A descriptive retrospective study on HIV care cascade in a tertiary hospital in the Philippines

Abstract

Introduction The HIV care cascade is a model used to examine the engagement of people living with HIV (PLHIV) in medical care from the time of diagnosis to sustained viral suppression. This study describes the stages of the cascade from linkage to care, antiretroviral therapy (ART) initiation, retention in care, and virologic suppression- at the University of the Philippines—Philippine General Hospital (UP-PGH) STD/AIDS Guidance and Intervention Prevention (SAGIP) treatment hub in the context of existing cascades with similar demographics. Methods We retrospectively reviewed the medical records of patients enrolled at the UP-PGH SAGIP treatment hub from June 2015 to December 2017. Baseline demographic and clinical data were collected, relevant to each stage of the cascade. Descriptive statistics using Microsoft Excel version 16.0 was used to characterize data and cumulative and conditional proportions were reported. Results Of the 584 patients included in the cohort, majority were male (91.1%), with a median age of 29 years (range, 0.17 to 68 years). Male-to-male sex was the most common mode of transmission (325/584, 55.6%). Among all patients enrolled at the UP PGH SAGIP treatment hub, 99.5% were linked to care, 95.0% initiated ART, 78.8% were retained in care and maintained on ART, 47.9% were tested for HIV viral load, and 45.5% achieved viral suppression. Conclusion A high proportion of patients enrolled at the UP-PGH SAGIP treatment hub are linked to care and initiate ART, exceeding the set goal of 90%, which is higher than reported nationwide. However, there is a substantial decrease in the number of patients who are subsequently retained in care, tested for HIV viral load, and achieve viral suppression. Gaps in the cascade related to healthcare delivery need to be investigated further and addressed by future studies. We recommend implementation of a community-based, patient-centered approach in order to reach the goals of the HIV cascade, with particular focus on young, MSM-PLHIV.

The State of the HIV Epidemic in the Philippines: Progress and Challenges in 2023

“…A study on the care cascade of 3137 MSM diagnosed to have HIV in a community-based clinic in Manila showed a 98% viral suppression rate among 84% of PLHIV on ART who were tested for viral load [ 115 ]. In another surveillance study, an HIV clinic in a tertiary hospital found 95% viral suppression among the 48.2% of PLHIV on ART who had viral load testing [ 116 ].…”

“…HIV RNA viral load testing is unfortunately not routinely performed in the country due to the associated costs and limited availability [ 116 ]. An administrative order was issued by the DOH in 2022 to facilitate the integration of HIV and TB services.…”