Table 1. Indicators used to monitor cascade engagement in the Ontario HIV Laboratory Cohort and most recent estimates for each indicator.
| Indicator | Definition (numerator) |
Denominator used for calculating percent of individuals per calendar year | 2015 cohort estimates |
|---|---|---|---|
| Diagnosed PLWH | |||
| Main | Confirmed nominal HIV-positive diagnostic test and/or ≥1 VL test, and not administratively lost to follow-up after 2 years | — | 16,110 |
| Upper | Confirmed HIV-positive diagnostic test (nominal or non-nominal) and/or ≥1 VL test, and not administratively lost to follow-up after 3 years | — | 17,423 |
| In care | |||
| Main | ≥ 1 VL test in given year | Diagnosed PLWH (Main) | 87.3% |
| Lower | ≥ 1 VL test in given year | Diagnosed PLWH (Upper) | 80.7% |
| On ART a | |||
| Main | Documented on ART, or ART status not documented and suppressed, on last VL test in a given year | Diagnosed PLWH (Main) | 81.1% |
| Upper | Documented on ART, or ART status not documented and suppressed, on any VL test in a given year | Diagnosed PLWH (Main) | 82.0% |
| Lower | Documented on ART, or ART status not documented and suppressed, on all VL tests in a given year | Diagnosed PLWH (Upper) | 69.9% |
| Virally suppressed a | |||
| Main | VL <200 copies/mL on last VL test in a given year | Diagnosed PLWH (Main) | 79.5% |
| Upper | VL <200 copies/mL on any VL test in a given year | Diagnosed PLWH (Main) | 80.8% |
| Lower | VL <200 copies/mL on all VL tests in a given year | Diagnosed PLWH (Upper) | 67.4% |
| Virally suppressed (among those on ART) | |||
| Main | VL <200 copies/mL, and known on ART or ART status not documented, on last VL test in a given year | Documented on ART on last VL, or ART status not documented, on last VL test in a given year | 94.4% |
| Upper | VL <200 copies/mL, and known on ART or ART status not documented, on any VL test in a given year | Documented on ART, or ART status not documented, on any VL test in a given year | 95.1% |
| Lower | VL <200 copies/mL, and known on ART or ART status not documented, on all VL tests in a given year | Documented on ART, or ART status not documented, on all VL tests in a given year | 90.9% |
| Newly diagnosed | |||
| Main | Confirmed nominal HIV-positive diagnostic test and no evidence of diagnosis prior to nominal HIV-positive diagnostic test | — | 473 (2014 estimate) |
| Time to linkage to care | |||
| Main | First VL test ≤ 3 months after diagnosis | Newly diagnosed (Main) | 81.8% (2014 estimate) |
| Time to suppression | |||
| Main | First suppressed VL (<200 copies/ml) ≤ 6 months after diagnosis | Newly diagnosed (Main) | 41.6% (2014 estimate) |
ART status documented by providers on VL test requisitions and missing from 17–20% of requisitions each year. Assumptions for requisitions with missing ART data differ by indicator. Bold text highlights differences between main and upper/lower definitions. 2015 estimates not shown for newly diagnosed indicators to avoid truncation bias.
a Conditional estimates were also calculated for these indicators using the number ‘in care’ in the denominator. VL = viral load. ART = antiretroviral treatment. PLWH = people living with HIV.