Trends in the San Francisco HIV Epidemic in the “Getting to Zero” Era

Abstract

Background

San Francisco (SF) has launched interventions to reduce new HIV infections and HIV-associated morbidity and mortality during the SF "Getting to Zero (GTZ)" era. We measured recent changes in HIV care indicators to assess the success of these interventions.

Methods

SF residents newly HIV-diagnosed from 2009-2014 were included. We measured temporal changes from HIV diagnosis to a) linkage to care ≤ 3 months, b) initiation of antiretroviral therapy (ART) ≤12 months, c) viral suppression (VS) ≤12 months, d) development of AIDS ≤3 months, e) death ≤12 months and f) retention in care 6-12 months after linkage. Kaplan-Meier analyses stratified by year of HIV diagnosis measured time from diagnosis to linkage, ART initiation, VS, AIDS and death.

Results

Overall, new diagnoses declined from 473 in 2009 to 329 in 2014. The proportion of new diagnoses among men (p=0.005), Latinos and Asian/Pacific Islanders (p=0.02), and men who have sex with men (p=0.003) increased. ART initiation and VS ≤12 months of diagnosis increased (P<0.001) while the proportion who were diagnosed with AIDS ≤3 months of HIV diagnosis declined (P<0.001). Time to ART initiation and time to VS were significantly shorter in more recent years of diagnosis (P<0.001). Time from HIV to AIDS diagnosis was significantly longer in more recent years (P<0.001). Retention in care did not significantly change.

Conclusions

In SF new HIV diagnoses have declined and HIV care indicators have improved during the "GTZ" era. Continued success requires attention to vulnerable populations and monitoring to adjust programmatic priorities.