Predictors of failure to achieve virologic suppression within one year after HIV diagnosis among people living with HIV in King County, WA: A surveillance-based analysis

Abstract

Health departments are increasing efforts toward rapid linkage to care after HIV diagnosis, with the goal of achieving optimal viral suppression early on.11 Their role in optimizing and implementing publicly funded prevention programs for their jurisdictions10 gives them unique access to surveillance data which is required for a population-based approach. Using surveillance data, identify factors that are associated with failure to achieve viral suppression in the first year after HIV diagnosis. We studied a population-based cohort of individuals newly diagnosed with HIV in King County, WA from January 1, 2013 to June 30, 2016. We examined, using Poisson regression, the association between the variables and two outcome groups (achieved and did not achieve suppression, defined as <200 copies per milliliter). We used a Kaplan-Meier curve to graphically present the difference in time (months) to virologic suppression for all independent variables associated with failure to achieve suppression at p<0.05. Individuals who had no plan for HIV care at the time of partner services interview were more likely than individuals with a plan to fail to achieve suppression [RR 1.19 (95% CI: 1.04-1.37)]. Individuals with unstable housing were more likely that individuals with stable housing to fail to achieve suppression [RR 1.21 (95% CI: 1.06-1.38)]. If patients are not suppressed at 7 months, they are unlikely to achieve suppression in one-year and need additional intensive interventions. The findings from this study can inform health department interventions to intervene early with at-risk individuals in order to improve viral suppression.