HIV Cascade of Care in South Carolina, Comparing Rural and Urban Residents
Background: The HIV cascade of care is a model that describes HIV care at key stages of diagnosis, linkage, retention in care and virologic suppression with national and state averages and percentage of engagement for each step. This model can help identify deficiencies and opportunities related to improving the delivery of services to people living with HIV/AIDS (PLWHA). Previous studies of the HIV epidemic in South Carolina (SC) have identified differences between the rural and urban populations with regards to progression to AIDS. This study seeks to identify at what step along the cascade of care these differences become apparent.
Methods: SC enhanced HIV/AIDS Reporting System database and geocoding data were linked to determine rural or urban status for all PLWHA in SC through 2011, who were alive at year‐end 2012. SC state law requires named-based confidential HIV reporting including all CD4+ cells and viral loads (VL). Each person was assigned a rural or urban status using the Office of Management and Budget (OMB) rural-urban definition. OMB defines a county as urban if it contains a metropolitan statistical area with an urban core of ≥50,000 persons. SC has 21 urban and 25 rural counties. Rural-urban status was determined for each individual based on their residence at diagnosis. PLWHA with at least one CD4 count or VL during 2012 were counted as being linked to care. Those with 2 or more CD4 count and/or VL taken at least 3 months apart in 2012 were considered to be retained in care. Virologic suppression was defined as a VL in 2012 of <200 copies/ml.
Results: A total of 14,523 PLWHA were included in the analysis. 9232 individuals (64%) of PLWHA in SC had received any care within the year 2012. Of these 7,716 (53.1%) were retained in care and 7023 (48%) were virologically suppressed (Figure). There was no significant difference in any step in the cascade of care between the rural and urban residents.
Conclusion: Although previous studies have shown that rural residents with HIV/AIDS living in SC were more likely to progress to AIDS within a year of diagnosis, when examining the cascade of care there was no difference between rural and urban residence. However, this cascade of care does not examine the immunologic response to treatment within the first year after diagnosis.
S. Weissman, None