Supplementary Material for

Looking beyond the cascade of HIV care to end the AIDS epidemic: estimation of the time interval from HIV infection to viral suppression

Virginie Supervie PhD1§, Lise Marty PhD1, Jean-Marc Lacombe1, Rosemary Dray-Spira PhD1, Dominique Costagliola PhD1, and the FHDH-ANRS CO4 study group2

1Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP UMR_S 1136), F75013, Paris, France

2http://www.ccde.fr/

§Correspondance and requests for reprints should be addressed to: Virginie Supervie

Address: INSERM, UMR_S 1136, 56 Bd Vincent Auriol, 75013 Paris;

Tel: +33(0)142164289; Fax: +33(0)142164261;

E-mail:

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Supplementary Tables

Table S1: Number and characteristics of HIV-infected individuals engaged in care in France in 2010 and enrolled onto the FHDH-ANRS CO4 cohort.

Number of FHDH-patients enrolled in care in 2010 (%) / Proportion of patients receiving cART for more than 6 months
(95% CI) / Proportion of patients with suppressed VL among those treated for more than 6 months (95% CI)
Overall / 54321 (100.0%) / 80.7
(80.4 - 81.0) / 86.1
(85.7 - 86.4)
MSM / 20128 (37.0%) / 80.7
(80.2 - 81.3) / 87.4
(86.8 - 87.9)
IDUs / 6148 (11.3%) / 87.8
(86.9 - 88.6) / 85.1
(84.0 - 86.1)
French heterosexual women / 8458 (15.6%) / 79.2
(78.3 - 80.1) / 88.0
(87.2 - 88.9)
Non French-national heterosexual women / 6929 (12.8%) / 75.6
(74.6 - 76.7) / 81.9
(80.8 - 83.0)
French heterosexual men / 6637 (12.2%) / 81.7
(80.8 - 82.7) / 85.3
(84.3 - 86.3)
Non French-national heterosexual men / 4161 (7.7%) / 79.7
(78.5 - 81.0) / 79.2
(77.7 - 80.7)
Othersa / 1860 (3.4%) / 81.4
(79.6 - 83.2) / 81.0
(78.8 - 83.1)

Missing data on the exposure category (<6%) were assumed to be missing at random and imputed using the marginal distribution. We used the normal approximation of the binomial distribution to calculate the 95% confidence intervals (CI) of proportions.

aThe category “Others” included hemophiliacs, blood transfusion recipients and perinatally infected individuals; MSM: men who have sex with men; IDUs: injecting drug users; cART: combined anti-retroviral treatment; VL: viral load.


Table S2: Number and characteristics of HIV-infected individuals who newly engaged in care in France between 2008 and 2010 and were enrolled onto the FHDH-ANRS CO4 cohort.

Number of HIV-infected cART-naïve individuals who newly engaged in care between 2008 and 2010 / Number of HIV-infected individuals who newly engaged in care between 2008 and 2010 and initiated cART / Number of HIV-infected individuals who newly engaged in care between 2008 and 2010, initiated cART and achieved viral suppression / Proportion of HIV-infected individuals newly engaged in care between 2008 and 2010 who knew their HIV status for more than 3 months (95% CI)
Overall / 6268 / 4418 / 3617 / 23.2
(22.2 - 24.3)
MSM / 2673 / 1827 / 1509 / 22.7
(21.1 - 24.3)
IDUs / 111 / 77 / 57 / 58.7
(49.5 - 68.0)
French heterosexual women / 763 / 531 / 456 / 23.9
(20.9 - 27.0)
Non French-national heterosexual women / 835 / 637 / 538 / 20.8
(16.2 - 25.3)
French heterosexual men / 750 / 535 / 442 / 22.4
(19.5 - 25.2)
Non French-national heterosexual men / 606 / 464 / 353 / 18.4
(15.6 - 21.2)
Othersa / 530 / 347 / 262 / 30.7
(26.7 - 34.7)

aThe category “Others” included hemophiliacs, blood transfusion recipients and perinatally infected individuals; MSM: men who have sex with men; IDUs: injecting drug users; cART: combined anti-retroviral treatment. We used the normal approximation of the binomial distribution to calculate the 95% confidence intervals (CI) of the proportion.


Table S3: Estimated mean numbers of HIV-infected individuals (and 95% confidence intervals) engaged in selected stages of the continuum of HIV care in France in 2010.

Number of undiagnosed HIV-infected individuals / Number of diagnosed HIV-infected individuals not in care / Number of HIV-infected individuals in care / Number of HIV-infected individuals receiving cART for >6 months / Number of treated HIV-infected individuals with suppressed VL (<50 copies/mL) for > 6 months / Number of individuals living with HIVa
Overall / 29000
(24200-33900) / 8400
(6900-10000) / 111500 / 90000
(89600-90400) / 76900
(76400-77300) / 148900
(142700-155100)
MSM / 9200
(7800-11200) / 2700
(2200-3300) / 41300
(40900-41800) / 33400
(32900-33800) / 29100
(28700-29600) / 53200
(51300-55900)
IDUs / 500
(100-1100) / 700
(100-1700) / 12600
(12300-12900) / 11100
(10800-11400) / 9400
(9200-9700) / 13800
(12900-15400)
French heterosexual women / 3600
(1700-5300) / 1100
(500-1700) / 17400
(17000-17700) / 13700
(13400-14100) / 12100
(11800-12400) / 22100
(19600-24300)
Non French-national heterosexual women / 4900
(3600-6600) / 1400
(1000-1700) / 14200
(13900-14500) / 10800
(10500-11000) / 8800
(8600-9100) / 20500
(18800-22800)
French heterosexual men / 6400
(3700-9800) / 1400
(800-2200) / 13600
(13300-13900) / 11100
(10900-11400) / 9500
(9200-9800) / 21400
(18100-25700)
Non French-national heterosexual men / 4400
(2400-6600) / 1000
(500-1600) / 8500
(8300-8800) / 6800
(6600-7000) / 5400
(5200-5600) / 14000
(11600-16600)
Othersb / - / - / 3800
(3000-4600) / 3100
(2400-3700) / 2500
(2000-3000) / >3800
(3000-4700)

MSM: men who have sex with men; IDUs: injecting drug users; cART: combined anti-retroviral treatment; VL: viral load; aobtained by summing up the first three columns. bThe category “Others” included hemophiliacs, blood transfusion recipients and perinatally infected individuals. Due to insufficient data, we did not estimate the number of HIV-infected individuals not in care in this exposure category. This means that the number of individuals living with HIV in this category is likely to be an underestimate.
Table S4: Estimated percentages of HIV-infected individuals (and 95% confidence intervals) engaged in a selected step of the continuum of care who proceeded to another step in France.

% diagnosed among those living with HIV / % in care among those living with diagnosed HIV / % on cART for more than 6 months among those living with diagnosed HIV / % on cART for more than 6 months among those in care / % virally suppressed (<50 copies/mL) among those treated for more than 6 months
Overall / 80.6
(78.1-83.1) / 93.0
(91.8-94.1) / 75.1
(74.1-76.0) / 80.7
(80.4-81.1) / 85.4
(85.1-85.8)
MSM / 82.7
(79.9-84.9) / 93.9
(92.5-94.9) / 75.8
(74.6-76.8) / 80.7
(80.2-81.3) / 87.4
(86.8-87.9)
IDUs / 96.5
(93.0-99.0) / 94.8
(88.7-98.8) / 83.2
(77.8-86.6) / 87.8
(87.0-88.6) / 85.1
(84.1-86.2)
French heterosexual women / 83.9
(78.3-91.3) / 93.9
(90.9-97.1) / 74.4
(71.9-77.2) / 79.2
(78.3-80.1) / 88.0
(87.2-88.8)
Non French-national heterosexual women / 76.2
(70.9-80.9) / 91.1
(87.7-93.6) / 68.8
(66.2-71.0) / 75.6
(74.6-76.7) / 81.9
(80.9-83.1)
French heterosexual men / 70.8
(61.6-79.8) / 90.5
(85.6-94.5) / 74.0
(69.8-77.4) / 81.7
(80.7-82.7) / 85.3
(84.2-86.3)
Non French-national heterosexual men / 68.8
(60.3-79.1) / 89.3
(84.2-94.0) / 71.2
(66.9-74.9) / 79.7
(78.4-81.0) / 79.2
(77.8-80.6)
Others* / - / - / - / 81.4
(79.2-83.2) / 81.0
(78.7-83.2)
Kruskal-Wallis test / p<0.001 / p<0.001 / p<0.001 / p<0.001 / p<0.001

Values given in parentheses represent the 95% confidence intervals; MSM: men who have sex with men; IDUs: injecting drug users; cART: combined anti-retroviral treatment; *The category “Others” included hemophiliacs, blood transfusion recipients and perinatally infected individuals. Due to insufficient data, we did not estimate the number of HIV-infected individuals not in care in this exposure category. Therefore, for this group, we could not estimate the % living with diagnosed HIV, the % in care among those living with diagnosed HIV and the % receiving cART for more than 6 months among those living with diagnosed HIV.


Table S5: Estimated distribution of times (in years) in between selected stages of the HIV care cascade in France

Time from HIV infection to diagnosis / Time from HIV diagnosis to entry in HIV care / Time from care entry to cART initiation / Time from cART initiation to viral suppression
(<50 copies/mL) / Time from HIV infection to viral suppression
(<50 copies/mL) / Time from HIV diagnosis to viral suppression
(<50 copies/mL)
Median
(IQR) / Mean / Median
(IQR) / Mean / Median
(IQR) / Mean / Median
(IQR) / Mean / Median
(IQR) / Mean / Median
(IQR) / Mean
Overall / 3.4
(1.1-5.7) / 3.8 / 0.1
(0.0-0.2) / 1.1 / 0.5
(0.1-1.9) / 1.2 / 0.5
(0.3-0.8) / 0.8 / 6.1
(3.6-9.2) / 6.9 / 1.9
(0.8-4.0) / 3.1
MSM / 2.9
(0.7-5.4) / 3.4 / 0.1
(0.0-0.2) / 0.8 / 0.8
(0.1-2.1) / 1.3 / 0.5
(0.3-0.8) / 0.9 / 5.7
(3.3-8.6) / 6.4 / 2.0
(0.9-4.1) / 3.0
IDUs / 4.0
(1.7-6.4) / 4.4 / 0.9
(0.0-11.8) / 6.5 / 0.3
(0.1-1.8) / 1.0 / 0.5
(0.3-1.1) / 0.9 / 9.6
(5.7-18.3) / 12.8 / 4.1
(1.4-13.9) / 8.4
French heterosexual women / 2.8
(0.8-5.3) / 3.4 / 0.1
(0.0-0.2) / 1.0 / 0.6
(0.1-2.1) / 1.2 / 0.4
(0.2-0.7) / 0.9 / 5.7
(3.2-9.0) / 6.5 / 2.0
(0.8-4.2) / 3.1
Non French-national heterosexual women / 3.0
(1.4-5.2) / 3.5 / 0.1
(0.0-0.2) / 0.8 / 0.3
(0.1-1.3) / 1.0 / 0.4
(0.2-0.6) / 0.9 / 5.7
(3.1-8.5) / 6.2 / 1.4
(0.6-3.8) / 2.7
French heterosexual men / 4.7
(1.9-7.5) / 4.9 / 0.1
(0.0-0.1) / 0.7 / 0.4
(0.1-1.7) / 1.1 / 0.5
(0.3-0.9) / 0.9 / 7.2
(4.1-10.2) / 7.5 / 1.8
(0.8-3.6) / 2.6
Non French-national heterosexual men / 4.6
(2.5-7.0) / 4.9 / 0.1
(0.0-0.1) / 0.7 / 0.2
(0.1-1.0) / 0.8 / 0.5
(0.3-1.1) / 0.8 / 6.9
(4.3-9.5) / 7.2 / 1.5
(0.7-3.0) / 2.3
Others* / - / - / 0.1
(0.0-0.6) / 1.8 / 0.4
(0.1-1.7) / 1.1 / 0.4
(0.3-1.0) / 0.9 / - / - / 2.3
(0.8-4.5) / 3.8
Kruskal-Wallis test / p<0.001 / p<0.001 / p<0.001 / p<0.001 / p<0.001 / p<0.001

IQR: inter-quartile range; MSM: men who have sex with men; IDUs: injecting drug users; cART: combined anti-retroviral treatment; *The category “Others” included hemophiliacs, blood transfusion recipients and perinatally infected individuals. Due to insufficient data, time from HIV infection to diagnosis was not estimated for this exposure category. Therefore, for this exposure group, we could not obtain estimates for the time from HIV infection to viral suppression.

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