Evaluating the care cascade after antiretroviral therapy initiation in Latin America

Accelerating antiretroviral therapy (ART) administration, improving retention, and achieving viral suppression in low- and middle-income countries must be prioritized. We evaluated trends and disparities in these milestones in a large Latin American cohort. Adults starting ART (ART_start) from 2003 to 2014 at Caribbean, Central, and South America network for HIV epidemiology sites were assessed for care cascade outcomes: CD4 cell count >200 cells/mm³ at ART_start; retention (≥1 visit at one year after ART_start); viral suppression (≥1 HIV-1 RNA <200 copies/ml at one year after ART_start). Modified Poisson regression provided adjusted prevalence ratios by age, gender, and HIV transmission risk, accounting for site and year of ART_start. Proportions achieving ART_start and suppression improved over time (p < 0.05). Older age was associated with better retention and viral suppression, but not ART_start at CD4 cell count >200 cells/mm³. Females and men who have sex with men (MSM) were more likely to have CD4 cell count >200 cells/mm³ at ART_start. Injection drug users (IDUs) were less likely to be retained while MSM were more likely to achieve viral suppression (all p < 0.05). Despite improvements in these outcomes over the course of a decade in this cohort, significant disparities existed, disadvantaging younger patients, men, and IDUs. These gaps indicate continued progress in providing early diagnosis and ART_start remain critical.