On a population level, trends in viral load (VL) and CD4 cell counts can provide a marker of infectivity and an indirect measure of retention in care. Thus, observing the trend of CD4/VL over time can provide useful information on disparities in populations across the HIV care continuum when stratified by demography. South Carolina (SC) maintains electronic records of all CD4 cell counts and HIV VL measurements reported to the state health department. We examined temporal trends in individual HIV VLs reported in SC between January 1, 2005 and December 31, 2012 by using mixed effects models adjusting for gender, race/ethnicity, age, baseline CD4 count, HIV risk category, and residence. Overall VL levels gradually decreased over the observation period. There were significant differences in the VL decline by gender, age groups, rural/urban residence, and HIV risk exposure group. There were significant differences in CD4 increases by race/ethnicity, age groups, and HIV risk exposure group. However, the population VL declines were slower among individuals aged 13-19 years compared to older age groups ( p < 0.0001), among men compared to women ( p = 0.002), and among people living with HIV/AIDS (PLWHA) with CD4 count £ 200 cell/mm 3 compared to those with higher CD4 counts ( p < 0.0001). Significant disparities were observed in VL decline by gender, age, and CD4 counts among PLWHA in SC. Population based data such as these can help streamline and better target local resources to facilitate retention in care and adherence to medications among PLWHA.

The reasons behind differences in proportions of rural and urban residents who were diagnosed as having AIDS or progressed to AIDS despite similar initial CD4(+) T-cell counts and VL suppression at 1 year are unclear and should be explored in future studies. Future prevention and treatment efforts may need to consider the unique characteristics of rural populations in the South.

This study examined the intensity of home health services, as defined by the number of visits and service delivery by rehabilitation specialists, among Medicare beneficiaries with stroke. A cross-sectional secondary data analysis was conducted using 2009 home health claims data obtained from the Centers for Medicare and Medicaid Services' Research Data Assistance Center. There were no significant rural-urban differences in the number of home health visits. Rural beneficiaries were significantly less likely than urban beneficiaries to receive services from rehabilitation specialists. Current home health payment reform recommendations may have unintended consequences for rural home health beneficiaries who need therapy services.

Community viral load is an aggregate measure of HIV viral load in a particular geographic location, community, or subgroup. Community viral load provides a measure of disease burden in a community and community transmission risk. This study aims to examine community viral load trend in South Carolina and identify differences in community viral load trends between selected population subgroups using a state-wide surveillance dataset that maintains electronic records of all HIV viral load measurements reported to the state health department. Community viral load trends were examined using random mixed effects models, adjusting for age, race, gender, residence, CD4 counts, HIV risk group, and initial antiretroviral regimen during the study period, and time. The community viral load gradually decreased from 2004 to 2013 ( p < 0.0001). The number of new infections also decreased ( p = 0.0001) over time. A faster rate of decrease was seen among men compared to women ( p < 0.0001), men who have sex with men ( p = 0.0001) compared to heterosexuals, patients diagnosed in urban areas compared to that in rural areas ( p = 0.0004), and patients prescribed single-tablet regimen compared to multiple-tablet regimen ( p < 0.0001). While the state-wide community viral load decreased over time, the decline was not uniform among residence at diagnosis, HIV risk group, and single-tablet regimen versus multiple-tablet regimen subgroups. Slower declines in community viral load among females, those in rural areas, and heterosexuals suggest possible disparities in care that require further exploration. The association between using single-tablet regimen and faster community viral load decline is noteworthy.

Section 1 Diagnoses of HIV Infection and Diagnoses of Infection Classified as Stage 3 (AIDS) 1a Diagnoses of HIV infection, by year of diagnosis and selected characteristics, 2008-2012-United States 1b Diagnoses of HIV infection, by year of diagnosis and selected characteristics, 2008-2012-United States and 6 dependent areas 2a Stage 3 (AIDS), by year of diagnosis and selected characteristics, 2008-2012 and cumulative-United States 2b Stage 3 (AIDS), by year of diagnosis and selected characteristics, 2008-2012 and cumulative-United States and 6 dependent areas 3a Diagnoses of HIV infection, by race/ethnicity and selected characteristics, 2012-United States 3b Diagnoses of HIV infection, by race/ethnicity and selected characteristics, 2012-United States and 6 dependent areas 4a Stage 3 (AIDS), by race/ethnicity and selected characteristics, 2012-United States 4b Stage 3 (AIDS), by race/ethnicity and selected characteristics, 2012-United States and 6 dependent areas 5a Diagnoses of HIV infection among children aged <13 years, by race/ethnicity, 2008-2012-United States 5b Diagnoses of HIV infection among children aged <13 years, by race/ethnicity, 2008-2012-United States and 6 dependent areas 6a Stage 3 (AIDS) among children aged <13 years, by race/ethnicity, 2008-2012 and cumulative-United States 6b Stage 3 (AIDS) among children aged <13 years, by race/ethnicity, 2008-2012 and cumulative-United States and 6 dependent areas 7 Stage 3 (AIDS) among children aged <13 years, by year of diagnosis, 1992-2012-United States and 6 dependent areas 8 Diagnoses of HIV infection among adult and adolescent Hispanics/Latinos, by transmission category and place of birth, 2012-United States and 6 dependent areas 9 Stage 3 (AIDS) among adult and adolescent Hispanics/Latinos, by transmission category and place of birth, 2012-United States and 6 dependent areas Section 2 Deaths and Survival after a Diagnosis of HIV Infection or Stage 3 (AIDS) Classification 10a Deaths of persons with diagnosed HIV infection, by year of death and selected characteristics, 2008-2011-United States 10b Deaths of persons with diagnosed HIV infection, by year of death and selected characteristics, 2008-2011-United States and 6 dependent areas 11a Deaths of persons with diagnosed HIV infection ever classified as stage 3 (AIDS), by year of death and selected characteristics, 2008-2011 and cumulative-United States 11b Deaths of persons with diagnosed HIV infection ever classified as stage 3 (AIDS), by year of death and selected characteristics, 2008-2011 and cumulative-United States and 6 dependent areas  4 12a Survival for more than 12, 24, and 36 months after a diagnosis of HIV infection during 2003-2008, by selected characteristics-United States 12b Survival for more than 12, 24, and 36 months after a diagnosis of HIV infection during 2003-2008, by selected characteristics-United States and 6 dependent areas 13a Survival for more than 12, 24, and 36 months after a stage 3 (AIDS) classification during 2003-2008, by selected characteristics-United States 13b ...