Assess social determinants as influential factors in HIV care continuum outcomes (late diagnosis, linkage to care, engagement/retention in care and viral suppression) among HIV-infected individuals in Trinidad and Tobago. Additionally, we will determine if there are differences by gender and mode of transmission (i.e. heterosexual, men who have sex with men (MSM)) and country of birth for continuum outcomes. (2) Cases (n>5000) will be analyzed among individuals, aged = 18, who met CDC HIV case definition for HIV. Late diagnosis will be defined as an AIDS diagnosis within 3 months of an HIV diagnosis; Engagement in care will be defined as one documented physician visit annually; Retention in care will be defined as engagement in care two or more times at least three months in one year; and, viral suppression will be defined as having a viral load of <200 copies/mL in the last laboratory test performed. Self-reported ART adherence will be measured with one of the three following indicators: percentage of patients with full adherence to ART percentage of ARV doses patients took during the recall period or percentage of patients with more than 95% adherence to ARV treatment (i.e., missed no more than 1 dose in 20, which for periods shorter than 3 days, is equivalent to full adherence). Chi square test will be used to evaluate differences by gender and mode of transmission. Multilevel logistic regression will be used to estimate adjusted odds ratios for each outcome.
