Background: Currently published HIV care continua are cross-sectional snapshots of the HIV care process in 12 – 15 month time frames. We examined retention and viral suppression in a clinic cohort over 36 months. We hypothesized that rates of retention and suppression would be lower after 36 months than in a single 12-month time period.
Methods: A retrospective cohort study with 36-month follow-up was conducted on patients who enrolled at the Infectious Diseases Center of the Grady Health system (IDP) in the year 2010. Retention for each 12 month period was defined as attending at least 2 provider visits separated by ≥ 90 days. Viral suppression was defined as the last viral load of 12 month period being < 1000 copies/mL. Chi-square tests were performed to evaluate the difference in rates of short-term and long-term retention and viral suppression.
Results: 650 patients were enrolled in 2010 (78.2% male; 82.5% Black; 55% men who have sex with men) with a mean age (SD) of 39 years old (10.6). The percent of patients retained for 12, 24 and 36 months were 77.4%, 48.8% and 38.2% respectively while those achieving viral suppression were 68.3%, 45.5%, and 36.9%. Retention and viral suppression for any single 12 month period were 80.3% and 76.3% respectively. The proportion of patients retained and virally suppressed in a single 12 month time period was statistically significantly greater (p<0.001) than those achieving the same benchmarks at 24 and 36 months.
Conclusions: A great majority of patients in our cohort were able to achieve both retention and viral suppression at a single point in time, however long-term (24 and 36 month) retention and viral suppression were suboptimal. Our data suggest that the current HIV care continuum model may portray falsely optimistic retention and viral suppression rates. The goal of HIV care is maintenance of viral suppression. As a tool for depicting the HIV care process, the care continuum should reflect the benchmarks of retentinon and viral suppression over longer periods of time than 12 – 15 months.
Graphical representation of retention in care and viral suppression over the course of 36 months compared with retention and viral suppression in any 12-month period (snapshot). The rates of both retention and viral suppression are significantly higher for the 12-month snapshot than for 24 or 36 months.