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[low] HIV Viral Suppression, 37 States and the District of Columbia, 2014
 
 
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April 2018
 
Abstract
 
Achieving viral suppression among HIV-positive persons is a critical component of HIV treatment and prevention, because it leads to improved health outcomes for the individual and reduced risk of HIV transmission. There is wide variation in viral suppression across jurisdictions, races/ethnicities, age groups, and transmission risk groups. This analysis uses HIV surveillance data to examine rates of viral suppression among people living with diagnosed HIV (PLWDH) in 38 jurisdictions with complete lab reporting. Among people who received a diagnosis in 2014, the percentage with viral suppression within 12 months of diagnosis and the average time to viral suppression was assessed.
 
Overall, among PLWDH in 2014, 57.9% were virally suppressed, and, among people with HIV diagnosed in 2014, 68.2% were suppressed within 12 months of diagnosis with an average time to suppression of 6.9 months.
 
All outcomes varied by jurisdiction, but most had similar patterns of disparities with a few exceptions. These data highlight the need for tailored interventions at the local level. In addition, jurisdictions with relatively low viral suppression among particular groups could adapt effective interventions from jurisdictions who have higher rates of suppression.
 
Discussion
 
Overall, in our analysis of viral suppression among PLWDH at year-end 2014 in 38 jurisdictions, none reached the national goal of 80%, but Montana was within 2 percentage points and six others had at least 70% viral suppression. This was an improvement over the 2013 viral suppression rates-only two jurisdictions out of 33 had at least 70% suppression [6]. When examining sub-populations, we found similar patterns of disparity across jurisdictions.
 
In almost all jurisdictions whites had a higher rate of viral suppression then blacks or Hispanics/Latinos. There were only a few exceptions to this pattern and these were mostly in low-morbidity states where small year-to-year changes in numbers may result in large percent changes. The observation that viral suppression increases with age also held true in most jurisdictions. There were only two jurisdictions where viral suppression was higher among younger age groups than older. Further study of the jurisdictions that have high viral suppression among younger age groups may reveal particularly effective strategies that could be shared with other jurisdictions. In general, MSM had higher rates of viral suppression than PWID and those with infections attributed to heterosexual contact. One state with high viral suppression among PWID was Alaska. Determining factors that contributed to this outcome could help other jurisdictions attain similar results.
 
In addition to having a high level of viral suppression among all PLWDH, it is also important for people with newly diagnosed HIV to be promptly linked to care to attain viral suppression quickly to reduce their window of infectiousness as well as to improve their health outcomes. Among people who received a diagnosis in 2014, 68% were virally suppressed within 12 months. Six jurisdictions had at least 80% viral suppression among persons who received a diagnosis in 2014. These jurisdictions met the national goal for viral suppression among these persons [3] and may serve as models for best practices for attaining a high rate of viral suppression. Four of these jurisdictions also met the national goal of linking 85% of people receiving an HIV diagnosis in 2014 to care within 1 month of diagnosis [6]. Effective interventions that can help improve viral suppression rates include interventions to support linkage and retention in care, such as linkage coordination and case management [7], and treatment adherence through support with mobile applications [8]. Public health departments and care providers can identify people who may be out of care and need re-engagement services or who are not virally suppressed and need treatment adherence counseling through surveillance or medical record data [9]. Ensuring all population segments have access to treatment as recommended will require addressing the challenges persons with HIV face with inadequate health insurance, comorbidities, mental health or substance misuse issues, or other social or economic disadvantages such as stigma or lack of transportation [10, 11].
 
Fig. 2 Viral suppression among persons living with diagnosed HIV, by jurisdiction, region, and age, 2014

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