The HIV Care Cascade Measured Over Multiple Time Periods Varies by Age and Gender
Background: The HIV Care Cascade provides a comprehensive view of the spectrum of HIV care, including these care stages: linkage to care at diagnosis, retention in care over time, prescription of antiretroviral therapy (ART), and achieving viral suppression. It is not known whether the degree of success in achieving engagement and outcomes differs by demographic subgroup, such as age and gender, and whether this has changed over time.
Methods: Kaiser Permanente (KP) is an integrated health care system in 9 US States and the District of Columbia, providing care to an insured population with equal access to care for all members. We evaluated cascades for all HIV+ KP members and ≥13 years old with ≥8 months membership in 2010 (N=16,816), 2011 (17,711), and 2012 (18,249). We measured linkage to care (1st visit/CD4 within 90 days of being identified HIV+ for new patients; ≥1 medical visit in year for established patients), retention in care (≥2 medical visits in year ≥60 days apart), ART treatment (filled ≥3 months of DHHS-defined ART in year), and viral suppression (HIV RNA <200 copies/mL last measured in year). In this analysis, success of a later stage is dependent on success in earlier stage and percent success is of total in subgroup for year. For each year, we compared cascades separately by gender (male/ female [87%/13%]) and age group (13-34 [11%], 35-54 [57%], 55+ [33%]), with differences assessed by chi-square statistics.
Results: Males had statistically (p<0.05) higher percent linkage to care, prescription of ART, and viral suppression for 2010 and 2011 compared with females, but not for 2012. Females had significantly greater retention in care for all years (Figure 1). Increasing age was significantly (p<0.05) associated with retention in care, prescription of ART and viral suppression but not linkage to care, for all years (Figure 2).
Conclusion: In all sub-populations, cascade success continues to improve over time. However, success varies significantly by age and gender, even in an integrated care system with equal access to care. The differences among male and female are generally less over time. Stratified cascades can help identify sub-populations requiring more targeted outreach. Analyses of success by race/ethnicity and risk group are warranted.
D. Klein, None
W. Towner, None
P. Kadlecik, None
C. Finnegan, None
M. Mogyoros, None
R. Matyas II, None
P. Brachman, None
J. Blank, None
C. Ellis, None
M. Silverberg, None