Sexually Transmitted Diseases
Volume 41, Issue 1, 2014, Pages 35-40

Migration distorts surveillance estimates of engagement in care: Results of public health investigations of persons who appear to be out of HIV care (Article)

Buskin S.E.* , Kent J.B. , Dombrowski J.C. , Golden M.R.
  • a Public Health-Seattle and King County, 401 5th Ave Suite 1152, Seattle, WA 94104, United States, Department of Epidemiology, University of Washington, Seattle, WA, United States
  • b Public Health-Seattle and King County, 401 5th Ave Suite 1152, Seattle, WA 94104, United States, Department of Epidemiology, University of Washington, Seattle, WA, United States
  • c Public Health-Seattle and King County, 401 5th Ave Suite 1152, Seattle, WA 94104, United States, Department of Epidemiology, University of Washington, Seattle, WA, United States, Department of Medicine, University of Washington, Seattle, WA, United States, Center for AIDS, STD, Seattle, WA, United States
  • d Public Health-Seattle and King County, 401 5th Ave Suite 1152, Seattle, WA 94104, United States, Department of Epidemiology, University of Washington, Seattle, WA, United States, Department of Medicine, University of Washington, Seattle, WA, United States, Center for AIDS, STD, Seattle, WA, United States

Abstract

Background: Prevention and clinical efforts are increasingly focused on improving the HIV care cascade, the sequential steps from diagnosis to engagement in care and viral suppression. Monitoring of this cascade is largely dependent on HIV laboratory surveillance data. However, little is known about the completeness of these data or the true care status of individuals for whom no data are reported. METHODS: We investigated people presumed to be living with HIV/AIDS in King County, WA, who had no laboratory results reported to HIV surveillance for at least 1 year between 2006 and 2010. We determined whether each person had relocated, died, or remained in the county. RESULTS: Of 7379 HIV-infected people presumed living in King County, 2545 (35%) had 1 or more 12-month gap in laboratory reporting. Among these individuals, 47% had relocated, 7% died, and 38% remained in King County; we were unable to determine the status of 8%. Of individuals remaining in the area, 91% had evidence of returning to or being in HIV care. Case investigations reduced the proportion of individuals thought to be out of care in 2011 from 27% to 16%. CONCLUSIONS: Investigations of individuals without laboratory results reported to HIV surveillance identified large numbers of people who are no longer living in the area. Our findings suggest that current estimates of the HIV care cascade may be too pessimistic and that individual case investigations are required to accurately define the size and composition of the population of people living with HIV in local areas. © 2013 American Sexually Transmitted Diseases Association.

Author Keywords

[No Keywords available]

Index Keywords

HIV Infections Human immunodeficiency virus infection Population Surveillance human middle aged Viral Load United States laboratory Young Adult Humans Adolescent male CD4 lymphocyte count female Article health care major clinical study adult Transients and Migrants acquired immune deficiency syndrome Health Services Accessibility Anti-HIV Agents public health health survey
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84891622921&doi=10.1097%2fOLQ.0000000000000072&partnerID=40&md5=0a02c22eff80318ab9d38ed8842866ea
DOI: 10.1097/OLQ.0000000000000072
ISSN: 01485717
Cited by: 48
Original Language: English