{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T22:03:29Z","timestamp":1783980209306,"version":"3.55.0"},"reference-count":22,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2023,4,1]],"date-time":"2023-04-01T00:00:00Z","timestamp":1680307200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Public Health Research"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>People living with HIV (PLWH) who have not achieved or maintained viral suppression post-diagnosis likely face multiple barriers to HIV care. To identify these barriers a universally accepted definition of viral suppression is needed. The most common definition, the Center for Disease Control and Prevention (CDC) definition, contains simplifying assumptions that may misclassify individuals and attenuate associations. In this study, we evaluated alternative definitions of viral suppression on their ability to identify barriers to care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and methods:<\/jats:title>\n                    <jats:p>We used HIV surveillance data to classify participants of the 2015\u20132019 Washington Medical Monitoring Project (MMP) as virally suppressed or not using the CDC definition and two definitions that assess viral suppression over a longer period (\u201cEnriched\u201d and \u201cDurable\u201d). We identified barriers to suppression from literature (unstable housing, illicit drug use, poor mental health, heavy drinking, recent incarceration, racism, and poverty) and measured them using interview questions from MMP. We compared the rate ratios (RR) of being not virally suppressed using each definition for each barrier.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>There were 858 PLWH in our study. All viral suppression definitions classified a similar proportion of people as suppressed (85%\u201389%). The durable viral suppression definition consistently yielded the largest rate ratios (e.g. unstable housing: CDC RR\u2009=\u20091.3, 95% CI 0.9\u20131.8; Enriched 1.5, 95% CI 1.0\u20132.2; Durable 2.2, 95% CI 1.6\u20133.1) and reclassified 10% of the population relative to the CDC definition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Longitudinal definitions for viral suppression may yield less misclassification and serve as superior tools for identifying and curtailing barriers to HIV care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/22799036231182031","type":"journal-article","created":{"date-parts":[[2023,6,15]],"date-time":"2023-06-15T08:07:06Z","timestamp":1686816426000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Evaluating surveillance definitions of HIV viral suppression 2015\u20132019: Which definition best detected barriers to care?"],"prefix":"10.1177","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5477-9660","authenticated-orcid":false,"given":"Steven","family":"Erly","sequence":"first","affiliation":[{"name":"Washington State Department of Health, Division of Disease Control and Health Statistics, Olympia, WA, USA"},{"name":"Department of Epidemiology, University of Washington, Olympia, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leticia","family":"Campos","sequence":"additional","affiliation":[{"name":"Washington State Department of Health, Division of Disease Control and Health Statistics, Olympia, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Buskin","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Washington, Olympia, WA, USA"},{"name":"Public Health \u2013 Seattle & King County, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Reuer","sequence":"additional","affiliation":[{"name":"Washington State Department of Health, Division of Disease Control and Health Statistics, Olympia, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,6,15]]},"reference":[{"key":"bibr1-22799036231182031","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0029679"},{"key":"bibr2-22799036231182031","unstructured":"Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data\u2014United States and 6 dependent areas, 2019. HIV Surveill Suppl Rep 2021; 24(2): http:\/\/www.cdc.gov\/hiv\/library\/reports\/hiv-surveillance.html; 58."},{"key":"bibr3-22799036231182031","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(20)30105-3"},{"key":"bibr4-22799036231182031","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-020-10088-7"},{"issue":"1","key":"bibr5-22799036231182031","first-page":"5122","volume":"22","author":"Zhang J","year":"2022","journal-title":"BMC Infect Dis"},{"key":"bibr6-22799036231182031","unstructured":"Koepsell TD, Weiss NS. Epidemiologic methods: studying the occurrence of illness. 2nd ed. New York: Oxford University Press, 2014, p.472."},{"key":"bibr7-22799036231182031","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw418"},{"key":"bibr8-22799036231182031","unstructured":"Centers for Disease Control and Prevention. Medical Monitoring Project (MMP) [Internet], https:\/\/www.cdc.gov\/hiv\/statistics\/systems\/mmp\/index.html (2020, accessed 17 August 2020)."},{"key":"bibr9-22799036231182031","unstructured":"Centers for Disease Control. Medical monitoring project protocol 2018-2020 [Internet]. Atlanta, GA: Centers for Disease Control, 2018, pp.7\u20138,\u2009Report No.: 1.0. https:\/\/www.cdc.gov\/hiv\/pdf\/statistics\/systems\/mmp\/cdc-hiv-mmp-protocol-2018-2020.pdf (accessed 17 August 2020)"},{"key":"bibr10-22799036231182031","unstructured":"HIV Reporting. Washington State Department of Health. doh.wa.gov\/public-health-healthcare-providers\/notifiable-conditions\/hivaids (2022, accessed 7 June 2022)."},{"key":"bibr11-22799036231182031","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0141912"},{"key":"bibr12-22799036231182031","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-016-1585-5"},{"key":"bibr13-22799036231182031","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000002227"},{"key":"bibr14-22799036231182031","doi-asserted-by":"publisher","DOI":"10.1007\/s11904-015-0285-5"},{"key":"bibr15-22799036231182031","unstructured":"Washington State Department of Health. Washington State HIV Surveilance Report 2020 Edition [Internet], https:\/\/www.doh.wa.gov\/Portals\/1\/Documents\/Pubs\/150-030-WAHIVSurveillanceReport2019.pdf (November 2019, accessed 1 June 2020)."},{"key":"bibr16-22799036231182031","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2017.0125"},{"issue":"41","key":"bibr17-22799036231182031","first-page":"963","volume":"53","author":"Centers for Disease Control and Prevention (CDC)","year":"2004","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"bibr18-22799036231182031","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000000166"},{"key":"bibr19-22799036231182031","unstructured":"SAS. Cary, NC: SAS Institute Inc; 2013."},{"key":"bibr20-22799036231182031","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000000072"},{"key":"bibr21-22799036231182031","doi-asserted-by":"publisher","DOI":"10.1186\/s13722-017-0090-0"},{"key":"bibr22-22799036231182031","doi-asserted-by":"publisher","DOI":"10.1177\/003335490712200312"}],"container-title":["Journal of Public Health Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/22799036231182031","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/22799036231182031","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/22799036231182031","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T23:49:28Z","timestamp":1777592968000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/22799036231182031"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4]]},"references-count":22,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,4]]}},"alternative-id":["10.1177\/22799036231182031"],"URL":"https:\/\/doi.org\/10.1177\/22799036231182031","relation":{},"ISSN":["2279-9036","2279-9036"],"issn-type":[{"value":"2279-9036","type":"print"},{"value":"2279-9036","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4]]},"article-number":"22799036231182031"}}