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BACKGROUND: HIV/AIDS treatment cascades are visual tools to demonstrate the number of persons living with HIV/AIDS who receive full medical care and treatment benefits. This information identifies gaps in care and can assist policymakers and service providers to better support the HIV-positive community.
METHODS: Demographic and laboratory information was extracted from Enhanced HIV/AIDS Reporting System (eHARS) for infected persons currently living in Nebraska, diagnosed on or before September 30, 2011 and surviving through December 31, 2011. Data were analyzed using SAS. HIV/AIDS treatment cascade comprises six categories and we used the following case definitions: ever in care (EIC) (Proportion of all HIV diagnoses ≥1 CD4 or viral load since diagnosis), linked to care (LTC) (proportion of EIC that had CD4 or viral load within 3 months of diagnosis), currently in care (CIC) (proportion of EIC that had ≥1 CD4 or viral load result in 2011), retained in care (RIC) (proportion of EIC who had (≥2CD4 or viral load result in 2011), virally suppressed (VS) (proportion of CIC who’s most recent viral load less than 50 copies/mL), requiring antiretroviral (ART) therapy (RAT) (proportion of CIC who’s most current CD4 count was ˂350 cells/mcL). We compared HIV/AIDS treatment cascades between urban and rural residents, black, white, and Hispanic, and by age group (25–34, 35–44, 45–54, 55–64, and ≥65).
RESULTS: Of 1,961 cases, proportions overall are as follows respectively for each category: 96% EIC; 67% CIC; 54% RIC; 58% LTC; 59% VS; and 27% RAT. There were no significant differences between urban and rural. Notable racial and ethnic disparities are as follows respectively (white, black, Hispanic) : 97%, 96%, 93% EIC; 57%, 57%, 65% LIC; 70%, 67%, 58% CIC; 61%, 54%, 67% VS; 22%, 35%, 34% RAT. Notable age group disparities are as follows respectively (25 to 34, 35 to 44, 45 to 54, 55 to 64, and ≥65): 92%, 96%, 97%, 96%, 98% EIC; 67%, 59%, 54%, 55%, 54% LIC; 73%, 64%, 66%, 70%, 82% CIC; 50%, 62%, 64%, 60%, 43% VS.
CONCLUSIONS: To reduce HIV/AIDS impact in Nebraska, improvements are needed at each cascade stage. Our results indicate that disparities exist between blacks and Hispanics compared to whites, and between age groups. All Nebraska service providers should use the cascade for strategic planning and focusing on improving HIV diagnosis and linkage to care for people newly diagnosed with HIV.