The HIV care cascade in Buenos Aires, Argentina: results in a tertiary referral hospital.

OBJECTIVE: To determine rates of retention, antiretroviral therapy (ART) use, and viral suppression in an adult cohort from a public tertiary referral hospital in the city of Buenos Aires, Argentina. METHODS: HIV-positive ART-naïve patients ≥ 18 years old starting care 2011-2013 contributed data until the end of 2014. Three outcomes were assessed in 2014: retention in care, ART use, and viral suppression. Patient characteristics associated with each outcome were assessed through logistic regression. RESULTS: A total of 1 031 patients were included. By the end of 2014, 1.5% had died and 14.8% were transferred to a different center. Of the remaining 859 patients, 563 (65.5%) were retained in 2014. Among those retained, 459 (81.5%) were on ART in 2014. Of those 459 on ART, 270 (58.8%) were virologically suppressed. Younger age was associated with lower retention (OR (odds ratio): 0.67; 95% CI (confidence interval): 0.44-0.92 for ≥ 35 vs. < 35 years), but unrelated with ART use or viral suppression. Low CD4 count at first visit was associated with ART use (OR: 35.72 for CD4 < 200, 7.13 for CD4 200-499 vs. ≥ 500, P < 0.001) and with virologic suppression (OR: 2.17 for CD4 < 200, 2.46 for CD4 200-499 vs. ≥ 500, P: 0.023). CONCLUSIONS: Our hospital in Buenos Aires is still below the recommended 90-90-90 targets of the Joint United Nations Programme on HIV/AIDS (UNAIDS) for ART use and viral suppression. We found a major gap in retention in care. Identifying younger age as being associated with worse retention will help in the design of targeted interventions.

[Retention in care and distance between home and hospital in HIV patients of Buenos Aires City]. / Retención en cuidado y distancia entre hospital y domicilio de pacientes HIV adultos de la Ciudad de Buenos Aires.

Background: Distance from patient's home to the hospital has been proposed as one of the limiting factors for patient's retention in care. Methods: Retrospective cohort study of HIV+ patients 18 years or older who had their first clinical visit between 2011 and 2013 at a reference center in Buenos Aires, Argentina. Patients were considered to be retained in care if they had>=1 clinical visit, laboratory markers (VL and/or CD4 count) and/or ARVs pick-up during the year after their first clinical visit. Each patient address's latitude-longitude was obtained using Google Maps® web service. Home-hospital distance and travel time were obtained with Google Maps Distance Matrix API® service. Results: Of 1020 patients who started follow-up, 15 died and 158 were transferred to another site. Of the remaining, 816 (96.3%) had identifiable address in their electronic medical record. Median age at the time of the first visit was 33 (IQR 27-41) years, 654 (77.9%) patients were male. Median home-hospital distance was 10.3 (IQR 4.4-34.7) km and median travel time was 58.5 (IQR 35-102.5) minutes. 730 patients (89.5%; CI 87.1-91.5%) remained in follow-up after 1 year of their first visit. We didnt find association between travel time and home-hospital distance with retention in this population. Conclusions: In our study, distance between home and the care center was not associated with lower retention one year after first visit in adult HIV patients attending a public hospital.

The HIV care cascade in Buenos Aires, Argentina: results in a tertiary referral hospital / La cascada en la atención de la infección por el VIH en Buenos Aires, Argentina: resultados en un hospital de referencia de atención terciaria

Objective. To determine rates of retention, antiretroviral therapy (ART) use, and viral suppression in an adult cohort from a public tertiary referral hospital in the city of Buenos Aires, Argentina. Methods. HIV-positive ART-naïve patients ≥ 18 years old starting care 2011-2013 contributed data until the end of 2014. Three outcomes were assessed in 2014: retention in care, ART use, and viral suppression. Patient characteristics associated with each outcome were assessed through logistic regression. Results. A total of 1 031 patients were included. By the end of 2014, 1.5% had died and 14.8% were transferred to a different center. Of the remaining 859 patients, 563 (65.5%) were retained in 2014. Among those retained, 459 (81.5%) were on ART in 2014. Of those 459 on ART, 270 (58.8%) were virologically suppressed. Younger age was associated with lower retention (OR (odds ratio): 0.67; 95% CI (confidence interval): 0.44-0.92 for ≥ 35 vs. < 35 years), but unrelated with ART use or viral suppression. Low CD4 count at first visit was associated with ART use (OR: 35.72 for CD4 < 200, 7.13 for CD4 200-499 vs. ≥ 500, P < 0.001) and with virologic suppression (OR: 2.17 for CD4 < 200, 2.46 for CD4 200-499 vs. ≥ 500, P: 0.023). Conclusions. Our hospital in Buenos Aires is still below the recommended 90-90-90 targets of the Joint United Nations Programme on HIV/AIDS (UNAIDS) for ART use and viral suppression. We found a major gap in retention in care. Identifying younger age as being associated with worse retention will help in the design of targeted interventions.

Objetivo. Determinar las tasas de retención, uso de tratamiento antirretroviral (TAR) y supresión viral en una cohorte adulta de un hospital público de referencia de atención terciaria en la ciudad de Buenos Aires (Argentina). Métodos. Pacientes de 18 años de edad o mayores seropositivos al VIH que no habían recibido tratamiento con antirretrovirales y que comenzaron a ser atendidos entre el 2011 y el 2013 aportaron datos hasta finales del 2014. En el 2014 se evaluaron tres resultados: la retención de los pacientes en los servicios de atención, el uso de TAR y la supresión viral. Se usó la regresión logística para evaluar las características de los pacientes asociadas con cada resultado. Resultados. Se estudió a 1 031 pacientes. A finales del 2014, 1,5% habían fallecido y 14,8% fueron transferidos a otro centro. De los 859 pacientes restantes, en el 2014 se retuvieron en los servicios a 563 (65,5%). Entre los que siguieron asistiendo a los servicios, 459 (81,5%) recibieron tratamiento antirretroviral ese año. De esos 459 que recibieron tratamiento antirretroviral, se alcanzó la supresión viral en 270 (58,8%). Se determinó que una menor edad estaba asociada a una menor tasa de retención (razón de posibilidades (OR): 0,67; intervalo de confianza de 95% (IC): 0,44-0,92 para ≥ 35 frente a < 35 años), pero no con el uso de tratamiento antirretroviral o la supresión viral. También se determinó que un bajo nivel de CD4 en la primera consulta estaba asociado al uso de tratamiento antirretroviral (OR: 35,72 para CD4 < 200, 7,13 para CD4 200-499 frente a ≥ 500, P < 0,001) y a la supresión viral (OR: 2,17 para CD4 < 200, 2,46 para CD4 200-499 frente a ≥ 500, P: 0,023). Conclusiones. Nuestro hospital en Buenos Aires todavía está por debajo de las metas 90‑90‑90 recomendadas por el Programa Conjunto de las Naciones Unidas sobre el VIH/SIDA (ONUSIDA) para el uso de terapia antirretroviral y la supresión viral. Encontramos una brecha importante en la retención de los pacientes en los servicios de atención. La asociación de una menor edad con peores tasas de retención será útil en el diseño de intervenciones destinadas a poblaciones específicas.

The HIV care cascade in Buenos Aires, Argentina: results in a tertiary referral hospital / La cascada en la atención de la infección por el VIH en Buenos Aires, Argentina: resultados en un hospital de referencia de atención terciaria

ABSTRACT Objective To determine rates of retention, antiretroviral therapy (ART) use, and viral suppression in an adult cohort from a public tertiary referral hospital in the city of Buenos Aires, Argentina. Methods HIV-positive ART-naïve patients ≥ 18 years old starting care 2011-2013 contributed data until the end of 2014. Three outcomes were assessed in 2014: retention in care, ART use, and viral suppression. Patient characteristics associated with each outcome were assessed through logistic regression. Results A total of 1 031 patients were included. By the end of 2014, 1.5% had died and 14.8% were transferred to a different center. Of the remaining 859 patients, 563 (65.5%) were retained in 2014. Among those retained, 459 (81.5%) were on ART in 2014. Of those 459 on ART, 270 (58.8%) were virologically suppressed. Younger age was associated with lower retention (OR (odds ratio): 0.67; 95% CI (confidence interval): 0.44-0.92 for ≥ 35 vs. < 35 years), but unrelated with ART use or viral suppression. Low CD4 count at first visit was associated with ART use (OR: 35.72 for CD4 < 200, 7.13 for CD4 200-499 vs. ≥ 500, P < 0.001) and with virologic suppression (OR: 2.17 for CD4 < 200, 2.46 for CD4 200-499 vs. ≥ 500, P: 0.023). Conclusions Our hospital in Buenos Aires is still below the recommended 90-90-90 targets of the Joint United Nations Programme on HIV/AIDS (UNAIDS) for ART use and viral suppression. We found a major gap in retention in care. Identifying younger age as being associated with worse retention will help in the design of targeted interventions.

RESUMEN Objetivo Determinar las tasas de retención, uso de tratamiento antirretroviral (TAR) y supresión viral en una cohorte adulta de un hospital público de referencia de atención terciaria en la ciudad de Buenos Aires (Argentina). Métodos Pacientes de 18 años de edad o mayores seropositivos al VIH que no habían recibido tratamiento con antirretrovirales y que comenzaron a ser atendidos entre el 2011 y el 2013 aportaron datos hasta finales del 2014. En el 2014 se evaluaron tres resultados: la retención de los pacientes en los servicios de atención, el uso de TAR y la supresión viral. Se usó la regresión logística para evaluar las características de los pacientes asociadas con cada resultado. Resultados Se estudió a 1 031 pacientes. A finales del 2014, 1,5% habían fallecido y 14,8% fueron transferidos a otro centro. De los 859 pacientes restantes, en el 2014 se retuvieron en los servicios a 563 (65,5%). Entre los que siguieron asistiendo a los servicios, 459 (81,5%) recibieron tratamiento antirretroviral ese año. De esos 459 que recibieron tratamiento antirretroviral, se alcanzó la supresión viral en 270 (58,8%). Se determinó que una menor edad estaba asociada a una menor tasa de retención (razón de posibilidades (OR): 0,67; intervalo de confianza de 95% (IC): 0,44-0,92 para ≥ 35 frente a < 35 años), pero no con el uso de tratamiento antirretroviral o la supresión viral. También se determinó que un bajo nivel de CD4 en la primera consulta estaba asociado al uso de tratamiento antirretroviral (OR: 35,72 para CD4 < 200, 7,13 para CD4 200-499 frente a ≥ 500, P < 0,001) y a la supresión viral (OR: 2,17 para CD4 < 200, 2,46 para CD4 200-499 frente a ≥ 500, P: 0,023). Conclusiones Nuestro hospital en Buenos Aires todavía está por debajo de las metas 90‑90‑90 recomendadas por el Programa Conjunto de las Naciones Unidas sobre el VIH/SIDA (ONUSIDA) para el uso de terapia antirretroviral y la supresión viral. Encontramos una brecha importante en la retención de los pacientes en los servicios de atención. La asociación de una menor edad con peores tasas de retención será útil en el diseño de intervenciones destinadas a poblaciones específicas.