409. The HIV Continuum of Care in the Bahamas in 2012
Session: 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 treatment cascade.

Figure 1

Nikkiah Forbes, MBBS, DM1,2, Glenise Johnson, MPH2, Morton Anthony C. Frankson, MBBS, MPH, MCCFP3, Kathy Johnston, BS, MPH2, Indira Martin, BSc (Hons), MPhil/PhD2, Andrica Smith, BSc, MPH2, Keith Mcconnell, BSc2, Rochelle Sands, BSc2, Audene Garrison, MD4, Sharon Weissman, MD5, Tamara Thompson, MBBS, DM4 and Stanley Read, MD, PhD, FRCPC, FAAP6,7, (1)Department of Medicine, The University Of The West Indies, Mona, Kingston 6, Jamaica, (2)HIV/AIDS Programme, Bahamas Ministry of Health, Nassau, Bahamas, (3)School of Clinical Medicine and Research/Bahamas, The University of the West Indies, Nassau, Bahamas, (4)Infectious Diseases, The University of the West Indies, Mona, Jamaica, (5)Medicine, University of South Carolina, Columbia, SC, (6)Paediatric Infectious Diseases, The University of Toronto, Toronto, ON, Canada, (7)Bahamas Ministry of Health, Nassau, Bahamas

Disclosures:

N. Forbes, None

G. Johnson, None

M. A. C. Frankson, None

K. Johnston, None

I. Martin, None

A. Smith, None

K. Mcconnell, None

R. Sands, None

A. Garrison, None

S. Weissman, None

T. Thompson, None

S. Read, None

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