Engagement in HIV Care among Persons Enrolled in a Clinical HIV Cohort in Ontario, Canada, 2001–2011

Ensuring that people living with HIV are accessing and staying in care is vital to achieving optimal health outcomes including antiretroviral therapy (ART) success. We sought to characterize engagement in HIV care among participants of a large clinical cohort in Ontario, Canada, from 2001 to 2011.

Methods:

The Ontario HIV Treatment Network Cohort Study (OCS) is a multisite HIV clinical cohort, which conducts record linkage with the provincial public health laboratory for viral load tests. We estimated the annual proportion meeting criteria for being in care (≥1 viral load per year), in continuous care (≥2 viral load per year ≥90 days apart), on ART, and with suppressed viral load <200 copies per milliliter. Ratios of proportions according to socio-demographic and clinical characteristics were examined using multivariable generalized estimating equations with a log-link.

Results:

A total of 5380 participants were followed over 44,680 person-years. From 2001 to 2011, we observed high and constant proportions of patients in HIV care (86.3%–88.8%) and in continuous care (76.4%–79.5%). There were statistically significant rises over time in the proportions on ART and with suppressed viral load; by 2011, a majority of patients were on ART (77.3%) and had viral suppression (76.2%). There was minimal variation in HIV engagement indicators by socio-demographic and HIV risk characteristics.

Conclusions:

In a setting with universal health care, we observed high proportions of HIV care engagement over time and an increased proportion of patients attaining successful virologic suppression, likely due to improvements in ART regimens and changing guidelines.

Below:  Proportion meeting HIV care engagement indicators among enrolled participants of the OHTN cohort study, 2001–2011. Proportions shown with 95% CIs. For each year and all indicators shown, the denominator included all participants ever enrolled and who had no record of death as of that year. In care: ≥1 viral load or CD4 cell count per year. In continuous care: ≥2 viral loads per year ≥90 days apart. On ART: initiated antiretroviral treatment in that year or earlier with no record of having stopped. With suppressed viral load: viral load <200 copies per milliliter. Figure ​Figure11 and text provide details.

Full article at:   http://goo.gl/g9vBGh

By:  Ann N. Burchell, PhD,*† Sandra Gardner, PhD,*‡ Lucia Light, MSc,* Brooke M. Ellis, MPHTM,* Tony Antoniou, PhD,§‖Jean Bacon, BA,* Anita Benoit, PhD,¶ Curtis Cooper, MD,# Claire Kendall, MD,**†† Mona Loutfy, MD,‡‡§§‖‖ Frank McGee, BA,¶¶ Janet Raboud, PhD,‡## Anita Rachlis, MD,‖‖*** Wendy Wobeser, MD,†††‡‡‡ and Sean B. Rourke, PhD§*§§§, on behalf of the OHTN Cohort Study Team

^*Ontario HIV Treatment Network, Toronto, Ontario, Canada;

Departments of ^†Epidemiology;

^‡Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada;

^§Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada;

^‖Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada;

^¶Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada;

^#Ottawa Hospital Research Institute, Ottawa, Ontario, Canada;

^**Bruyère Research Institute, Ottawa, Ontario, Canada;

^††Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada;

^‡‡Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada;

^§§Department of Medicine, Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada;

^‖‖Department of Medicine, University of Toronto, Toronto, Ontario, Canada;

^¶¶AIDS Bureau, Ontario Ministry of Health and Long-Term Care, Toronto, Ontario, Canada;

^##Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada;

^***Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada;

^†††Department of Medicine, Queen's University, Kingston, Ontario, Canada;

^‡‡‡Hotel Dieu Hospital, Kingston, Ontario, Canada; and

^§§§Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.

Correspondence to: Sean B. Rourke, PhD, Ontario HIV Treatment Network, Suite 600, 1300 Yonge Street, Toronto, ON M4T 1X3, Canada (e-mail: ac.no.ntho@ekruors).

  

More at:  https://twitter.com/hiv_insight

And:        http://twitter.com/Prison_Health