Format

Send to

Choose Destination
J Int AIDS Soc. 2016 Apr 4;19(1):20707. doi: 10.7448/IAS.19.1.20707. eCollection 2016.

A picture is worth a thousand words: maps of HIV indicators to inform research, programs, and policy from NA-ACCORD and CCASAnet clinical cohorts.

Author information

1
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; kalthoff@jhu.edu.
2
Department of Medicine, Vanderbilt University, Nashville, TN, USA.
3
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
4
Department of Internal Medicine, Infectious Disease Service, Instituto Hondureño de Seguridad Social, Tegucigalpa, Honduras.
5
Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA.
6
Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, Brasil.
7
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
8
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
9
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
10
Departamento de Medicina, Facultad de Medicina, Universidad de Chile and Fundación Arriarán, Santiago, Chile.
11
Department of Internal Medicine, Universidad Central del Caribe, Bayamón, Puerto Rico, USA.
12
Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
13
Epidemiology, Basic Science Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA.
14
Department of Medicine, University of Washington, Seattle, WA, USA.
15
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
16
Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
17
Investigaciones Clínicas, Fundación Huésped, Buenos Aires, Argentina, USA.
18
HIV Research Group, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú
19
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
20
Departamento de Infectología, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico DF, Mexico.
21
Le Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti and Department of Medicine, Weill Cornell Medical College, New York, NY, USA.

Abstract

INTRODUCTION:

Maps are powerful tools for visualization of differences in health indicators by geographical region, but multi-country maps of HIV indicators do not exist, perhaps due to lack of consistent data across countries. Our objective was to create maps of four HIV indicators in North, Central, and South American countries.

METHODS:

Using data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) and the Caribbean, Central, and South America network for HIV epidemiology (CCASAnet), we mapped median CD4 at presentation for HIV clinical care, proportion retained in HIV primary care, proportion prescribed antiretroviral therapy (ART), and the proportion with suppressed plasma HIV viral load (VL) from 2010 to 2012 for North, Central, and South America. The 15 Canadian and US clinical cohorts and 7 clinical cohorts in Argentina, Brazil, Chile, Haiti, Honduras, Mexico, and Peru represented approximately 2-7% of persons known to be living with HIV in these countries.

RESULTS:

Study populations were selected for each indicator: median CD4 at presentation for care was estimated among 14,811 adults; retention was estimated among 87,979 adults; ART use was estimated among 84,757 adults; and suppressed VL was estimated among 51,118 adults. Only three US states and the District of Columbia had a median CD4 at presentation >350 cells/mm(3). Haiti, Mexico, and several states had >85% retention in care; lower (50-74%) retention in care was observed in the US West, South, and Mid-Atlantic, and in Argentina, Brazil, and Peru. ART use was highest (90%) in Mexico. The percentages of patients with suppressed VL in the US South and Northeast were lower than in most of Central and South America.

CONCLUSIONS:

These maps provide visualization of gaps in the quality of HIV care and allow for comparison between and within countries as well as monitoring policy and programme goals within geographical boundaries.

KEYWORDS:

CD4 T-lymphocyte count; Central America; HIV RNA suppression; HIV indicators; Map; North America; South America; antiretroviral therapy; implementation science; retention in care

PMID:
27049052
PMCID:
PMC4821890
DOI:
10.7448/IAS.19.1.20707
[Indexed for MEDLINE]
Free PMC Article

Publication types, MeSH terms, Grant support

Publication types

MeSH terms

Grant support

Supplemental Content

Full text links

Icon for Wiley Icon for PubMed Central
Loading ...
Support Center