The cascade of HIV care in British Columbia, Canada, 1996-2011: a population-based retrospective cohort study

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• 作者：Bohdan Nosyk ; Julio S G Montaner ; Guillaume Colley ; Viviane D Lima ; Keith Chan ; Katherine Heath ; Benita Yip ; Hasina Samji ; Mark Gilbert ; Rol ; o Barrios ; R茅ka Gustafson ; Robert S Hogg ; for the STOP HIV/AIDS Study Group
• 刊名：The Lancet Infectious Diseases
• 出版年：January, 2014
• 年：2014
• 卷：14
• 期：1
• 页码：40-49
• 全文大小：449 K

文摘

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Summary

Background

The cascade of HIV care has become a focal point for implementation efforts to maximise the individual and public health benefits of antiretroviral therapy. We aimed to characterise longitudinal changes in engagement with the cascade of HIV care in British Columbia, Canada, from 1996 to 2011.

Methods

We used estimates of provincial HIV prevalence from the Public Health Agency of Canada and linked provincial population-level data to define, longitudinally, the numbers of individuals in each of the eight stages of the cascade of HIV care (HIV infected, diagnosed, linked to HIV care, retained in HIV care, highly active antiretroviral therapy (HAART) indicated, on HAART, adherent to HAART, and virologically suppressed) in British Columbia from 1996 to 2011. We used sensitivity analyses to determine the sensitivity of cascade-stage counts to variations in their definitions.

Findings

13鈥?40 people were classified as diagnosed with HIV/AIDS in British Columbia during the study period. We noted substantial improvements over time in the proportions of individuals at each stage of the cascade of care. Based on prevalence estimates, the proportion of unidentified HIV-positive individuals decreased from 49路0% (estimated range 36路2-57路5%) in 1996 to 29路0% (11路6-40路7%) in 2011, and the proportion of HIV-positive people with viral suppression reached 34路6% (29路0-43路1%) in 2011.

Interpretation

Careful mapping of the cascade of care is crucial to understanding what further efforts are needed to maximise the beneficial effects of available interventions and so inform efforts to contain the spread of HIV/AIDS.

Funding

British Columbia Ministry of Health, US National Institute on Drug Abuse (National Institutes of Health).