Ongoing HIV Transmission and the HIV Care Continuum in North Carolina

<div><p>Objective</p><p>HIV transmission is influenced by status awareness and receipt of care and treatment. We analyzed these attributes of named partners of persons with acute HIV infection (index AHI cases) to characterize the transmission landscape in North Carolina (NC).</p><p>Design</p><p>Secondary analysis of programmatic data.</p><p>Methods</p><p>We used data from the NC Screening and Tracing of Active Transmission Program (2002–2013) to determine HIV status (uninfected, AHI, or chronic HIV infection [CHI]), diagnosis status (new or previously-diagnosed), and care and treatment status (not in care, in care and not on treatment, in care and on treatment) of index AHI cases' named partners. We developed an algorithm identifying the most likely transmission source among known HIV-infected partners to estimate the proportion of transmissions arising from contact with persons at different HIV continuum stages. We conducted a complementary analysis among a subset of index AHI cases and partners with phylogenetically-linked viruses.</p><p>Results</p><p>Overall, 358 index AHI cases named 932 partners, of which 218 were found to be HIV-infected (162 (74.3%) previously-diagnosed, 11 (5.0%) new AHI, 45 (20.6%) new CHI). Most transmission events appeared attributable to previously-diagnosed partners (77.4%, 95% confidence interval 69.4–85.3%). Among these previously-diagnosed partners, 23.2% (14.0–32.3%) were reported as in care and on treatment near the index AHI case diagnosis date. In the subset study of 33 phylogenetically-linked cases and partners, 60.6% of partners were previously diagnosed (43.9–77.3%).</p><p>Conclusions</p><p>A substantial proportion of HIV transmission in this setting appears attributable to contact with previously-diagnosed partners, reinforcing the need for improved engagement in care after diagnosis.</p></div

HIV Status of sexual and needle-sharing partners reported by index AHI cases.

<p>(A) HIV status of partners of index AHI cases identified via the STAT program between November 2002 and June 2013. (B) HIV status of partners reported by index AHI cases enrolled in CHAVI-001 between May 2006 and June 2011.</p

HIV care continuum stages for HIV-infected partners.

<p>The diagnosis status and the care and treatment status (if available) are presented for 1) all HIV-infected partners named by the index AHI cohort and identified by the STAT program, 2) the most likely transmission source among identified HIV-infected partners presented by the pattern of HIV-infected, uninfected, and status-unknown partners reported to the STAT program (unconfirmed linkage) and 3) phlyogenetically-linked partners identified via the CHAVI-001 study (confirmed linkage). For the data originating from the STAT program, repeated random sampling was used to estimate diagnosis, care, and treatment status of the most likely transmission source when >1 potential transmitting partner was named.</p

Demographics of Index AHI and Named Partners.

<p>*The North Carolina Screening and Tracing of Active Transmission Program. The STAT cases are inclusive of CHAVI-001 cases.</p><p>** Center for HIV/AIDS Vaccine Immunology 001 Study: Acute HIV Infection Prospective Cohort Study.</p><p>^{^} 932 partners were named by Index AHI cases during the STAT investigation. Index AHI cases refused to provide detailed demographic information for the STAT Program for a total of 276 partners, leaving 656 with detailed demographic information.</p><p>^@ One partner identified in CHAVI-001 was missing gender.</p><p>^# Missing Race not included in table.</p><p>Demographics of Index AHI and Named Partners.</p