Evaluating Linkage to Care Among Patients With HIV Viremia in Los Angeles, California

Multiple barriers hinder retention in the HIV care continuum, including structural, systemic, and individual factors. We conducted a retrospective study to characterize people living with HIV (PLH) in our health system, with detectable HIV-1 viral loads, and identify factors associated with achieving virologic suppression. We included patients with at least one detectable viral load (HIV RNA >200 copies/mL) and at least one clinical encounter during the study period (from January 1, 2021, to August 31, 2023). We collected demographic, clinical, and healthcare utilization data. Patients were stratified by whether they achieved virologic suppression (HIV RNA <200 copies/mL) following a detectable result. Statistical comparisons were performed to identify significant differences. For the included 216 patients, the median age was 53 years (IQR: 39-61), with 91% (n = 196) male participants. The cohort was racially diverse, with 34% (n = 74) White, 25% (n = 54) Hispanic/Latine, and 20% (n = 43) Black/African American. Most patients (92%) had an active antiretroviral therapy (ART) prescription during the study period. Of the 117 patients with follow-up encounters, those who achieved virologic suppression were significantly older (median 56 vs. 50 years, p = 0.020) and more likely to initiate or modify ART after their first detectable viral load (74%, n = 39, vs. 50%, n = 32 already on ART, p = 0.009). Hepatitis B/HIV co-infection was observed only among patients with persistent viremia (3.1%, n = 2, vs. 0%, p = 0.002). Patients who achieved suppression underwent more HIV RNA testing (median 3 tests vs. 1 test, p < 0.001), had more total healthcare encounters (median 9 vs. 7, p = 0.003), and had five or more outpatient visits (66%, n = 35, vs. 39%, n = 25, p = 0.027). Conversely, patients with persistent viremia were more likely to be seen in a dedicated HIV clinic (77%, n = 49, vs. 49%, n = 25, p = 0.002). Older age, ART initiation or modification after detectable HIV viremia, and higher frequency of monitoring and encounters were associated with virologic suppression. Structured follow-up and timely ART interventions may support better outcomes for PLH with detectable viral loads.