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Krentz HB, MacDonald J, John Gill M. High Mortality Among Human Immunodeficiency Virus (HIV)-Infected Individuals Before Accessing or Linking to HIV Care: A Missing Outcome in the Cascade of Care?. Open Forum Infect Dis. 2014;1(1):ofu011doi: 10.1093/ofid/ofu011.
Krentz, H. B., MacDonald, J., & John Gill, M. (2014). High Mortality Among Human Immunodeficiency Virus (HIV)-Infected Individuals Before Accessing or Linking to HIV Care: A Missing Outcome in the Cascade of Care?. Open forum infectious diseases, 1(1), ofu011. https://doi.org/10.1093/ofid/ofu011
Krentz, Hartmut B, et al. "High Mortality Among Human Immunodeficiency Virus (HIV)-Infected Individuals Before Accessing or Linking to HIV Care: A Missing Outcome in the Cascade of Care?." Open forum infectious diseases vol. 1,1 (2014): ofu011. doi: https://doi.org/10.1093/ofid/ofu011
Krentz HB, MacDonald J, John Gill M. High Mortality Among Human Immunodeficiency Virus (HIV)-Infected Individuals Before Accessing or Linking to HIV Care: A Missing Outcome in the Cascade of Care?. Open Forum Infect Dis. 2014 May 07;1(1):ofu011. doi: 10.1093/ofid/ofu011. eCollection 2014 Mar. PMID: 25734085; PMCID: PMC4324205.
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Open Forum Infect Dis. 2014 May 07;1(1):ofu011. doi: 10.1093/ofid/ofu011. eCollection 2014 Mar.

High Mortality Among Human Immunodeficiency Virus (HIV)-Infected Individuals Before Accessing or Linking to HIV Care: A Missing Outcome in the Cascade of Care?.

Open forum infectious diseases

Hartmut B Krentz, Judy MacDonald, M John Gill

Affiliations

  1. Southern Alberta Clinic, Calgary, Canada ; Departments of Medicine.
  2. Community Health Sciences, University of Calgary, Calgary, Canada ; Alberta Health Services, Population and Public Health, Calgary, Canada.

PMID: 25734085 PMCID: PMC4324205 DOI: 10.1093/ofid/ofu011

Abstract

BACKGROUND: The "cascade of care" displays the proportion of individuals who are infected with human immunodeficiency virus (HIV), diagnosed, linked, retained, on antiretroviral treatment, and HIV suppressed. We examined the implications of including death in the use of this cascade for program and public health performance metrics.

METHODS: Individuals newly diagnosed with HIV and living in Calgary between 2006 and 2013 were included. Through linkage with Public Health and death registries, the deaths (ie, all-cause mortality) and their distribution within the cascade were determined. Mortality rates are reported per 100 person-years.

RESULTS: Estimated new HIV infections were 680 (543 confirmed and 137 unknown cases). Forty-three individuals, after diagnosis, were never referred for HIV care. Despite referral(s), 88 individuals (18%) never attended the clinic for HIV care. Of individuals retained in care, 87% received antiretroviral therapy and 76% achieved viral suppression. Thirty-six deaths were reported (mortality rate, 1.50/100 person-years). One diagnosis was made posthumously. Deaths (20 of 35; 57%) occurred for individuals linked but not retained in care (6.93/100 person-years), and 70% were HIV-related. Mortality rate for patients in care was 0.79/100 person-years. Retained patients with detectable viremia had a death rate of 2.49/100, which contrasted with 0.28/100 person-years in those with suppressed viremia. Eight of these 15 deaths (53%) were HIV-related.

CONCLUSIONS: Over half of deaths occurred in those referred but not effectively linked or retained in HIV care, and these cases may be easily overlooked in standard HIV mortality studies. Inclusion of deaths into the cascade may further enhance its value as a public health metric.

Keywords: Canada; HIV/AIDS; accessing care; cascade of care; mortality

References

  1. Curr Opin HIV AIDS. 2013 Jan;8(1):59-64 - PubMed
  2. Int J Womens Health. 2010 Aug 09;2:45-52 - PubMed
  3. Lancet Infect Dis. 2014 Jan;14(1):40-9 - PubMed
  4. Lancet. 2006 Aug 5;368(9534):531-6 - PubMed
  5. J Acquir Immune Defic Syndr. 2013 Nov 1;64 Suppl 1:S42-51 - PubMed
  6. Clin Infect Dis. 2013 Oct;57(8):1164-71 - PubMed
  7. AIDS Patient Care STDS. 2009 Jan;23(1):41-9 - PubMed
  8. Arch Intern Med. 2008 Jun 9;168(11):1181-7 - PubMed
  9. Lancet. 2002 Jul 13;360(9327):119-29 - PubMed
  10. J Acquir Immune Defic Syndr. 2006 Sep;43(1):27-34 - PubMed
  11. Clin Infect Dis. 2010 Jun 1;50(11):1512-20 - PubMed
  12. Clin Infect Dis. 2011 Mar 15;52(6):793-800 - PubMed
  13. AIDS. 2010 Jan 2;24(1):123-37 - PubMed
  14. AIDS Care. 2005 Aug;17(6):773-83 - PubMed
  15. Int J Infect Dis. 2010 Feb;14(2):e127-31 - PubMed
  16. J Acquir Immune Defic Syndr. 2007 Sep;46 Suppl 1:S3-8 - PubMed
  17. Clin Infect Dis. 2010 Oct 15;51(8):947-56 - PubMed
  18. PLoS Med. 2009 Apr 28;6(4):e1000066 - PubMed
  19. AIDS. 2010 Mar 13;24(5):697-706 - PubMed
  20. Clin Infect Dis. 2010 May 15;50(10):1387-96 - PubMed
  21. AIDS. 2006 Nov 28;20(18):2371-9 - PubMed
  22. N Engl J Med. 2009 Apr 30;360(18):1815-26 - PubMed
  23. Public Health Rep. 2013 Mar-Apr;128(2):117-26 - PubMed
  24. AIDS. 2006 Jan 2;20(1):67-71 - PubMed
  25. Clin Infect Dis. 2009 Jan 15;48(2):248-56 - PubMed
  26. AIDS Patient Care STDS. 2007;21 Suppl 1:S3-8 - PubMed
  27. Lancet. 2009 Jan 3;373(9657):48-57 - PubMed
  28. AIDS Patient Care STDS. 2010 Oct;24(10):607-13 - PubMed

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