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Hassan A, De Gruttola V, Hu YW, Sheng Z, Poortinga K, Wertheim JO. The relationship between the human immunodeficiency virus-1 transmission network and the HIV care continuum in Los Angeles County. Clin Infect Dis. 2020;71(9):e384-e391. PMID: 32020172. PMCID: 7904072.
About This Paper: The HIV continuum of care begins with a life-changing and frightening positive test followed by confirming tests, counseling, meetings with medical providers, and most importantly, staying in care and on treatment to keep the virus suppressed. The continuum of care also includes any assistance patients may need to stay in care, such as housing, transportation, psychological or social care, and treatment for substance use.
While the HIV continuum of care is available in most communities, no one has yet studied whether different outbreaks (transmission clusters) of HIV contribute to greater or lesser access to HIV care. We reviewed HIV data from 5226 adults in Los Angeles County who were diagnosed between 2010-2014. We did not have access to any identifying information about these persons; every record was labeled with a code number.
We reviewed details about the virus using a program called HIV-TRACE. We looked for similarities in the genetic sequence of the virus to identify the various transmission clusters and how quickly each cluster grew. Finally, we compared viral loads between clusters over time to see if the different clusters influenced access to the continuum of care.
We found that while there were variations between transmission clusters, people in the same clusters accessed care and treatment to suppress the virus in about the same timeframe. However, people in the faster-growing clusters accessed care more quickly and remained virally suppressed longer than people in the slower-growing clusters. Our methods and findings may help public health officials find people most likely to benefit from assistance with accessing and staying in the HIV care continuum.