The continuum of care for people living with HIV in Suriname: identifying factors influencing the care delivery process

Abstract

Abstract Background Identifying gaps along the human immunodeficiency virus (HIV) continuum of care is essential in reaching viral suppression. Objective The aim of this study aims to identify sociodemographic and clinical factors influencing HIV diagnosis, linkage to care, antiretroviral therapy (ART) initiation and retention, and viral suppression in Suriname. Method Adults, over 15 years, enrolled as HIV positive in the national surveillance system from 2010 to 2015, were included. Multiple regression looking into sociodemographic and clinical factors was executed. Indicators evaluated were ‘knowing HIV status’, people initiating ART, 1-year ART retention, and viral suppression with ART. Results There were 2939 registered adults registered. Based on yearly average, of the 52% (95% confidence interval (CI), 52–53%) of estimated people living with HIV, 4950 knew their HIV status; 63% (95% CI, 62–64%) of these diagnosed initiated ART; and 81% (95% CI, 22–32%) of those on ART were virally suppressed. If tested positive at a non-voluntary counseling testing (VCT) site, better linkage to care (adjusted odds ratio (aOR), 1.6; 95% CI, 1.2–2.1) is seen. Although better linked to care (aOR, 1.5; 95% CI, 1.2–1.8), no difference was noted in viral suppression (aOR, 0.8; 95% CI, 0.6–1.0) for men compared to women. Men initiate treatment at a more advanced stage of disease (CD4 ≤ 200) than women (47.4% versus 31.4%), leading to higher mortality rates. People from the interior were less likely linked to care (aOR, 0.6; 95% CI, 0.4–0.8) than those from urban regions but did not display significant differences in treatment initiation. Conclusion In each step, the continuum shows a significant drop. Innovative interventions with a particular focus on men and people living in the interior are needed. Also, a more proactive system of linking people in care, especially at VCT sites, is needed.