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Disparities and Trends in Viral Suppression During a Transition to a “Test and Treat” Approach to the HIV Epidemic, San Francisco, 2008–2012

Background:In 2010, 2 years before national recommendations to provide antiretroviral therapy for HIV-infected persons regardless of CD4 count, the San Francisco Department of Public Health (SFDPH) implemented a “test and treat” strategy that expanded HIV testing and offered antiretroviral therapy to persons at all publicly funded HIV clinics. We used the SFDPH registry of HIV-infected persons to measure trends in the time to viral suppression of persons suppressed. Methods:The Kaplan–Meier product limit method was used to assess trends in time from HIV diagnosis to viral suppression (HIV RNA <200 copies/mL) among persons diagnosed from 2008 to 2012. The annual proportion of persons living with HIV who were virally suppressed was measured for the years 2008 to 2012. Independent predictors of viral suppression were determined using proportional hazards regression for newly diagnosed cases and Poisson regression for living cases. Results:Of the 2349 persons newly diagnosed, the median time from diagnosis to suppression decreased from 13 months in 2008 to 5 months in 2012 (P < 0.0001). Among the 11,787 persons living with HIV, the annual proportion suppressed increased from 69% in 2008 to 78% in 2012. African Americans, persons who inject drugs, persons without private insurance, and persons with nadir CD4 counts above 350 cells per cubic millimeter, were less likely to be virally suppressed. Discussion:We found a decrease in time and overall population-level increases in viral suppression under a test and treat strategy and highlight sociodemographic disparities that may hamper the full benefit of this approach.