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A longitudinal, HIV care continuum: 10-year restricted mean time in each care continuum stage after enrollment in care, by history of IDU.

A longitudinal, HIV care continuum: 10-year restricted mean time in each care continuum stage after enrollment in care, by history of IDU.
Author Information (click to view)

Lesko CR, Edwards JK, Moore RD, Lau B,


Lesko CR, Edwards JK, Moore RD, Lau B, (click to view)

Lesko CR, Edwards JK, Moore RD, Lau B,

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AIDS (London, England) 30(14) 2227-34 doi 10.1097/QAD.0000000000001183

Abstract
OBJECTIVES
We present a novel, patient-centric, longitudinal summary of patient progress through the HIV care continuum. Using this new approach, we compare person-time spent alive, in care, on antiretroviral therapy (ART), and virally suppressed among people who inject drugs (PWID) and those who do not (non-IDU).

DESIGN
Prospective clinical observational cohort study.

METHODS
We followed ART-naive patients with detectable HIV viral loads who enrolled in the Johns Hopkins HIV Clinical Cohort from enrollment until the occurrence of several care continuum-related milestones, including ART initiation and viral suppression, and until several care continuum-related failures, including loss to clinic and death. We added and subtracted cumulative incidence curves to estimate the proportion of the cohort in each of seven continuum stages across the 10 years following enrollment in clinical care.

RESULTS
PWID composed 32% of the study sample (n = 1443). Over 10 years following enrollment in care, PWID and non-IDU spent only 23 and 37%, respectively, of person-time in care, on ART, and virally suppressed. PWID lost 8.9 more months of life compared with non-IDU and spent an additional 5.0 months on ART but not virally suppressed, and an additional 5.5 months in care but not on ART. There were not meaningful improvements in the 5-year restricted mean person-time differences comparing PWID to non-IDU across enrollment cohorts (2000-2003, 2004-2007, 2008-2014).

CONCLUSION
Efforts to increase viral suppression among PWID should focus on increasing ART initiation and improving adherence to therapy.

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