Predictors of Failure to Reach Viral Suppression Within 1 Year After Human Immunodeficiency Virus Diagnosis: A Surveillance-Based Analysis.

Abstract

Identifying factors associated with poor human immunodeficiency virus (HIV) care continuum outcomes in the first year after HIV diagnosis could guide care engagement efforts at the time of diagnosis. We analyzed data from newly diagnosed persons living with HIV (PLWH) who received a partner services (PS) interview in King County, WA from January 1, 2013, to June 30, 2016. The outcome measure was failure to reach viral suppression, defined as the lack of an HIV RNA result <200 copies/mL reported to surveillance within one year after diagnosis. We constructed Kaplan-Meier curves of time to viral suppression and examined associations between viral suppression and demographic characteristics, substance use, housing status, and plan for HIV care. Among 549 individuals, 69 (13%) did not achieve viral suppression within 1 year. Failure to reach suppression was associated with having no plan for HIV care at the time of PS interview (n = 72; 13% of the total population; RR, 1.19; 95% CI, 1.04-1.36] and unstable housing (n = 81; 15% of the total population; [RR, 1.19; 95% CI, 1.05-1.35). Among persons with one of these two risk factors, 76% achieved viral suppression, compared with 91% of those with stable housing and a plan for care. Overall, 80% of persons who ultimately reached suppression did so by 7.3 months. Providing early support services to PLWH who have unstable housing or no plan for care at the time of HIV partner services interview and to those who do not reach viral suppression shortly after diagnosis could improve the HIV care continuum.