Assessment and Characterization of HIV Care Continuum in Mecklenburg County, North Carolina 2013-2019
Background: The high burden of Human Immunodeficiency Virus (HIV) disease and the increasing rate of new HIV infections among some populations and jurisdictions could reflect failed prevention strategies. Despite progress in controlling the epidemic in the United States, there are deficiencies in the continuum of care at each stage of the clinical care cascade among people diagnosed with the disease. These deficiencies are usually a result of late diagnosis, poor and delayed linkage to care, and disengagement from treatment which could be associated with suboptimal outcomes. To achieve epidemic control at the community level, deficiencies in the continuum of care must be identified, quantified, and addressed. We examined the HIV Care Continuum (HCC) and characterized the cascade of clinical care deficiencies in Mecklenburg County, NC. Methods: The 2010–2020 National HIV/AIDS Strategy (NHAS) called for research to fill gaps in knowledge along with the HCC and recommended that 90% of the estimated people living with HIV be aware of their HIV status. Of those, the proportion of persons with newly diagnosed HIV linked to care within one month should be increased to 85%. Of those, the proportion of HIV-diagnosed individuals who achieve viral suppression should be increased to 80%. However, currently, there has been no comprehensive evaluation of the HCC in Mecklenburg County. Therefore, we evaluated elements of the HCC in Mecklenburg. HIV incidence cohort data for Mecklenburg County residents from January 2013 to December 2019 were used for the analyses. Results: 1,521 people living with HIV in Mecklenburg County over 13 years old were newly diagnosed and linked to care (LtC) from 2013–2019. Of those, only 64% were linked to care within 30 days (LtC30), falling short of the second NHAS goal of 85% of patients aware of their status. We found that Blacks and Hispanics have lower odds of LtC30 compared to Whites. Among 1,134 persons linked to care and available viral load data, 939 (82.8%) achieved viral suppression (VS) within 12 months. Time to the achievement of VS was shorter among those who linked within 30 days (median, 85 days) when compared to those who linked after 30 days (median, 90 days). We found that of those who achieved the initial VS, 86% remained suppressed while about 13% lost viral suppression. The odds of viral rebound were three times higher for young adults, 13–24 year-olds, compared with patients over 45 years old (OR, 3.06; 95% CI, 1.77–5.30) and 2.5 times higher among Blacks compared to Whites (OR, 2.49; 95% CI, 1.27–4.91).Conclusion: We found race and sex associated with LtC30; baseline VL and LtC30 were associated with time to achievement of VS; and, young age and race were associated with loss of viral suppression and other poor outcomes for people living with HIV in Mecklenburg County, NC. To achieve the NHAS strategic objectives, Mecklenburg County and similar local health departments need to design locally targeted interventions to close cascade gaps.