Cascade of care and factors associated with virological suppression among HIV-positive persons linked to care in the Test and Keep in Care (TAK) project

Abstract

IntroductionEarly treatment remains the most effective HIV prevention strategy; poor linkage to care after HIV diagnosis may compromise this benefit. We sought to better understand patient characteristics and their association with virological suppression (VS) following cART initiation.MethodsThe TAK project collects pre-linkage to care and clinical data on patients diagnosed with HIV in voluntary testing facilities in central Poland. Data collected for persons diagnosed in 2010–2013 were linked with HIV clinic records. Individuals linked to care who commenced cART were followed from until the earliest of first VS (HIV RNA < 50 copies/ml), last visit, death or 6 January 2016. Cox-proportional hazard models were used to identify factors associated with first viral suppression.Results232 persons were HIV positive, 144 (62%, 95% CI 55, 68%) linked to care, 116 (81% of those linked to care, 95% CI 73, 87%) started cART during follow up, of which 113 (97%, 95% CI 93, 99%) achieved VS. Non-PI based regimen (for integrase inhibitors aHR: 5.03: 1.90, 13.32) and HLA B5701-positive (aHR: 3.97: 1.33, 11.85) were associated with higher chance of VS. Unknown syphilis status (aHR: 0.27: 0.13, 0.57) and higher HIV RNA (aHR a tenfold increase: 0.56: 0.42, 0.75) remained associated with lower chance of VS.ConclusionsAlthough a low proportion of persons were linked to care, almost all those linked to care started cART and achieved rapid VS. The high rates of VS were irrespective of prior HIV-associated risk behaviours. Linkage to care remains the highest priority in prevention strategies in central Poland.

HIV and AIDS in Poland in 2017

“…According to the Polish AIDS Society, access to free treatment is possible to all infected person irrespective of CD4 count or viral suppression (10). Nonetheless, as research study TAK indicate, many people with HIV infection are not linked to specialist care -37.9% (88/232) (11,12).…”

“…Zgodnie z rekomendacjami Polskiego Towarzystwa Naukowego AIDS, obecnie dostęp do bezpłatnego leczenia jest możliwy bez względu na liczbę komórek CD4, czy poziomu wiremii, dla każdego zakażonego pacjenta (10). Pomimo to, jak potwierdzają także wyniki badań projektu TAK, znaczny odsetek osób z rozpoznanym zakażeniem HIV nie jest objętych opieką specjalistyczną po rozpoznaniu zakażenia -37,9% (88/232) (11,12). Natomiast jak wskazują wieloośrodkowe badania prof. Parczewskiego i wsp., odsetek pacjentów leczonych, którzy osiągają supresję HIV RNA wynosi ponad 90% (13).…”

Acquired immune deficiency syndrome (AIDS) and late presentation in Poland – data from Test and Keep in Care (TAK) Polska project

“…The basis for this study was formed by Test and Keep in Care (TAK) Project Polska aimed at understanding barriers in linkage to care for patients diagnosed with HIV in voluntary counselling and testing centres (VCTs) in Poland. Earlier TAK analyses found that four in 10 people who tested HIV‐positive at the VCTs in central Poland were not linked to care, while the majority of those who were linked to care started combination antiretroviral therapy (cART) with rapid viral suppression during follow‐up [1].…”

Transmitted HIV drug resistance and subtype patterns among blood donors in Poland

“…This is in line with the previous reports from Poland for the years 2001–2007 51 , however in our study calculation of HIV recency was based solely on the HIV-RNA, p24 and Western-blot patterns, with no implementation of the Recent Infection Testing Algorithm (RITA) assays. Donor testing is obviously intended to ensure blood safety, but it should not be overlooked that early HIV diagnosis in the cohort of blood donors in the setting of the low populational testing prevalence 52 allows for the rapid antiretroviral treatment initiation, reduction of infectivity and risk of onward transmissions 21 , 50 .…”