Progress Along the HIV Care Continuum in a U.S. Sample of HIV-positive MSM Recruited Online

Background: Viral suppression (VS) achieved through HIV care and antiretroviral therapy (ART) adherence is associated with decreased HIV transmission. However, reaching and maintaining VS is difficult as demonstrated by large proportions of people who drop off at each stage of the HIV care continuum (HCC). Identifying men who have sex with men (MSM) disengaged from the HCC is critical to preventing forward HIV transmission.

Methods: In 2015, U.S. HIV-positive MSM (n=10,747) were recruited from MSM-oriented websites and applications to screen for eligibility in an eHealth intervention. Participants were categorized into three groups based on the HCC: engaged in care, on ART, or VS. Analyses assessed age and race/ethnicity within each HCC stage and compared to the Centers for Disease Control and Prevention (CDC) surveillance-based HCC estimates.

Results: Median age was 40; 52% were White, 28% Black, and 15% Hispanic. One-fifth of participants were diagnosed with HIV in the past year. At each step of the HCC, younger, Black, and Hispanic MSM had the lowest levels of care compared to older and white MSM. Those diagnosed ≤1 year were less likely to achieve VS (53% vs. 76%; p<.0001) and more likely to have engaged in serodiscordant condomless anal sex in the past six months (74% vs. 65%; p<.0001) compared to men diagnosed >1 year ago. Participants who did not reach VS (n=3,019 [28%]) were significantly (p≤0.05) younger (25 – 34 vs. 45 – 54), Black (vs. White), and more likely to be diagnosed in the past year compared to participants reaching VS. Finally, when compared to CDC HCC estimates, we identified significantly (p≤0.05) more individuals engaged in care (99% vs. 51%), on ART (93% vs. 49.5%), and reaching VS (72% vs. 42%).

Conclusion: In a convenience sample of high-risk HIV-positive MSM recruited online, younger and ethnic/racial minority MSM were less likely to achieve VS. Moreover, there were significant differences in HCC progression by time since HIV diagnosis. Compared to CDC HCC estimates, men recruited online were more likely to be in care at each HCC step. Strategies to engage newly diagnosed MSM, especially younger non-White MSM, are necessary to reduce HIV transmission.