HIV Care Continuum

The HIV care continuum is a public health model that outlines the steps or stages that people with HIV go through from diagnosis to achieving and maintaining viral suppression (a very low or undetectable amount of HIV in the body).

The steps are:

1. Diagnosis
2. Linked to medical care
3. Receipt of care
4. Retained in care
5. Achieve and maintain viral suppression

The HIV care continuum is useful both as an individual-level tool to assess care outcomes, as well as a population-level framework to analyze the proportion of people with HIV in a given community who are engaged in each successive step. This helps policymakers and service providers better pinpoint where gaps in services might exist and develop strategies to better support people with HIV to achieve the treatment goal of viral suppression.

Supporting people with HIV to move through the steps of the continuum to achieve and maintain viral suppression is critical. There are important health benefits to getting the viral load as low as possible:

• people living with HIV who get and keep an undetectable viral load can live long, healthy lives
• people with HIV who take HIV medicine daily as prescribed and get and keep an undetectable viral load have effectively no risk of transmitting HIV to their HIV-negative sexual partners

Individuals with HIV that receive these benefits, need to be aware that they have HIV, that they must remain connected to and engaged in regular HIV care, and receive and adhere to treatment with HIV medicine. However, there are obstacles that can contribute to poor engagement in HIV care and treatment, substantially limiting the effectiveness of efforts to improve health outcomes for those with HIV and reduce new HIV transmissions (HIV.gov 2021).

Health care providers play a crucial collaborative role in screening patients and helping them overcome barriers to adherence with their lifelong viral suppression regimens.

Some common barriers to treatment adherence include:

• Patient beliefs and behaviors, such as not taking their medications when they "feel well."
• Cognitive or organizational barriers, such as lack of logistic skills and comprehension level
• Treatment competence or the overall ability to adhere to a potentially complicated and long-term regimen
• Comorbid conditions – such as diabetes, dyslipidemia, hypertension, and viral hepatitis – may further complicate the treatment plan design and the ability of the patient to adhere to the plan
• Regimen-related barriers, including fear of treatment, fear of treatment-related side effects, and confusion about doses.
• Short-term side effects can occur when patients start or change ART regimens, such as nausea, fatigue, disturbed sleep, or dreaming.
• Psychosocial barriers, such as mental health issues (e.g., depression, perceived low quality of life), drug or alcohol abuse, negative attitudes or beliefs about HIV, and lack of social support.
• Structural barriers, such as lack of transportation, housing, childcare, or insurance covering ART and long-term HIV care (CDC HIV Treatment) .

Reference

CDC. HIV Treatment and Care. N.D. [Reviewed 8/2020]. Retrieved 4/24/2021. from https://www.cdc.gov/hiv/clinicians/treatment/treatment-clinicians.html

HIV.gov. HIV Care Continuum. [Updated 2/2021] Retrieved 4/24/2021 from https://www.hiv.gov/federal-response/policies-issues/hiv-aids-care-continuum