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.
| Language | English (US) |
|---|---|
| Pages | 548-553 |
| Number of pages | 6 |
| Journal | Journal of Acquired Immune Deficiency Syndromes |
| Volume | 75 |
| Issue number | 5 |
| DOIs | |
| State | Published - Aug 15 2017 |
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Keywords
- antiretroviral therapy
- HIV continuum of care
- operations research
- queueing model
- viral suppression
ASJC Scopus subject areas
- Pharmacology (medical)
- Infectious Diseases
Cite this
A Flow-Based Model of the HIV Care Continuum in the United States. / Gonsalves, Gregg S.; Paltiel, A. David; Cleary, Paul D.; Gill, Michael J.; Kitahata, Mari M.; Rebeiro, Peter F.; Silverberg, Michael J.; Horberg, Michael; Abraham, Alison G.; Althoff, Keri N.; Moore, Richard; Bosch, Ronald J.; Tang, Tian; Hall, H. Irene; Kaplan, Edward H.
In: Journal of Acquired Immune Deficiency Syndromes, Vol. 75, No. 5, 15.08.2017, p. 548-553.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - A Flow-Based Model of the HIV Care Continuum in the United States
AU - Gonsalves,Gregg S.
AU - Paltiel,A. David
AU - Cleary,Paul D.
AU - Gill,Michael J.
AU - Kitahata,Mari M.
AU - Rebeiro,Peter F.
AU - Silverberg,Michael J.
AU - Horberg,Michael
AU - Abraham,Alison G.
AU - Althoff,Keri N.
AU - Moore,Richard
AU - Bosch,Ronald J.
AU - Tang,Tian
AU - Hall,H. Irene
AU - Kaplan,Edward H.
PY - 2017/8/15
Y1 - 2017/8/15
N2 - 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.
AB - 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.
KW - antiretroviral therapy
KW - HIV continuum of care
KW - operations research
KW - queueing model
KW - viral suppression
UR - http://www.scopus.com/inward/record.url?scp=85025616302&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85025616302&partnerID=8YFLogxK
U2 - 10.1097/QAI.0000000000001429
DO - 10.1097/QAI.0000000000001429
M3 - Article
VL - 75
SP - 548
EP - 553
JO - Journal of Acquired Immune Deficiency Syndromes
T2 - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
SN - 1525-4135
IS - 5
ER -