Poster Abstract Session: HIV Engagement in Care and the Care Cascade
Thursday, October 8, 2015
Room: Poster Hall
Background: Improving care of people living with HIV
and AIDS (PLWHIV) involves expedient diagnosis and linkage to care; retention
in care; appropriate antiretroviral (ARV); and adherence to ARV with the goal of viral suppression (VS). The HIV cascade of care describes the spectrum of engagement
in HIV care from diagnosis to VS has been widely used to determining the
progress and success in public health efforts to control the HIV epidemic There is a paucity of currently
available literature on the HIV continuum of care in Caribbean countries.
Methods: The Bahamas National HIV Program (BNHP) monitors
new HIV diagnoses, ARV prescription and laboratory results in the Bahamas. All
HIV tests done in the public sector are reported to the National HIV Program,
data is reported annually. Using data from the BNHP a
baseline HIV cascade of care was
developed for all new HIV diagnosis in The Bahamas in 2012. All newly diagnosed HIV individuals in
2012 and known to be alive within a year of diagnosis were included (N= 270). Individuals
with 1 CD4 or HIV viral load (VL) measure in 2012 were considered linked to
care. Those with ≥2 CD4
counts in a year were considered retained in care. ARV eligibility was based on having a CD4
count ≤ 350 cells/ml . ARV adherence was
defined as filled prescriptions ≥11months /year. VL < 1000 copies/ml was considered
suppressed. Comparisons were made
in the cascades by gender and age.
Results: Of 269 new HIV diagnosis
in 2012, 61% were linked to care and 59% were linked within 6 months of
diagnosis. 20% were retained in care, ARV was prescribed to 24%, and 8 % of
patients achieved VS (Figure 1). A
higher percentage of women than men were linked to care and retained in care. ARV
prescription did not vary by gender.
More men achieved VS than women. This difference did
not reach statistical significance.
50% of people under 14 yrs, 26% of 15-49 yrs and 36% of over 50 years were retained in care while 0%
under 14 years, 6% of 15-24 yrs, 7% of 25-49 yrs and 15% over 50 yrs attained VS.
Conclusion: Increased effort is needed to link and
retain HIV positive patients to care in the Bahamas. Less than 50% are eligible
for ARV based on current guidelines. VS may remain suboptimal unless ARV scale
ups and adherence interventions are included in measures to improve the
M. A. C. Frankson,