for Health Care Providers
HIV Care Continuum
The HIV care continuum is a model used by Federal, state, and local agencies to identify issues and opportunities related to improving the delivery of services to people living with HIV. The cascade of HIV care in the United States also has become a focus for interventions aimed at improving the success of HIV treatment (Mangal, Rimland, and Marconi, 2014).
Examining engagement at each stage of the HIV care continuum (Diagnosed, Linked to Care, Retained in Care, Prescribed ART, and Virally Suppressed) helps to identify potential gaps or areas for improvement with care.
In many ways, Veterans with HIV in VA care represent the future wave of the HIV epidemic in the United States. Compared with the overall HIV-infected population in the United States, Veterans with HIV in VA care are older, more likely to be members of minority groups, and more likely to have a history of substance use. Thus, it is not surprising that they are experiencing an increasing burden of medical and psychiatric comorbid disease. HIV infection has become a complex, chronic disease in which any given problem likely has multiple etiologies. Although this disease is substantially improved by antiretroviral treatment, there are many unaddressed barriers that interfere with initiation of treatment and retention in care. As individuals with HIV infection age, organ injury associated with HIV infection, aging-related comorbid illness, and substance use disorders likely will lead to even more mortality. It is of utmost importance to prioritize and coordinate screening and treatment for important comorbid conditions while maintaining excellence in the care of individuals infected with HIV.
Patient-Aligned Care Teams (PACTs) are an essential part of care in VA. PACTs include primary care providers, nurse/care managers, psychologists, mental health providers, social workers, and pharmacists. Focusing care on the whole person is a patient-driven, proactive approach to wellness, prevention, and health promotion.
Mangal JP, Rimland D, Marconi VC. The continuum of HIV care in a Veterans' Affairs Clinic. AIDS Res Hum Retroviruses. 2014 May;30(5):409-15.