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BACKGROUND: To increase survival and reduce transmission of HIV, it is vital to improve engagement at every stage in a continuum of care that includes HIV testing and subsequent diagnosis, linkage to HIV medical care, continuous engagement in HIV medical care, initiation of antiretroviral therapy, and viral suppression (<200 copies/mL).
METHODS: Florida HIV Laboratory Surveillance, Unmet Need, and Medical Monitoring Project data were used to estimate the indicators on the continuum of HIV care. In addition to a statewide continuum of HIV care, continua were developed for relevant demographic characteristics, transmission categories, and geographical areas.
RESULTS: Almost 86% of persons living with diagnosed HIV as of the end of 2013 had at least one HIV-related lab following diagnosis. More than 55% of persons living with HIV had at least one HIV-related care visit, lab, or prescription in the previous year, 50% were on antiretroviral therapy and 39% had a suppressed viral load. Areas with a lower population density exhibited increased linkage to HIV care, antiretroviral use, and viral suppression compared to areas with higher population density. Linkage to HIV care, antiretroviral use, and viral suppression occurred more frequently among females compared to males. Lower rates of linkage to HIV care, antiretroviral use, and viral suppression occurred among blacks and Hispanics compared to whites, with Hispanics having the lowest rates for all indicators. Young adults aged 13-24 had the lowest rates of linkage to HIV care while persons aged 25–49 years had lower rates of antiretroviral use and viral suppression compared to other age groups. Among transmission risk categories, rates of linkage to HIV care and antiretroviral use among injection drug users was highest compared to men who have sex with men and heterosexuals. However, compared to all other transmission risks, the highest rate of viral suppression was among men who have sex with men.
CONCLUSIONS: The continuum of HIV care provides insight into the variation of care patterns across the state and highlights priority populations to target statewide and local HIV prevention and treatment initiatives. In line with the goals of the National HIV/AIDS Strategy, increased HIV testing, improvements in linkage and retention to HIV care and routine prescription of ART as standard HIV medical care are critical to reduce new infections and improve the health of persons living with HIV.