TY - JOUR
T1 - A longitudinal, HIV care continuum
T2 - 10-year restricted mean time in each care continuum stage after enrollment in care, by history of IDU
AU - Lesko, Catherine R.
AU - Edwards, Jessie K.
AU - Moore, Richard D.
AU - Lau, Bryan
N1 - Publisher Copyright:
© 2016 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2016
Y1 - 2016
N2 - Objectives: We present a novel, patient-centric, longitudinal summary of patient progress through the HIV care continuum. Using this new approach, we compare person-time spent alive, in care, on antiretroviral therapy (ART), and virally suppressed among people who inject drugs (PWID) and those who do not (non-IDU). Design: Prospective clinical observational cohort study. Methods: We followed ART-naive patients with detectable HIV viral loads who enrolled in the Johns Hopkins HIV Clinical Cohort from enrollment until the occurrence of several care continuum-related milestones, including ART initiation and viral suppression, and until several care continuum-related failures, including loss to clinic and death. We added and subtracted cumulative incidence curves to estimate the proportion of the cohort in each of seven continuum stages across the 10 years following enrollment in clinical care. Results: PWID composed 32% of the study sample (n = 1443). Over 10 years following enrollment in care, PWID and non-IDU spent only 23 and 37%, respectively, of persontime in care, on ART, and virally suppressed. PWID lost 8.9 more months of life compared with non-IDU and spent an additional 5.0 months on ART but not virally suppressed, and an additional 5.5 months in care but not on ART. There were not meaningful improvements in the 5-year restricted mean person-time differences comparing PWID to non-IDU across enrollment cohorts (2000-2003, 2004-2007, 2008-2014). Conclusion: Efforts to increase viral suppression among PWID should focus on increasing ART initiation and improving adherence to therapy.
AB - Objectives: We present a novel, patient-centric, longitudinal summary of patient progress through the HIV care continuum. Using this new approach, we compare person-time spent alive, in care, on antiretroviral therapy (ART), and virally suppressed among people who inject drugs (PWID) and those who do not (non-IDU). Design: Prospective clinical observational cohort study. Methods: We followed ART-naive patients with detectable HIV viral loads who enrolled in the Johns Hopkins HIV Clinical Cohort from enrollment until the occurrence of several care continuum-related milestones, including ART initiation and viral suppression, and until several care continuum-related failures, including loss to clinic and death. We added and subtracted cumulative incidence curves to estimate the proportion of the cohort in each of seven continuum stages across the 10 years following enrollment in clinical care. Results: PWID composed 32% of the study sample (n = 1443). Over 10 years following enrollment in care, PWID and non-IDU spent only 23 and 37%, respectively, of persontime in care, on ART, and virally suppressed. PWID lost 8.9 more months of life compared with non-IDU and spent an additional 5.0 months on ART but not virally suppressed, and an additional 5.5 months in care but not on ART. There were not meaningful improvements in the 5-year restricted mean person-time differences comparing PWID to non-IDU across enrollment cohorts (2000-2003, 2004-2007, 2008-2014). Conclusion: Efforts to increase viral suppression among PWID should focus on increasing ART initiation and improving adherence to therapy.
KW - Competing risks
KW - HIV care continuum
KW - IDU
KW - Survival analysis
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U2 - 10.1097/QAD.0000000000001183
DO - 10.1097/QAD.0000000000001183
M3 - Article
C2 - 27314178
AN - SCOPUS:84975127236
SN - 0269-9370
VL - 30
SP - 2227
EP - 2234
JO - AIDS
JF - AIDS
IS - 14
ER -