@article{3d398eb99702418aa5c4fcc8ab8207f7,
title = "A Flow-Based Model of the HIV Care Continuum in the United States",
abstract = "Background: Understanding the flow of patients through the continuum of HIV care is critical to determine how best to intervene so that the proportion of HIV-infected persons who are on antiretroviral treatment and virally suppressed is as large as possible. Methods: Using immunological and virological data from the Centers for Disease Control and Prevention and the North American AIDS Cohort Collaboration on Research and Design from 2009 to 2012, we estimated the distribution of time spent in and dropout probability from each stage in the continuum of HIV care. We used these estimates to develop a queueing model for the expected number of patients found in each stage of the cascade. Results: HIV-infected individuals spend an average of about 3.1 months after HIV diagnosis before being linked to care, or dropping out of that stage of the continuum with a probability of 8%. Those who link to care wait an additional 3.7 months on average before getting their second set of laboratory results (indicating engagement in care) or dropping out of care with probability of almost 6%. Those engaged in care spent an average of almost 1 year before achieving viral suppression on antiretroviral therapy or dropping out with average probability 13%. For patients who achieved viral suppression, the average time suppressed on antiretroviral therapy was an average of 4.5 years. Conclusions: Interventions should be targeted to more rapidly identifying newly infected individuals, and increasing the fraction of those engaged in care that achieves viral suppression.",
keywords = "HIV continuum of care, antiretroviral therapy, operations research, queueing model, viral suppression",
author = "Gonsalves, {Gregg S.} and Paltiel, {A. David} and Cleary, {Paul D.} and Gill, {Michael J.} and Kitahata, {Mari M.} and Rebeiro, {Peter F.} and Silverberg, {Michael J.} and Michael Horberg and Abraham, {Alison G.} and Althoff, {Keri N.} and Richard Moore and Bosch, {Ronald J.} and Tian Tang and Hall, {H. Irene} and Kaplan, {Edward H.}",
note = "Funding Information: This work was supported by National Institutes of Health grants U01AI069918, F31DA037788, G12MD007583, K01AI093197, K23EY013707, K24DA000432, K24AI065298, KL2TR000421, M01RR000052, N02CP055504, P30AI027757, P30AI027763, P30AI027767, P30AI036219, P30AI050410, P30AI094189, P30AI110527, P30MH62246, R01AA016893, R01CA165937, R01DA004334, R01DA011602, R01DA012568, R24AI067039, U01AA013566, U01AA020790, U01AI031834, U01AI034989, U01AI034993, U01AI034994, U01AI035004, U01AI035039, U01AI035040, U01AI035041, U01AI035042, U01AI037613, U01AI037984, U01AI038855, U01AI038858, U01AI042590, U01AI068634, U01AI068636, U01AI069432, U01AI069434, U01AI103390, U01AI103397, U01AI103401, U01AI103408, U01DA036935, U01HD032632, U10EY008057, U10EY008052, U10EY008067, U24AA020794, U54MD007587, UL1RR024131, UL1TR000004, UL1TR000083, UL1TR000454, UM1AI035043, Z01CP010214, and Z01CP010176; contracts CDC-200-2006-18797 and CDC-200-2015-63931 from the Centers for Disease Control and Prevention, USA; contract 90047713 from the Agency for Healthcare Research and Quality, USA; contract 90051652 from the Health Resources and Services Administration, USA; grants CBR-86906, CBR-94036, HCP-97105, and TGF-96118 from the Canadian Institutes of Health Research, Canada; Ontario Ministry of Health and Long Term Care; and the Government of Alberta, Canada. Additional support was provided by the Intramural Research Program of the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. G.S.G. was supported by a Public Health Services and Systems Research Award for Predoctoral and Postdoctoral Scholars in Public Health Delivery, from the University of Kentucky Research Foundation. A.D.P. is supported by NIMH R01 MH105203 and NIDA R01DA015612. Publisher Copyright: {\textcopyright} Copyright 2017 Wolters Kluwer Health, Inc. All rights reserved.",
year = "2017",
month = aug,
day = "15",
doi = "10.1097/QAI.0000000000001429",
language = "English (US)",
volume = "75",
pages = "548--553",
journal = "Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology",
issn = "1525-4135",
publisher = "Lippincott Williams and Wilkins",
number = "5",
}