@article{3003147,
    title = "HIV continuum of care: Bridging cross-sectional and longitudinal analyses",
    author = "Touloumi, G. and Thomadakis, C. and Pantazis, N. and Papastamopoulos, V. and Paparizos, V. and Metallidis, S. and Adamis, G. and Chini, M. and Psichogiou, M. and Chrysos, G. and Sambatakou, H. and Barbunakis, E. and Vourli, G. and Antoniadou, A. and Lazanas, M. and Papastamopoulos, V. and Paraskevis, D. and Touloumi, G. and Papadopoulos, A. and Nitsotolis, T. and Basoulis, D. and Astriti, M. and Gogos, H.A. and Marangos, M.N. and Katsarou, O. and Kouramba, A. and Sipsas, N.V. and Kontos, A. and Lioni, A. and Tsachouridou, O. and Paparizos, V. and Kourkounti, S. and Papastamopoulos, V. and Panagopoulos, P. and Ganitis, A. and Gikas, A. and Barbounakis, E. and Gogos, H. and the AMACS",
    journal = "Ελληνικά Αρχεία AIDS=:  Hellenic Archives of AIDS",
    year = "2022",
    volume = "36",
    number = "4",
    pages = "583-591",
    publisher = "Lippincott Williams and Wilkins",
    issn = "11058900",
    doi = "10.1097/QAD.0000000000003131",
    keywords = "article;  cohort analysis;  controlled study;  cumulative incidence;  diagnosis;  diagnosis time;  early diagnosis;  follow up;  human;  Human immunodeficiency virus;  Human immunodeficiency virus infected patient;  multicenter study;  nonhuman;  rebound;  virus load",
    abstract = "Objective: The aim of this study was to propose a unified continuum-of-care (CoC) analysis combining cross-sectional and longitudinal elements, incorporating time spent between stages. Design: The established 90-90-90 target follows a cross-sectional four-stage CoC analysis, lacking information on timing of diagnosis, antiretroviral therapy (ART) initiation, and viral suppression durability. Methods: Data were derived from the Athens Multicenter AIDS Cohort Study (AMACS). In the cross-sectional CoC, we added stratification of diagnosed people with HIV (PWH) by estimated time from infection to diagnosis; of those who ever initiated ART or achieved viral suppression by corresponding current status (in 2018); and cumulative incidence function (CIF) of ART initiation and viral suppression, treating loss-to-followup (LTFU) as competing event. Viral suppression was defined as viral load less than 500 copies/ml. Viral suppression durability was assessed by the CIF of viral load rebound. Findings: About 89.1% of PWH in 2018 were diagnosed (range of diagnoses: 1980 - 2018). Median time to diagnosis was 3.5 years (IQR: 1.1 - 7.0). Among diagnosed, 89.1% were ever treated, of whom 86.7% remained on ART. CIF of ART initiation and LTFU before ART initiation were 80.9 and 6.0% at 5 years since diagnosis, respectively. Among treated, 89.4% achieved viral suppression, of whom 87.4% were currently virally suppressed. The CIF of viral load rebound was 24.2% at 5 years since first viral suppression but substantially reduced in more recent years. Interpretation: The proposed analysis highlights time gaps in CoC not evident by the standard cross-sectional approach. Our analysis highlights the need for early diagnosis and identifies late presenters as a key population for interventions that could decrease gaps in the CoC. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved."
}