High levels of heterogeneity in the HIV cascade of care across different population subgroups in British Columbia, Canada.
The HIV cascade of care (cascade) is a comprehensive tool which identifies attrition along the HIV care continuum. We executed analyses to explicate heterogeneity in the cascade across key strata, as well as identify predictors of attrition across stages of the cascade.Using linked individual-level...
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doaj-fde2a814a9e148128ac6a0879ca7ff922020-11-25T02:40:00ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-01912e11527710.1371/journal.pone.0115277High levels of heterogeneity in the HIV cascade of care across different population subgroups in British Columbia, Canada.Lillian LourençoGuillaume ColleyBohdan NosykDmitry ShopinJulio S G MontanerViviane D LimaSTOP HIV/AIDS Study GroupThe HIV cascade of care (cascade) is a comprehensive tool which identifies attrition along the HIV care continuum. We executed analyses to explicate heterogeneity in the cascade across key strata, as well as identify predictors of attrition across stages of the cascade.Using linked individual-level data for the population of HIV-positive individuals in BC, we considered the 2011 calendar year, including individuals diagnosed at least 6 months prior, and excluding individuals that died or were lost to follow-up before January 1st, 2011. We defined five stages in the cascade framework: HIV 'diagnosed', 'linked' to care, 'retained' in care, 'on HAART' and virologically 'suppressed'. We stratified the cascade by sex, age, risk category, and regional health authority. Finally, multiple logistic regression models were built to predict attrition across each stage of the cascade, adjusting for stratification variables.We identified 7621 HIV diagnosed individuals during the study period; 80% were male and 5% were <30, 17% 30-39, 37% 40-49 and 40% were ≥ 50 years. Of these, 32% were MSM, 28% IDU, 8% MSM/IDU, 12% heterosexual, and 20% other. Overall, 85% of individuals 'on HAART' were 'suppressed'; however, this proportion ranged from 60%-93% in our various stratifications. Most individuals, in all subgroups, were lost between the stages: 'linked' to 'retained' and 'on HAART' to 'suppressed'. Subgroups with the highest attrition between these stages included females and individuals <30 years (regardless of transmission risk group). IDUs experienced the greatest attrition of all subgroups. Logistic regression results found extensive statistically significant heterogeneity in attrition across the cascade between subgroups and regional health authorities.We found that extensive heterogeneity in attrition existed across subgroups and regional health authorities along the HIV cascade of care in B.C., Canada. Our results provide critical information to optimize engagement in care and health service delivery.http://europepmc.org/articles/PMC4277297?pdf=render |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Lillian Lourenço Guillaume Colley Bohdan Nosyk Dmitry Shopin Julio S G Montaner Viviane D Lima STOP HIV/AIDS Study Group |
spellingShingle |
Lillian Lourenço Guillaume Colley Bohdan Nosyk Dmitry Shopin Julio S G Montaner Viviane D Lima STOP HIV/AIDS Study Group High levels of heterogeneity in the HIV cascade of care across different population subgroups in British Columbia, Canada. PLoS ONE |
author_facet |
Lillian Lourenço Guillaume Colley Bohdan Nosyk Dmitry Shopin Julio S G Montaner Viviane D Lima STOP HIV/AIDS Study Group |
author_sort |
Lillian Lourenço |
title |
High levels of heterogeneity in the HIV cascade of care across different population subgroups in British Columbia, Canada. |
title_short |
High levels of heterogeneity in the HIV cascade of care across different population subgroups in British Columbia, Canada. |
title_full |
High levels of heterogeneity in the HIV cascade of care across different population subgroups in British Columbia, Canada. |
title_fullStr |
High levels of heterogeneity in the HIV cascade of care across different population subgroups in British Columbia, Canada. |
title_full_unstemmed |
High levels of heterogeneity in the HIV cascade of care across different population subgroups in British Columbia, Canada. |
title_sort |
high levels of heterogeneity in the hiv cascade of care across different population subgroups in british columbia, canada. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2014-01-01 |
description |
The HIV cascade of care (cascade) is a comprehensive tool which identifies attrition along the HIV care continuum. We executed analyses to explicate heterogeneity in the cascade across key strata, as well as identify predictors of attrition across stages of the cascade.Using linked individual-level data for the population of HIV-positive individuals in BC, we considered the 2011 calendar year, including individuals diagnosed at least 6 months prior, and excluding individuals that died or were lost to follow-up before January 1st, 2011. We defined five stages in the cascade framework: HIV 'diagnosed', 'linked' to care, 'retained' in care, 'on HAART' and virologically 'suppressed'. We stratified the cascade by sex, age, risk category, and regional health authority. Finally, multiple logistic regression models were built to predict attrition across each stage of the cascade, adjusting for stratification variables.We identified 7621 HIV diagnosed individuals during the study period; 80% were male and 5% were <30, 17% 30-39, 37% 40-49 and 40% were ≥ 50 years. Of these, 32% were MSM, 28% IDU, 8% MSM/IDU, 12% heterosexual, and 20% other. Overall, 85% of individuals 'on HAART' were 'suppressed'; however, this proportion ranged from 60%-93% in our various stratifications. Most individuals, in all subgroups, were lost between the stages: 'linked' to 'retained' and 'on HAART' to 'suppressed'. Subgroups with the highest attrition between these stages included females and individuals <30 years (regardless of transmission risk group). IDUs experienced the greatest attrition of all subgroups. Logistic regression results found extensive statistically significant heterogeneity in attrition across the cascade between subgroups and regional health authorities.We found that extensive heterogeneity in attrition existed across subgroups and regional health authorities along the HIV cascade of care in B.C., Canada. Our results provide critical information to optimize engagement in care and health service delivery. |
url |
http://europepmc.org/articles/PMC4277297?pdf=render |
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