HIV Care Continuum

According to HIV.gov, The 2016 National HIV/AIDS Strategy "is a five-year plan that details principles, priorities, and actions to guide our collective national response to the HIV epidemic." The goals are to:

1. Reduce new infections
2. Increase access to care and improve health outcomes for people living with HIV
3. Reduce HIV-related health disparities and health inequities
4. Achieve a more coordinated national response to the HIV epidemic

The Centers for Disease Control and Prevention (CDC) uses its surveillance data to track indicators for the first three goals. State and local health departments submit data on six indicators of the HIV epidemic, and CDC analyzes them to create a national picture. The six indicators track the number of people who are:

• tested for HIV
• diagnosed with HIV
• connected to care
• retained in care
• taking antiretroviral therapy
• virally suppressed

Together these numbers are summarized into four stages of HIV care known as the HIV Care Continuum. Sometimes the HIV Care Continuum is referred to as the Treatment Cascade. When Gardner et. al first measured these numbers and represented them graphically, the graph cascaded down from diagnoses to viral suppression. It identified that more people need to be in HIV medical care to stop the drop-off in achieving viral suppression gaps.

A November 2014 Vital Signs report published by the CDC discusses the following stages of the continuum:

• HIV testing and diagnosis: The HIV Care Continuum begins with a diagnosis of HIV infection. The only way to know for sure that someone is HIV-positive is to get an HIV test. People who don't know they are infected are not accessing the care and treatment they need to stay healthy. They can also unknowingly pass the virus on to others. CDC recommends that all adolescents be tested for HIV infection at least once, and that persons at increased risk for HIV infection be tested at least annually.
• Getting and staying in medical care: For youth that test HIV positive, it is important to get them connected to an HIV health care provider who can offer treatment and prevention counseling to help them stay as healthy as possible and prevent passing HIV on to others. Because there is no cure for HIV at this time, treatment is a lifelong process. To stay healthy, youth living with HIV need to receive regular HIV medical care.
• Getting on antiretroviral therapy (ART): Antiretrovirals are drugs that are used to prevent a retrovirus, such as HIV, from making more copies of itself. ART is the recommended treatment for HIV infection. Treatment with ART can help people with HIV live longer, healthier lives, and has been shown to reduce sexual transmission of HIV by 96 percent.
• Achieving viral suppression: By taking ART regularly, youth living with HIV can achieve viral suppression, meaning a very low level of HIV in the blood. However, it is not a cure, and there is still some HIV in the body. But lowering the amount of virus in the body with medicines can help people stay healthy, live longer, and greatly reduce the chance of passing HIV on to others.

The HIV Care Continuum data for youth shows that youth living with HIV, especially young Black men who have sex with men, are falling out of care and not maintaining viral suppression. Among youth living with HIV, only 40% are getting connected to care. Even fewer are being retained in care, starting ART, and achieving viral suppression. To add to that, over half of young people ages 13-24 living with HIV do not know they are infected.