Use of Multiple Data Sources and Individual Case Investigation to Refine Surveillance-Based Estimates of the HIV Care Continuum

Abstract

Objectives To assess the HIV care continuum among HIV-infected persons residing in Seattle & King County, Washington at the end of 2011 and compare estimates of viral suppression derived from different population-based data sources. Methods We derived estimates for the HIV care continuum using a combination of HIV case and laboratory surveillance data supplemented with individual investigation of cases that appeared to be unlinked to or not retained in HIV care, a jurisdiction-wide population-based retrospective chart review, and local data from the CDC's Medical Monitoring Project and National HIV Behavioral Surveillance. Results Adjusting for in- and out-migration of persons diagnosed with HIV, laboratory surveillance data supplemented with individual case investigation suggest that 67% of persons diagnosed with HIV and 57% of all HIV-infected persons living in King County at the end of 2011 were virally suppressed (plasma HIV RNA <200 copies/mL). The viral suppression estimates we derived from a population-based chart review and adjusted local Medical Monitoring Project data were similar to the surveillance-derived estimate and identical to each other (59% viral suppression among all HIV-infected persons). Conclusions The level of viral suppression in King County is more than twice the national estimate and exceeds estimates of control for other major chronic diseases in the U.S. Our findings suggest that national care continuum estimates may be substantially too pessimistic, and highlight the need to improve HIV surveillance data.

Improving Retention in HIV Care Through New York's Expanded Partner Services Data-to-Care Pilot

“…Most existing literature on DTC has focused on the impact various linkage-to-care definitions have on the Care Continuum,7,8 or validating HIV surveillance–based estimates through field investigation, medical records, direct patient access, or other methodologies 9–13. Just a handful of studies have addressed the feasibility of using HIV surveillance data to identify, locate, and link out-of-care (OOC) individuals to HIV medical care.…”

Barriers to HIV Care and Treatment Among Participants in a Public Health HIV Care Relinkage Program

“…The percentage of persons who link to HIV care within 3 months after HIV diagnosis is among the highest reported in the US (92% in 2011). 10 Nonetheless, many PLWHA in Washington are not consistently engaged in care and are not virologically suppressed. 10,11 We began a health department-based intervention to promote HIV care relinkage and ART use among PLWHA in King County, WA in 2011.…”

“…10 Nonetheless, many PLWHA in Washington are not consistently engaged in care and are not virologically suppressed. 10,11 We began a health department-based intervention to promote HIV care relinkage and ART use among PLWHA in King County, WA in 2011. As part of this program, we systematically collected data from patients about their perceived barriers to HIV care and ART initiation and reasons for ART discontinuation, which we present in this article.…”

“Out of Care” HIV Case Investigations: A Collaborative Analysis Across 6 States in the Northwest US

“…Prior work in King County, Washington demonstrated that individual case investigations led to a large decrease in the number of persons estimated to be out of HIV care. 18-20 However, the generalizability of this finding to other areas has been unclear. Local and state health department staff from six Northwest US states (Alaska, Idaho, Montana, Oregon, Washington, and Wyoming) and investigators from University of Washington (UW) Center for AIDS Research (CFAR) conducted a coordinated effort to refine estimates of retention in care with individual case investigation.…”