From the *Public Health Seattle & King County, Seattle, WA; †Department of Epidemiology, University of Washington, Seattle, WA; and ‡Department of Medicine, University of Washington, Seattle, WA and Center for AIDS and STD, Seattle, WA.
Sex Transm Dis. 2014 Jan;41(1):35-40. doi: 10.1097/OLQ.0000000000000072.
Prevention and clinical efforts are increasingly focused on improving the HIV care cascade, the sequential steps from diagnosis to engagement in care and viral suppression. Monitoring of this cascade is largely dependent on HIV laboratory surveillance data. However, little is known about the completeness of these data or the true care status of individuals for whom no data are reported.
We investigated people presumed to be living with HIV/AIDS in King County, WA, who had no laboratory results reported to HIV surveillance for at least 1 year between 2006 and 2010. We determined whether each person had relocated, died, or remained in the county.
Of 7379 HIV-infected people presumed living in King County, 2545 (35%) had 1 or more 12-month gap in laboratory reporting. Among these individuals, 47% had relocated, 7% died, and 38% remained in King County; we were unable to determine the status of 8%. Of individuals remaining in the area, 91% had evidence of returning to or being in HIV care. Case investigations reduced the proportion of individuals thought to be out of care in 2011 from 27% to 16%.
Investigations of individuals without laboratory results reported to HIV surveillance identified large numbers of people who are no longer living in the area. Our findings suggest that current estimates of the HIV care cascade may be too pessimistic and that individual case investigations are required to accurately define the size and composition of the population of people living with HIV in local areas.
预防和临床工作越来越注重改善 HIV 关怀链，即从诊断到参与护理和病毒抑制的连续步骤。对该关怀链的监测在很大程度上依赖于 HIV 实验室监测数据。然而，对于这些数据的完整性或没有报告数据的个体的真实护理状况，知之甚少。
我们调查了 2006 年至 2010 年间，在华盛顿州金县（King County）被认为患有艾滋病毒/艾滋病的人，这些人至少有 1 年没有向 HIV 监测报告实验室结果。我们确定每个人是否已经搬离、死亡或仍留在该县。
在 7379 名被认为居住在金县的 HIV 感染者中，有 2545 人（35%）有 1 次或多次实验室报告 12 个月的空白期。在这些人中，47%已经搬离，7%死亡，38%仍留在金县；我们无法确定 8%的人的状况。在留在该地区的人中，91%有证据表明他们重新或正在接受 HIV 护理。在 2011 年，通过对未向 HIV 监测报告实验室结果的个体进行调查，将被认为脱离护理的个体比例从 27%降低到 16%。
对未向 HIV 监测报告实验室结果的个体进行调查，发现了大量已不在该地区居住的人。我们的研究结果表明，目前对 HIV 关怀链的估计可能过于悲观，需要进行个体案例调查，以准确确定当地 HIV 感染者的规模和构成。
