Marion County Public Health Department, Epidemiology Request DR2370
Prepared by: Tammie L. Nelson (TNelson@MarionHealth.org)

The Marion County Public Health Department’s Ryan White Services Program (RWSP) oversees Ryan White Part A, C, and Minority AIDS Initiative grants in the Indianapolis-Carmel Metropolitan Statistical Area (MSA). These programs serve the needs of persons newly infected or living with HIV and out of care and/or uninsured or medically underserved.

HIV Continuum of Care: Delayed linkage and poor engagement in care among people living with HIV (PLWH) has been associated with increased transmission, drug resistance, quicker progression to AIDS, decreased quality of life, and increased mortality.^1,2,3 Thus, it is vital to monitor and improve engagement in each step of the HIV continuum of care. The RWSP employs a continuum of care based on common indicators published by the Health Resources and Service Administration’s HIV/AIDS Bureau (HAB). This method encourages similarity in jurisdictional reporting. The measures are used by RWSP staff, Planning Council, and providers to measure program efficacy.

Indianapolis MSA and U.S. Continuum of Care – 2014 vs. 2013: Continuum of care measures were compared between calendar year 2014 and 2013 and MSA versus the U.S. Figure 1 illustrates the differences found. Definitions and data sources for each category can be viewed at [April 2015 definitions attachment].

Figure 1: HAB Continuum of Care Measures among People Living with HIV/AIDS, Indianapolis-Carmel Metropolitan Statistical Area and U.S.: 2014 v. 2013

When examining differences by calendar year for the MSA (Figure 1), decreases in the percentage of people linked to care and prescribed ART were reported. A significant (P<0.05) 23.5% decrease in retention in care is reflected. During the same period, however, a small increase in the percentage with suppressed viral loads was reported.

It makes little sense that suppressed viral loads would have increased while retention in care and prescriptions for ART decreased. This strengthens a previous argument [January article] that, “If it wasn’t documented, then it didn’t happen.” That being said, it is important to provide your clients with regular viral load checks and to provide your local and/or state health department with information regarding all prescriptions for ART (i.e., patient, date, medication).

Note: The 2013 data presented here varies from that published in a past Quality Matters article. Database updates led to revisions in 2013 linkage to care (previously reported as 79.2%), retention in care (previously reported as 62.1%), and prescription of antiretroviral therapy (ART) (previously reported as 47.8%). Percentage of PLWH who have been diagnosed was increased to 86% from 84.2% based upon a revised estimation of the number of PLWH but undiagnosed and unaware of their serostatus by the Centers for Disease Control and Prevention (CDC).⁴ Lastly, a substantial difference is seen in the percent with suppressed viral loads (previously reported as 61.9%). The difference reported is due to a combination of database updates, reporting lag, improved match-merges, and LOINC code changes.

1 Branson, B. M., Handsfield, H. H., Lampe, M. A., Janssen, R. S., Taylor, A. W., Lyss, S. B., and Clark, J. E. (2006). Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR, 2006;55(RR14): 1-17.

2 Gardner, E. M., McLees, M. P., Steiner, J. F., del Rio, C., and Burman, W. J. (2011). The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52(6): 793-800.

3 Centers for Disease Control and Prevention. (2011). Vital signs: HIV prevention through care and treatment – United States. MMWR, 2011;60(47):1621.

4 Centers for Disease Control and Prevention. (2014). Monitoring selected national HIV prevention and care objectives by using HIV surveillance data – United States and 6 dependent areas – 2012. HIV Surveillance Supplemental Report, 19(3).