Modeling the HIV Cascade of Care Using Routinely Collected Clinical Data to Guide Programmatic Interventions and Policy Decisions.

Autor:	Bakoyannis G; Indiana University Fairbanks School of Public Health, Indianapolis, IN., Elul B; Mailman School of Public Health, Columbia University, New York, NY., Wools-Kaloustian KK; Indiana University School of Medicine, Indianapolis, IN., Brown S; Indiana University School of Medicine, Indianapolis, IN., Semeere A; Infectious Disease Institutes, College of Health Sciences, Makerere University, Kampala, Uganda., Castelnuovo B; Infectious Disease Institutes, College of Health Sciences, Makerere University, Kampala, Uganda., Diero L; Department of Medicine, Moi University School of Medicine, Eldoret, Kenya., Nakigozi G; Rakai Health Sciences Program, Rakai, Uganda; and., Lyamuya R; Morogoro Regional Hospital, Morogoro, Tanzania., Yiannoutsos CT; Indiana University Fairbanks School of Public Health, Indianapolis, IN.
Jazyk:	angličtina
Zdroj:	Journal of acquired immune deficiency syndromes (1999) [J Acquir Immune Defic Syndr] 2024 Jul 01; Vol. 96 (3), pp. 223-230.
DOI:	10.1097/QAI.0000000000003413
Abstrakt:	Background: The HIV care cascade is a framework to examine effectiveness of HIV programs and progress toward global targets to end the epidemic but has been conceptualized as a unidirectional process that ignores cyclical care patterns. We present a dynamic cascade that accounts for patient "churn" and apply novel analytic techniques to readily available clinical data to robustly estimate program outcomes and efficiently assess progress toward global targets. Methods: Data were assessed for 35,649 people living with HIV and receiving care at 78 clinics in East Africa between 2014 and 2020. Patients were aged ≥15 years and had ≥1 viral load measurements. We used multi-state models to estimate the probability of being in 1 of 5 states of a dynamic HIV cascade: (1) in HIV care but not on antiretroviral therapy (ART), (2) on ART, (3) virally suppressed, (4) in a gap-in-care, and (5) deceased and compared these among subgroups. To assess progress toward global targets, we summed those probabilities across patients and generated population-level proportions of patients on ART and virally suppressed in mid-2020. Results: One year after enrollment, 2.8% of patients had not initiated ART, 86.7% were receiving ART, 57.4% were virally suppressed, 10.2% were disengaged from care, and 0.3% had died. At 5 years, the proportion on ART remained steady but viral suppression increased to 77.2%. Of those aged 15-25, >20% had disengaged from care and <60% were virally suppressed. In mid-2020, 90.1% of the cohort was on ART, 90.7% of whom had suppressed virus. Conclusions: Novel analytic approaches can characterize patient movement through a dynamic HIV cascade and, importantly, by capitalizing on readily available data from clinical cohorts, offer an efficient approach to estimate population-level proportions of patients on ART and virally suppressed. Significant progress toward global targets was observed in our cohort but challenges remain among younger patients. Competing Interests: The authors have no conflicts of interest to disclose. (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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