Abstract
The HIV care continuum is a framework that models the dynamic stages of HIV care. The continuum consists of five main steps, which, at the population level, are depicted cross-sectionally as the HIV treatment cascade. These steps include diagnosis, linkage to care (LTC), retention in care (RiC), adherence to antiretroviral therapy (ART), and viral suppression. Although the HIV treatment cascade is represented as a linear, unidirectional framework, persons living with HIV (PLWH) often experience the care continuum in a less streamlined fashion, skip steps altogether, or even exit the continuum for a period of time and regress to an earlier stage. The proportion of PLWH decreases at each successive step of the cascade, beginning with an estimated 86% who are diagnosed and dropping dramatically to approximately 30% of PLWH who are virally suppressed in the United States (US). In this current issues review, we describe each step in the cascade, discuss targeted interventions that address weak points in the continuum, review domestic and international policies that help shape and direct HIV care strategies, and conclude with recommendations and future directions for HIV providers and policymakers. While we primarily examine issues related to domestic HIV care in the US, we also discuss international applications of the continuum in order to provide broader context.
Highlights
The human immunodeficiency virus (HIV) care continuum is an internationally-recognized framework, initially depicted in the United States (US) to represent HIV care as a progression from testing to engagement in medical care, antiretroviral therapy (ART) treatment, and, suppression of the virus [1,2,3,4]
The majority of persons living with HIV (PLWH) in the US do not have their disease adequately managed, and, every year, approximately 50,000 people are newly infected with HIV [11]. In this current issues review, we focus on successive steps of the HIV treatment cascade in which we provide summaries of each component, describe data monitoring strategies for accurately accounting for PLWH at each step, and discuss effective interventions specific to each phase
While the standard HIV care model places ART adherence after the retention stage, Hallett and Eaton suggest that a unidirectional model fails to represent other entry points into a “leaky” continuum, wherein PLWH are lost at each step [41]
Summary
The HIV care continuum is an internationally-recognized framework, initially depicted in the United States (US) to represent HIV care as a progression from testing to engagement in medical care, antiretroviral therapy (ART) treatment, and, suppression of the virus [1,2,3,4]. The Centers for Disease Control and Prevention (CDC) emphasize the importance of universal HIV testing at one end of the continuum and viral suppression at the other [1], researchers have drawn attention to the fact that steps in the middle of the continuum— linkage to care (LTC) and retention in care (RiC)—are vital in securing optimal health outcomes [3, 7, 8].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
