HIV Care Continuum and Meeting 90-90-90 Targets: Cascade of Care Analyses of a U.S. Military Cohort

Abstract

Introduction The new initiative by the Department of Health and Human Services (DHHS) aims to decrease new HIV infections in the U.S. by 75% within 5 years and 90% within 10 years. Our objective was to evaluate whether the U.S. military provides a good example of the benefits of such policies. Materials and methods We conducted an analysis of a cohort of 1,405 active duty military personnel with HIV enrolled in the Natural History Study who were diagnosed between 2003 and 2015 at six U.S. military medical centers. The study was approved by institutional review boards at the Uniformed Services University of the Health Sciences and each of the sites. We evaluated the impact of Department of Defense (DoD) HIV care policies, including screening, linkage to care, treatment eligibility, and combined antiretroviral therapy (cART) initiation on achieving viral suppression (VS) within 3 years of diagnosis. As a secondary outcome, we evaluated the DoD’s achievement of UNAIDS 90-90-90 targets. Results Nearly all (99%) were linked to care within 60 days. Among patients diagnosed in 2003–2009, 77.5% (95% confidence intervals (CI) 73.9–80.6%) became eligible for cART within 3 years of diagnosis, 70.6% (95% CI 66.6–74.1%) overall initiated cART, and 64.2% (95% CI 60.1–68.0%) overall achieved VS. Among patients diagnosed in 2010–2015, 98.7% (95% CI 96.7–99.5%) became eligible for cART within 3 years of diagnosis, 98.5% (95% CI 96.4–99.4%) overall initiated cART, and 89.8% (95% CI 86.0–92.5%) overall achieved VS. Conclusions U.S. military HIV policies have been highly successful in achieving VS goals, exceeding the UNAIDS 90-90-90 targets. In spite of limitations, including generalizability, this example demonstrates the feasibility of the DHHS initiative to decrease new infections through testing, early treatment, and retention in care.

Resumption of Sexual Activity After Voluntary Medical Male Circumcision: Data from a Population Based Cohort in Rakai, Uganda, 2013 to 2020

“…ESR prevalence was also higher among those with primary education in two survey rounds, 23.4% in 2015/16 and 22.8% in 2018/20 compared to those who completed post-primary education and men without formal education. [17] . Despite the decline, ESR prevalence remains higher than the recommended WHO target [5].…”

Statistical methods applied for the assessment of the HIV cascade and continuum of care: a systematic scoping review

“…Currently, most HIV treatment programme assessments and evaluations are performed following the HIV care cascade approach, which aims to report progress towards UNAIDS targets for 2020 or 2025. [13][14][15][16][17][18][19][20][21][22] These assessments often apply descriptive statistics and show progress at a particular time point, referred to as a cross-sectional design. In recent years, assessments of the HIV cascade and continuum of care that use a longitudinal design have been increasingly featured in the published literature.…”

“…Currently, most HIV treatment programme assessments and evaluations are performed following the HIV care cascade approach, which aims to report progress towards UNAIDS targets for 2020 or 2025 13–22. These assessments often apply descriptive statistics and show progress at a particular time point, referred to as a cross-sectional design.…”

HIV therapy adherence and outcomes in Peruvian military personnel over a 30-year period

“…Currently, literature on adherence to HAART among military personnel in developing countries is scarce, although it has been demonstrated in the USA that comprehensive programs are very successful and effective in military personnel [3,17]. The main objective of this study was to describe the sociodemographic, clinical, and therapeutic characteristics of military personnel diagnosed with HIV at the "Hospital Militar Central (HMC) Coronel Luis Arias Schreiber" between 1989 and 2020.…”