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Attrition across the HIV cascade of care among a
diverse cohort of women living with HIV in Canada
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Reported by Jules levin
Durban 2016 July 18-22
Presenter
Genevieve Kerkerian
Authors
G. Kerkerian1,2, M. Kestler3,4, A. Carter5,6, L. Wang6, P. Sereda6, E. Roth7, M.-J. Milloy6,8, N. Pick3,4, D. Money3,4, N. Kronfli9, A. Lacombe-Duncan10, K. Webster5, M. Desbiens11, D. Dubuc12, R.S. Hogg5,6, A. de Pokomandy12,13, M. Loutfy11,14, A. Kaida5, on behalf of the CHIWOS Research Team
Institutions
1University of British Colombia, Faculty of Medicine, Vancouver, Canada, 2Vancouver Coastal Health Authority, Vancouver, Canada, 3Oak Tree Clinic, BC Women's Health Centre, Vancouver, Canada, 4Division of Infectious Diseases, University of British Colombia, Department of Medicine, Vancouver, Canada, 5Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada, 6British Colombia Centre for Excellence in HIV/AIDS, Vancouver, Canada, 7University of Victoria, Victoria, Canada, 8Division of AIDS, University of British Colombia, Vancouver, Canada, 9McMaster University, Department of Infectious Diseases, Hamilton, Canada, 10Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada, 11Women's College Research Institute, Women's College Hospital, Toronto, Canada, 12McGill University, Department of Family Medicine, Montreal, Canada, 13Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada, 14Management and Evaluation, University of Toronto, Department of Medicine and Institute of Health Policy, Toronto, Canada
Abstract
Background: In North American settings, women are less likely to be engaged across the HIV care cascade. Among Canadian women living with HIV (WLWH), we explored cascade attrition by stage and key sub-populations, and assessed correlates of attrition from ''antiretroviral (ART) adherence'' to ''viral suppression''.
Methods: We analyzed baseline survey data from 1,425 WLWH (≥16 years; trans-inclusive) enrolled in the Canadian HIV Sexual and Reproductive Health Cohort Study (CHIWOS), Canada''s largest community-based cohort of WLWH. We measured the proportion of women engaged in seven nested stages of the care cascade, via self-report: HIV-diagnosed, linked to HIV care, retained in HIV care, initiated ART, currently on ART, ART adherence (≥90%), and viral suppression (< 50 copies/mL). We examined attrition across stages overall and by age, ethnicity, housing stability, food security, illicit drug use, and violence. Among those currently on ART, multivariable logistic regression identified factors associated with not being suppressed.
Results:Median age was 43 (IQR: 35-50); 96% of women identified as cis-gender; 22% were Indigenous, 29% African/Caribbean/Black, and 41% Caucasian/White. Median years living with HIV was 11 (IQR: 6-17). Overall: 98% were linked to care; 96% retained; 88% initiated ART; 83% were currently on ART; 68% were adherent; and, among those on ART, 72% were virally suppressed with variation (45%-84%) by sub-population. The largest attrition occurred between ''on ART'' and ''ART adherence'' (-17%), with the greatest losses among women with Indigenous ancestry (-25%), current violence (-27%), and current illicit drug use (-32%). Substantial attrition also occurred between ''linked to HIV care'' and ''initiated ART''(-11%), with the greatest losses occurring among women 16-29 years (-20%) and with unstable housing (-27%). Adjusted odds of not being virally suppressed were significantly higher among women who were young [aOR: 1.4 (95% CI: 1.1-1.79) per 10 years younger], food insecure [1.77 (1.03-3.05)], incarcerated in the past year [3.84 (1.56-9.45)], and currently using illicit drugs [3.25 (1.46-7.25)].
Conclusions: Nearly one-in-three WLWH in this Canadian cohort were lost across the HIV care cascade, with significant differences by stage, sub-population, and social inequities. Targeted interventions are needed to improve engagement across the care cascade for a diverse community of WLWH.
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