Rethinking metrics used for goals

Ensure early diagnosis

One obstacle to the success of the U.S. national HIV/AIDS strategy involves the accuracy of metrics used for monitoring HIV care, including late diagnoses and linkage to sustained care, a new study notes.1

"We have not worked on the metrics to use in progress of the strategy's goals," says Julia Dombrowski, MD, MPH, acting instructor in the department of medicine at the University of Washington and deputy director for clinical services in the HIV/STD program at the Public Health Seattle King County in Seattle, WA.

"That was our paper's purpose, to evaluate metrics that other public health networks can use to evaluate the goals," she adds.

Dombrowski and co-investigators found that 32% of persons living with HIV/AIDS in King County (WA) in 2009, had been diagnosed with AIDS within one year of their HIV diagnosis.1

"Within that group, a significant proportion — almost a third — said they had their last negative test within two years," Dombrowski says. "That brings up the question of whether having AIDS in one year is the best method for measuring late diagnosis."

Investigators found no trends in a five-year period that would suggest there is a more virulent form of HIV in this population, she notes.

"Another explanation is that some people progress to AIDS more quickly, and it could be that some people reported their last negative test incorrectly," she adds.

Researchers also looked closely at linkage to care. They found that a focus on linking a newly-diagnosed HIV patient to his or her first appointment might be less informative than measuring linking patients to sustained medical care, Dombrowski says.

The study found that linkage to sustained care had a significant association with virologic suppression, but linkage to initial care, was not.1

"We as a public health community and medical community need to focus on getting people into sustained medical care," she adds.

Measuring a proportion of people in sustained care is limited by obstacles to follow-up.

For instance, patients can move out of state or die without their death being reported, Dombrowski says.

"None of us has a good handle on the status of people with no recent labs," she adds. "They could be out of care, moved away, or they might have died."

One best practice for improving linkage to care is to provide a one-on-one program in which patients meet with doctors to discuss HIV engagement in care and prognosis, she says.

"We'll make sure people are linked to sustained care and make sure that happens over the first year of care," Dombrowski says.

Reference:

  1. Dombrowski JC, Kent JB, Buskin SE, et al. Population-based metrics for the timing of HIV diagnosis, engagement in HIV care, and virologic suppression. AIDS. 2011;Oct. 15;[Epub ahead of print.]