Background

Most studies assessing the HIV care cascade have typically been cross-sectional analyses, which do not capture the transition time to subsequent stages. We aimed to assess the longitudinal HIV cascade of care in Australia, and changes over time in transition times and associated factors.

Methods

In this longitudinal cohort study, we included linked data for gay and bisexual men (GBM) with a new HIV diagnosis who attended clinics participating in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance in New South Wales and Victoria between Jan 1, 2012, and Dec 31, 2019. We assessed three cascade transition periods: diagnosis to linkage to care (stage 1 transition); linkage to care to antiretroviral therapy (ART) initiation (stage 2 transition); and ART initiation to virological suppression (viral load ≤200 copies per mL; stage 3 transition). We also calculated the probability of remaining virologically suppressed after the first recorded viral load of less than 200 copies per mL. We used the Kaplan-Meier method to estimate transition times and cumulative probability of stage transition.

Findings

We included 2196 GBM newly diagnosed with HIV between 2012 and 2019 contributing 6747 person-years of follow-up in our analysis. Median time from HIV diagnosis to linkage to care (stage 1 transition) was 2 days (IQR 1–3). Median time from linkage to care to ART initiation (stage 2 transition) was 33 days (30–35). Median time from ART initiation to first recorded virological suppression (stage 3 transition) was 49 days (47–52). The cumulative probability of ART initiation within 90 days of linkage to care increased from 36·9% (95% CI 32·9–40·6) in the 2012–13 calendar period to 94·1% (91·2–96·0) in the 2018–19 calendar period and cumulative probability of virological suppression within 90 days of ART initiation increased from 54·3% (48·8–59·3) in the 2012–13 calendar period to 82·9% (78·4–86·4) in the 2018–19 calendar period. 91·6% (90·1–93·1) of GBM remained virologically supressed up to 2 years after their first recorded virological suppression event.

Interpretation

In countries with high cross-sectional cascade estimates such as Australia, the impact of treatment as prevention is better estimated using longitudinal cascade analyses.

Funding

National Health and Medical Research Council Australia.

中文翻译：

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在澳大利亚新南威尔士州和维多利亚州（2012-19 年）通过 HIV 级联护理对新诊断 HIV 的男同性恋和双性恋男性进行 HIV 级联护理改善过渡时间：一项纵向队列研究

背景

大多数评估 HIV 护理级联的研究通常是横断面分析，没有捕捉到后续阶段的过渡时间。我们旨在评估澳大利亚的纵向 HIV 级联护理，以及过渡时间和相关因素随时间的变化。

方法

在这项纵向队列研究中，我们纳入了 2012 年 1 月 1 日至 2012 年 12 月期间在新南威尔士州和维多利亚州参加澳大利亚协作加强哨点监测的诊所就诊的同性恋和双性恋男性 (GBM) 与新 HIV 诊断的关联数据2019 年 3 月 31 日。我们评估了三个级联过渡期：从诊断到联系到护理（第 1 阶段过渡）；将护理与抗逆转录病毒治疗 (ART) 启动（第 2 阶段过渡）联系起来；和 ART 开始病毒学抑制（病毒载量≤200 拷贝/mL；第 3 阶段过渡）。我们还计算了在首次记录的病毒载量低于每毫升 200 个拷贝后保持病毒学抑制的概率。我们使用 Kaplan-Meier 方法来估计过渡时间和阶段过渡的累积概率。

发现

我们在分析中纳入了 2012 年至 2019 年期间新诊断出患有 HIV 的 2196 例 GBM，共进行了 6747 人年的随访。从 HIV 诊断到联系护理（第 1 阶段过渡）的中位时间为 2 天（IQR 1-3）。从联系到护理到 ART 开始（第 2 阶段过渡）的中位时间为 33 天（30-35 天）。从 ART 开始到首次记录到病毒学抑制（第 3 阶段过渡）的中位时间为 49 天（47-52）。与护理相关的 90 天内开始 ART 的累积概率从 2012-13 日历期间的 36·9% (95% CI 32·9–40·6) 增加到 94·1% (91·2–96· 0) 在 2018-19 日历期间，ART 开始后 90 天内病毒学抑制的累积概率从 2012-13 日历期间的 54·3% (48·8-59·3) 增加到 82·9% (78 ·4–86·4) 在 2018–19 日历期间。

解释

在澳大利亚等横截面级联估计值较高的国家，使用纵向级联分析可以更好地估计治疗作为预防的影响。

资金

澳大利亚国家健康和医学研究委员会。