The cascade of HIV care in British Columbia, Canada, 1996–2011: a population-based retrospective cohort study

Abstract

Summary Background The cascade of HIV care has become a focal point for implementation efforts to maximise the individual and public health benefits of antiretroviral therapy. We aimed to characterise longitudinal changes in engagement with the cascade of HIV care in British Columbia, Canada, from 1996 to 2011. Methods We used estimates of provincial HIV prevalence from the Public Health Agency of Canada and linked provincial population-level data to define, longitudinally, the numbers of individuals in each of the eight stages of the cascade of HIV care (HIV infected, diagnosed, linked to HIV care, retained in HIV care, highly active antiretroviral therapy (HAART) indicated, on HAART, adherent to HAART, and virologically suppressed) in British Columbia from 1996 to 2011. We used sensitivity analyses to determine the sensitivity of cascade-stage counts to variations in their definitions. Findings 13 140 people were classified as diagnosed with HIV/AIDS in British Columbia during the study period. We noted substantial improvements over time in the proportions of individuals at each stage of the cascade of care. Based on prevalence estimates, the proportion of unidentified HIV-positive individuals decreased from 49·0% (estimated range 36·2–57·5%) in 1996 to 29·0% (11·6–40·7%) in 2011, and the proportion of HIV-positive people with viral suppression reached 34·6% (29·0–43·1%) in 2011. Interpretation Careful mapping of the cascade of care is crucial to understanding what further efforts are needed to maximise the beneficial effects of available interventions and so inform efforts to contain the spread of HIV/AIDS. Funding British Columbia Ministry of Health, US National Institute on Drug Abuse (National Institutes of Health).

HIV treatment outcomes in Europe and North America: what can we learn from the differences?

“…It is unknown whether these rates of coverage have increased since 2012, with the recommendation of universal treatment. In British Columbia, Canada, findings seem a little more promising: almost 35% of patients were virologically suppressed in 2011 [16]. Thus, rates of suppression seem similarly poor for specific populations such as Latin Americans in the USA and in specific regions such as eastern Europe, and comparably better among northern and western European countries and the Canadian or the American private systems.…”

Improving linkage to HIV care at low-threshold STI/HIV testing sites: An evaluation of the Immediate Staging Pilot Project in Vancouver, British Columbia

“…However, there are subpopulations of MSM that are experiencing increased rates of HIV and attrition along the cascade, such as young MSM and MSM of colour. 2,13,29 While this program evaluation did not consider how age, race and injection drug use impact the effectiveness of the ISPP, these factors may be worth considering in the future because they have been shown to affect engagement in the cascade of care. 13 This information could be used to inform how the ISPP and future initiatives that seek to improve linkage to HIV care could be tailored towards subpopulations among MSM that face intersectional barriers.…”

Psicologia e Políticas Públicas na Saúde: Experiências, Reflexões, Interfaces e Desafios

“…Um conceito importante emerge no contexto do monitoramento clí-nico de pessoas vivendo com HIV/Aids na política de tratamento como prevenção: a cascata de cuidado contínuo (NOSYK et al, 2014). Dados do Ministério da Saúde (BRASIL, 2014, p. 55 Nota-se que a noção de cascata de cuidado contínuo parte de indicadores mais abrangentes − como o número estimado de casos −, passando pelo número de pessoas diagnosticadas, seguido dos que estavam em acompanhamento em algum serviço, até o número de pessoas em TARV e as que alcançaram a supressão viral.…”