Progress Toward Achieving the UNAIDS 90-90-90 Goals in HIV Care From Diagnosis to Durable Viral Suppression in the Country of Georgia.

Successful engagement in HIV care is required to reach UNAIDS targets of 90-90-90. We analyzed routine programmatic data to quantify losses along the HIV care continuum in the country of Georgia. Analysis was limited to diagnosed persons and did not include estimated number of HIV-infected persons. Cascade of HIV care continuum was constructed for adult (age ≥18 years) HIV-infected persons newly diagnosed in Georgia in 2008-2012. Data were extracted from the national AIDS Health Information System as of June 30, 2014. Among 1,931 patients included, the median age was 37 years, 72% were men, and 40.7% had CD4 count <200 cells/mm3 . A total of 1,711 (88.6%) were linked to care, 1,333 (69.0%) ever started antiretroviral therapy (ART), 1,044 (54.1%) ever achieved viral suppression, and 792 (41.0%) maintained viral suppression till the end of follow-up. Overall, 1,139 patients were lost from HIV diagnosis to maintaining viral suppression, including 761 (66.8%) patients who remained alive and 378 (33.2%) patients who died. Among 378 deceased patients, 324 (85.7%) died before achieving viral suppression after the median 3.5 months since diagnosis and 54 (14.3%) died after achieving viral suppression after the median 21.2 months since diagnosis. Among 761 alive patients without viral suppression, 297 (39.0%) were fully disengaged, 144 (18.9%) had never been prescribed ART, 161 (21.2) either never achieved suppression or discontinued ART, and 159 (20.9%) experienced rebound while on ART. Efforts are needed to improve earlier HIV diagnosis, to reduce the number of patients not in care, and to extend durability of viral suppression.