Cascade of care and factors associated with virological suppression among HIV-positive persons linked to care in the Test and Keep in Care (TAK) project

• DOI: 10.1007/s15010-018-1154-0
• Publication Date: 2018-05-21T11:52:13Z
• Authors: Justyna D. Kowalska; Magdalena Ankiers...; Leah Shepherd; Amanda Mocroft
• Keywords: Adult; Male; Cascade of care; Anti-HIV Agents; HIV Infections; Kaplan-Meier Estimate; Ambulatory Care Facilities; 03 medical and health sciences; 0302 clinical medicine; Antiretroviral Therapy, Highly Active; Humans; Proportional Hazards Models; Original Paper; Linkage; HIV; Disease Management; Viral Load; Viral suppression; Antiretroviral therapy; CD4 Lymphocyte Count; 3. Good health; Treatment Outcome; Female; Poland; Factor Analysis, Statistical; Biomarkers

Early treatment remains the most effective HIV prevention strategy; poor linkage to care after HIV diagnosis may compromise this benefit. We sought to better understand patient characteristics and their association with virological suppression (VS) following cART initiation.The TAK project collects pre-linkage to care and clinical data on patients diagnosed with HIV in voluntary testing facilities in central Poland. Data collected for persons diagnosed in 2010-2013 were linked with HIV clinic records. Individuals linked to care who commenced cART were followed from until the earliest of first VS (HIV RNA < 50 copies/ml), last visit, death or 6 January 2016. Cox-proportional hazard models were used to identify factors associated with first viral suppression.232 persons were HIV positive, 144 (62%, 95% CI 55, 68%) linked to care, 116 (81% of those linked to care, 95% CI 73, 87%) started cART during follow up, of which 113 (97%, 95% CI 93, 99%) achieved VS. Non-PI based regimen (for integrase inhibitors aHR: 5.03: 1.90, 13.32) and HLA B5701-positive (aHR: 3.97: 1.33, 11.85) were associated with higher chance of VS. Unknown syphilis status (aHR: 0.27: 0.13, 0.57) and higher HIV RNA (aHR a tenfold increase: 0.56: 0.42, 0.75) remained associated with lower chance of VS.Although a low proportion of persons were linked to care, almost all those linked to care started cART and achieved rapid VS. The high rates of VS were irrespective of prior HIV-associated risk behaviours. Linkage to care remains the highest priority in prevention strategies in central Poland.