were derived from the Athens Multicenter AIDS Cohort Study (AMACS). In the cross-sectional CoC, we added stratification of diagnosed people with HIV (PWH) by estimated time from infection to diagnosis; of those who ever initiated ART or achieved viral suppression by corresponding current status (in 2018); and cumulative incidence function (CIF) of ART initiation and viral suppression, treating loss-to-follow-up (LTFU) as competing event. Viral suppression was defined as viral load less than 500âcopies/ml. Viral suppression durability was assessed by the CIF of viral load rebound.FINDINGS:
About 89.1% of PWH in 2018 were diagnosed (range of diagnoses 1980-2018). Median time to diagnosis was 3.5âyears (IQR 1.1-7.0). Among diagnosed, 89.1% were ever treated, of whom 86.7% remained on ART. CIF of ART initiation and LTFU before ART initiation were 80.9 and 6.0% at 5âyears since diagnosis, respectively. Among treated, 89.4% achieved viral suppression, of whom 87.4% were currently virally suppressed. The CIF of viral load rebound was 24.2% at 5âyears since first viral suppression but substantially reduced in more recent years.INTERPRETATION:
The proposed analysis highlights time gaps in CoC not evident by the standard cross-sectional approach. Our analysis highlights the need for early diagnosis and identifies late presenters as a key population for interventions that could decrease gaps in the CoC.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Infecções por HIV
/
Fármacos Anti-HIV
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article