Sage Journals: Discover world-class research

Abstract

Accelerating antiretroviral therapy (ART) administration, improving retention, and achieving viral suppression in low- and middle-income countries must be prioritized. We evaluated trends and disparities in these milestones in a large Latin American cohort. Adults starting ART (ART_start) from 2003 to 2014 at Caribbean, Central, and South America network for HIV epidemiology sites were assessed for care cascade outcomes: CD4 cell count >200 cells/mm³ at ART_start; retention (≥1 visit at one year after ART_start); viral suppression (≥1 HIV-1 RNA <200 copies/ml at one year after ART_start). Modified Poisson regression provided adjusted prevalence ratios by age, gender, and HIV transmission risk, accounting for site and year of ART_start. Proportions achieving ART_start and suppression improved over time (p < 0.05). Older age was associated with better retention and viral suppression, but not ART_start at CD4 cell count >200 cells/mm³. Females and men who have sex with men (MSM) were more likely to have CD4 cell count >200 cells/mm³ at ART_start. Injection drug users (IDUs) were less likely to be retained while MSM were more likely to achieve viral suppression (all p < 0.05). Despite improvements in these outcomes over the course of a decade in this cohort, significant disparities existed, disadvantaging younger patients, men, and IDUs. These gaps indicate continued progress in providing early diagnosis and ART_start remain critical.

Keywords

HIV AIDS Epidemiology ART homosexual South America

Get full access to this article

View all access options for this article.

References

UNAIDS. AIDSInfo Database, http://aidsinfo.unaids.org/ (accessed 15 August 2016).

UNAIDS. Global AIDS Update 2016, Geneva: UNAIDS, 2016.

Hirnschall

Harries

Easterbrook

et al.

The next generation of the World Health Organization’s global antiretroviral guidance. J Int AIDS Soc 2013; 16: 18757–18757.

Gardner

McLees

Steiner

et al.

The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis 2011; 52: 793–800.

Alonso-González M. Antiretroviral treatment in the spotlight: a public health analysis in Latin America and the Caribbean. Pan American Health Organization, ed. Washington: PAHO, 2013, p.52.

Avila

Althoff

Mugglin

et al.

Immunodeficiency at the start of combination antiretroviral therapy in low-, middle-, and high-income countries. J Acquir Immune Defic Syndr 2014; 65: e8–16.

McGowan

Cahn

Gotuzzo

et al.

Cohort profile: Caribbean, Central and South America Network for HIV research (CCASAnet) collaboration within the International Epidemiologic Databases to Evaluate AIDS (IeDEA) programme. Int J Epidemiol 2007; 36: 969–976.

Ford

Spicer

. Monitoring HIV care in the United States: indicators and data systems, Washington, DC: National Academies Press, 2012.

Valdiserri

Forsyth

Yakovchenko

et al.

Measuring what matters: development of standard HIV core indicators across the U.S. Department of Health and Human Services. Public Health Rep 2013; 128: 354–359.

10.

Zou

. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol 2004; 159: 702–706.

11.

Harrell

. Regression modeling strategies with applications to linear models, logistic regression, and survival analysis, New York: Springer, 2001.

12.

Crabtree-Ramírez

Caro-Vega

Belaunzarán-Zamudio

et al.

High prevalence of late diagnosis of HIV in Mexico during the HAART era. Salud publica de Mexico. SciELO Public Health 2012; 54: 506–514.

13.

Crabtree-Ramírez

Caro-Vega

Shepherd

et al.

Cross-sectional analysis of late HAART initiation in Latin America and the Caribbean: late testers and late presenters. PLoS One 2011; 6: e20272–e20272.

14.

Martin-Onraët

Volkow-Fernández

Alvarez-Wyssmann

et al.

Late diagnosis due to missed opportunities and inadequate screening strategies in HIV infected Mexican women. AIDS Behav 2017; 21: 505–514.

15.

Maquera-Afaray

Cvetkovic-Vega

Cardenas

et al.

Late diagnosis and advanced disease of HIV in adult patients from a Peruvian social security hospital. Rev Chilena Infectol 2016; 33: S20–S26.

16.

Yiannoutsos

Johnson

Boulle

et al.

Estimated mortality of adult HIV-infected patients starting treatment with combination antiretroviral therapy. Sex Transm Infect 2012; 88: i33–43.

17.

Braitstein

Boulle

Nash

et al.

Gender and the use of antiretroviral treatment in resource-constrained settings: findings from a multicenter collaboration. J Womens Health 2008; 17: 47–55.

18.

Rodríguez

Marques

Touzé

. HIV and injection drug use in Latin America. AIDS 2002; 16: S34–41.

19.

Altice

Kamarulzaman

Soriano

et al.

Treatment of medical, psychiatric, and substance-use comorbidities in people infected with HIV who use drugs. Lancet 2010; 376: 367–387.

20.

Rebeiro

Cesar

Shepherd

et al.

Assessing the HIV Care Continuum in Latin America: progress in clinical retention, cART use, and viral suppression. J Int AIDS Soc 2016; 19: 20636–20636.

21.

Rebeiro

Althoff

Buchacz

et al.

Retention among North American HIV-infected persons in clinical care, 2000–2008. J Acquir Immune Defic Syndr 2013; 62: 356–362.

22.

Yehia

Rebeiro

Althoff

et al.

Impact of age on retention in care and viral suppression. J Acquir Immune Defic Syndr 2015; 68: 413–419.

23.

De Boni RB, Shepherd BE, Grinsztejn B, et al. Substance use and adherence among people living with HIV/AIDS receiving cART in Latin America. AIDS Behav. Epub ahead of print 18 April 2016. DOI: 10.1007/s10461-016-1398-6.

24.

Vega

Aguilar-Gaxiola

Andrade

et al.

Prevalence and age of onset for drug use in seven international sites: results from the international consortium of psychiatric epidemiology. Drug Alcohol Depend 2002; 68: 285–297.

25.

Degenhardt

Whiteford

Ferrari

et al.

Global burden of disease attributable to illicit drug use and dependence: findings from the Global Burden of Disease Study 2010. Lancet 2013; 382: 1564–1574.

26.

Tassie

J-M

Baijal

Vitoria

et al.

Trends in retention on antiretroviral therapy in national programs in low-income and middle-income countries. J Acquir Immune Defic Syndr 2010; 54: 437–441.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.07 MB

Evaluating the care cascade after antiretroviral therapy initiation in Latin America

Abstract

Keywords

Get full access to this article

References

Supplementary Material