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 1 and text
provide details.
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).
