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The Relationship Between the Human Immunodeficiency Virus-1 Transmission Network and the HIV Care Continuum in Los Angeles County.
- Source :
-
Clinical Infectious Diseases . Nov2020, Vol. 71 Issue 9, pe384-e391. 8p. - Publication Year :
- 2020
-
Abstract
- Background Public health action combating human immunodeficiency virus (HIV) includes facilitating navigation through the HIV continuum of care: timely diagnosis followed by linkage to care and initiation of antiretroviral therapy to suppress viral replication. Molecular epidemiology can identify rapidly growing HIV genetic transmission clusters. How progression through the care continuum relates to transmission clusters has not been previously characterized. Methods We performed a retrospective study on HIV surveillance data from 5226 adult cases in Los Angeles County diagnosed from 2010 through 2014. Genetic transmission clusters were constructed using HIV-TRACE. Cox proportional hazard models were used to estimate the impact of transmission cluster growth on the time intervals between care continuum events. Gamma frailty models incorporated the effect of heterogeneity associated with genetic transmission clusters. Results In contrast to our expectations, there were no differences in time to the care continuum events among individuals in clusters with different growth dynamics. However, upon achieving viral suppression, individuals in high growth clusters were slower to experience viral rebound (hazard ratio 0.83, P = .011) compared with individuals in low growth clusters. Heterogeneity associated with cluster membership in the timing to each event in the care continuum was highly significant (P < .001), with and without adjustment for transmission risk and demographics. Conclusions Individuals within the same transmission cluster have more similar trajectories through the HIV care continuum than those across transmission clusters. These findings suggest molecular epidemiology can assist public health officials in identifying clusters of individuals who may benefit from assistance in navigating the HIV care continuum. [ABSTRACT FROM AUTHOR]
- Subjects :
- *HIV infection genetics
*HIV infection risk factors
*HIV infection epidemiology
*CLUSTER analysis (Statistics)
*CONTINUUM of care
*HIV
*HIV infections
*HIV-positive persons
*MOLECULAR epidemiology
*PUBLIC health surveillance
*TIME
*VIRAL load
*PROPORTIONAL hazards models
*RETROSPECTIVE studies
*DESCRIPTIVE statistics
*ADULTS
Subjects
Details
- Language :
- English
- ISSN :
- 10584838
- Volume :
- 71
- Issue :
- 9
- Database :
- Academic Search Index
- Journal :
- Clinical Infectious Diseases
- Publication Type :
- Academic Journal
- Accession number :
- 147502672
- Full Text :
- https://doi.org/10.1093/cid/ciaa114