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Use of Multiple Data Sources and Individual Case Investigation to Refine Surveillance-Based Estimates of the HIV Care Continuum

Dombrowski, Julia C. MD, MPH*,†; Buskin, Susan E. PhD, MPH†,‡; Bennett, Amy MPH; Thiede, Hanne DVM, MPH†,‡; Golden, Matthew R. MD, MPH*,†,‡

JAIDS Journal of Acquired Immune Deficiency Syndromes: 1 November 2014 - Volume 67 - Issue 3 - p 323–330
doi: 10.1097/QAI.0000000000000302
Epidemiology and Prevention

Objectives: To assess the HIV care continuum among HIV-infected persons residing in Seattle and King County, WA, at the end of 2011 and compare estimates of viral suppression derived from different population-based data sources.

Methods: We derived estimates for the HIV care continuum using a combination of HIV case and laboratory surveillance data supplemented with individual investigation of cases that seemed to be unlinked to or not retained in HIV care, a jurisdiction-wide population-based retrospective chart review, and local data from the CDC's Medical Monitoring Project and National HIV Behavioral Surveillance.

Results: Adjusting for in- and out-migration of persons diagnosed with HIV, laboratory surveillance data supplemented with individual case investigation suggest that 67% of persons diagnosed with HIV and 57% of all HIV-infected persons living in King County at the end of 2011 were virally suppressed (plasma HIV RNA <200 copies/mL). The viral suppression estimates we derived from a population-based chart review and adjusted local Medical Monitoring Project data were similar to the surveillance-derived estimate and identical to each other (59% viral suppression among all HIV-infected persons).

Conclusions: The level of viral suppression in King County is more than twice the national estimate and exceeds estimates of control for other major chronic diseases in the United States. Our findings suggest that national care continuum estimates may be substantially too pessimistic and highlight the need to improve HIV surveillance data.

*Department of Medicine, University of Washington, Seattle, WA;

Public Health—Seattle and King County HIV/STD Program, Seattle, WA; and

Department of Epidemiology, University of Washington, Seattle, WA.

Correspondence to: Julia C. Dombrowski, MD, MPH, Department of Medicine, University of Washington, 325 Ninth Avenue, Box 359777, Seattle, WA 98104 (e-mail:

Supported by a grant to J.C.D. from the National Institute of Mental Health (5K23MH090923); the University of Washington Center for AIDS Research (CFAR), an NIH funded program under award number P30AI027757, which is supported by the following NIH Institutes and Centers (NIAID, NCI, NIMH, NIDA, NICHD, NHLBI, NIA, NIGMS, and NIDDK); and programmatic funding from the CDC, the Washington State Department of Health, and Public Health—Seattle and King County.

J.C.D. and M.R.G. have received research support for STD studies unrelated to this work from Cempra pharmaceuticals and Genentech. The remaining authors have no conflicts of interest to disclose.

Presented in part at the 20th Conference on Retroviruses and Opportunistic Infections (Abstract 1027), March 4, 2013, Atlanta, Georgia.

Received February 17, 2014

Accepted July 07, 2014

© 2014 by Lippincott Williams & Wilkins