Implementation and Operational Research

摘要: Ensuring that people living with HIV are accessing and staying in care is vital to achieving optimal health outcomes including antiretroviral therapy (ART) adherence prevention of secondary transmission.1–4 A number jurisdictions quantifying patterns engagement among persons diagnosed an eye identifying potential barriers against the full realization these individual population benefits.5–9 The continuum or “HIV cascade” a framework depicts degree which infected timely fashion, become engaged care, successfully treated ART such they achieve virologic suppression.5 Findings 1 setting may not be generalizable another, given differences systems populations affected by local epidemics. International comparisons indicate variation percent loss from cascade step next vary considerably,10 suggesting locally informed strategies required improve retention ultimately proportion suppressed viral load. Estimation indicators commonly uses administrative data clinics, laboratory systems, insurance programs.5,8,9,11–13 Although sources typically benefit being population-based, lack patient-level characteristics (eg, risk factors, race/ethnicity, immigration status) or, for those measures collected, have extensive missing data. Data consented participants ongoing cohort studies far better ascertainment but prone selection biases because differential enrollment attrition. Ideally, one would triangulate using both types robust inferences. Our overall objective was characterize large clinical Ontario, Canada, conducts record linkage population-based databases. All been were linked care; nevertheless, this can inform subsequent after care. Specifically, we sought estimate annual proportions continuous on ART, load 2001 2011 examine whether varied temporally according socio-demographic characteristics.