Evaluating the care cascade after antiretroviral therapy initiation in Latin America.

Accelerating antiretroviral therapy (ART) administration, improving retention, and achieving viral suppression in low- and middle-income countries must be prioritized. We evaluated trends and disparities in these milestones in a large Latin American cohort. Adults starting ART (ART) from 2003 to 2014 at Caribbean, Central, and South America network for HIV epidemiology sites were assessed for care cascade outcomes: CD4 cell count >200 cells/mm at ART; retention (≥1 visit at one year after ART); viral suppression (≥1 HIV-1 RNA <200 copies/ml at one year after ART). Modified Poisson regression provided adjusted prevalence ratios by age, gender, and HIV transmission risk, accounting for site and year of ART. Proportions achieving ART and suppression improved over time (p < 0.05). Older age was associated with better retention and viral suppression, but not ART at CD4 cell count >200 cells/mm. Females and men who have sex with men (MSM) were more likely to have CD4 cell count >200 cells/mm at ART. Injection drug users (IDUs) were less likely to be retained while MSM were more likely to achieve viral suppression (all p < 0.05). Despite improvements in these outcomes over the course of a decade in this cohort, significant disparities existed, disadvantaging younger patients, men, and IDUs. These gaps indicate continued progress in providing early diagnosis and ART remain critical.