Initial Experience with Transition to a “Test and Treat” ART Strategy: San Francisco

Keith Henry, MD reviewing Schwarcz S et al. J Acquir Immune Defic Syndr 2015 Aug 11.

A “test and treat” antiretroviral therapy strategy decreased time from diagnosis of HIV infection to virologic suppression; nonetheless, key groups remained less likely to achieve suppression.

In 2010, the San Francisco Department of Public Health implemented a “test and treat” antiretroviral therapy strategy at all publicly funded clinics. To measure success with that more aggressive approach, researchers analyzed data from the San Francisco HIV/AIDS case registry for individuals aged ≥13 who had received a new diagnosis of HIV infection between 2008 and 2012 (n=2349). In addition, to examine disparities in achieving virologic suppression, they analyzed data on patients aged ≥13 who were alive as of December 31, 2012 (≥1 year after diagnosis), were still residing in San Francisco, and had HIV-related laboratory tests reported (n=11,787).

Between 2008 and 2012, the median time from new HIV diagnosis to virologic suppression decreased from 13 to 5 months (P<0.0001). Over the same 5-year period, the overall virologic suppression rate for those living with HIV increased from 69% to 78%. The likelihood of achieving virologic suppression was significantly decreased for patients who were black, injected drugs, lived in an impoverished neighborhood, did not have private insurance, or had nadir CD4 counts >350 cells/mm3.

Citation(s):

Schwarcz S et al. Disparities and trends in viral suppression during a transition to a ‘test and treat' approach to the HIV epidemic, San Francisco, 2008-2012 J Acquir Immune Defic Syndr 2015 Aug 11; [e-pub].