Cascade of care for people living with HIV infection in the Wellington region
Nigel Raymond, Kelly Bargh, Kyi Lai Lai Aung, James Rice
Antiretroviral therapy (ART), with once or twice daily medication regimens, is highly effective in providing better health for people living with HIV infection (PLHIV) and greatly reduces the risk of HIV transmission to others. In NZ, as in many other developed countries, the rates of new HIV diagnoses have risen over the last decade compared with prior to 2000. For PLHIV, impairment of the immune system is mainly assessed by measuring the level of CD4 lymphocytes (normal is above 600 x 10^6/L), while the effectiveness of antiretroviral therapy is assessed by whether the HIV viral load is suppressed to a consistently low level. This study included all people known to be living with HIV in the Wellington region and assessed the cascade of care which describes steps in delivering care: diagnosis, linkage and retention in care, and the provision and success of ART. The study described that main gaps in the cascade of care were the people with undiagnosed HIV infection (based on prior Auckland estimates) and those in whom treatment had not yet been initiated because their CD4 lymphocyte count was above the 500 cells/10^6/L threshold for publically funded ART, providing further evidence that earlier HIV diagnosis and increased access to ART are clinical and public health priorities.
