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Published on: December 27, 2010
The cascade of HIV care in British Columbia, Canada, 1996-2011: a population-based retrospective cohort study
Bohdan Nosyk1, Julio S G Montaner2, Guillaume Colley3
1Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; BC Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, BC, Canada.
Insights
Engagement in the HIV care cascade improved significantly in British Columbia between 1996 and 2011. This progress in HIV treatment and viral suppression highlights advancements in care for people living with HIV/AIDS.
Area of Science:
- Public Health
- Epidemiology
- Infectious Diseases
Background:
- The cascade of HIV care is critical for maximizing benefits of antiretroviral therapy (ART).
- Longitudinal engagement with HIV care stages in British Columbia (BC) from 1996-2011 was analyzed.
- Funding was provided by the BC Ministry of Health and NIH.
Purpose of the Study:
- To characterize longitudinal changes in engagement with the HIV care cascade in BC.
- To identify improvements in HIV diagnosis, treatment, and viral suppression over time.
Main Methods:
- Population-level data from BC linked with HIV prevalence estimates were used.
- Eight stages of the HIV care cascade were longitudinally defined and analyzed.
- Sensitivity analyses were conducted to assess the impact of definition variations.
Main Results:
- 13,140 individuals diagnosed with HIV/AIDS in BC were included.
- Proportion of undiagnosed HIV-positive individuals decreased from 49.0% in 1996 to 29.0% in 2011.
- Proportion of HIV-positive individuals achieving viral suppression reached 34.6% in 2011.
Conclusions:
- Mapping the HIV care cascade is essential for optimizing interventions.
- Understanding cascade dynamics informs strategies to control HIV/AIDS spread.
- Continued efforts are needed to maximize the benefits of HIV interventions.
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).
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