The Care Continuum Tool is a public health model designed to illustrate the sequential stages individuals progress through from initial diagnosis to achieving sustained health outcomes through consistent care and treatment. This framework is particularly crucial in managing chronic conditions, where ongoing engagement with healthcare services is essential for well-being. A prime example of the care continuum tool in action is its application to HIV management. In the context of HIV, the care continuum outlines the critical steps individuals with HIV undertake, starting from diagnosis and culminating in viral suppression – a state where the virus is significantly reduced or undetectable in the bloodstream through consistent adherence to antiretroviral therapy (ART).
These key stages within the HIV care continuum tool are:
- HIV diagnosis
- Linkage to dedicated HIV medical care
- Engagement in ongoing HIV medical care
- Consistent retention in medical care programs
- Achieving and maintaining viral suppression
Viral suppression, a cornerstone of effective HIV management, is defined by maintaining a viral load of fewer than 200 copies of HIV per milliliter of blood through the consistent use of HIV medication. Advanced HIV medicines can even reduce the viral load to undetectable levels, meaning it doesn’t appear in standard laboratory tests. This undetectable status is a major goal of HIV treatment. Medical experts recommend HIV treatment for all individuals diagnosed with HIV, irrespective of the duration of infection or their current health status.
The Importance of the Care Continuum Tool in Healthcare
The care continuum tool is invaluable because it serves as both an individual assessment tool and a population health framework. On an individual level, it allows healthcare providers to track a patient’s progress through each stage of care, identifying areas where support may be needed. At a population level, it provides a framework to analyze the proportion of individuals within a community who are engaged at each successive step of care. This broader view is essential for policymakers and healthcare service providers to pinpoint systemic gaps in service delivery and to strategically develop interventions that better support individuals in achieving optimal health outcomes, such as viral suppression in the case of HIV.
Facilitating movement through each stage of the care continuum tool, ultimately leading to sustained viral suppression or an undetectable viral load, is of paramount importance. Extensive research has demonstrated that individuals with HIV who achieve and maintain an undetectable viral load not only live longer, healthier lives but also eliminate the risk of sexually transmitting HIV to their HIV-negative partners. This groundbreaking concept is often referred to as “Undetectable = Untransmittable” or U=U, highlighting the transformative impact of effective HIV management.
For individuals with HIV to reap these significant health benefits and prevent transmission, awareness of their HIV status is the first crucial step. Following diagnosis, connecting with and actively engaging in regular HIV care, alongside consistent adherence to prescribed HIV medication, are essential. However, various barriers can impede engagement in HIV care and treatment, significantly diminishing the effectiveness of public health efforts aimed at improving health outcomes for those living with HIV and reducing new HIV transmissions.
Identifying where these engagement gaps are most prevalent and for which specific populations is crucial for informing targeted interventions. This knowledge is vital to strategically direct resources and efforts to break the cycle of HIV transmission and improve health outcomes for individuals living with HIV.
Insights from the HIV Care Continuum Tool
CDC, Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2019. HIV Surveillance Supplemental Report 2021; 26(No. 2). Published May 2021.
Prevalence-based continuum. This HIV care continuum chart illustrates data based on the prevalence of HIV in the U.S. in 2019, reflecting the latest available prevalence-based HIV care continuum data from the CDC, published in May 2021. Prevalence data is crucial for resource allocation and planning, capturing both diagnosed and undiagnosed individuals needing HIV services.
Data derived from the care continuum tool provides critical insights into the state of HIV care. According to the CDC, approximately 1.2 million people aged 13 and older were living with HIV in the United States at the close of 2019. Analysis using the care continuum tool revealed the following:
- Diagnosis: An estimated 87% had received an HIV diagnosis. This means a significant 13% of individuals with HIV, roughly 1 in 7, were unaware of their status and, consequently, not accessing necessary care and treatment.
- Receipt of Care: Around 66% had engaged in HIV medical care, defined by the CDC as having at least one CD4 count or viral load test conducted by a healthcare professional within the year. Initiating ART is a crucial step following entry into medical care, recommended for all diagnosed individuals to maintain health and prevent transmission. Guidelines recommend initiating ART for all people with diagnosed HIV.
- Retention in Care: Approximately 50% were retained in care. Retention is measured as having two or more CD4 or viral load tests at least three months apart. Consistent, scheduled medical care is linked to improved health outcomes and increased safer sexual practices.
- Viral Suppression: An estimated 57% had achieved viral suppression, defined as a viral load test result of <200 copies/mL of blood.
- Linkage to Care: Among those newly diagnosed with HIV in 2019, 81% were linked to care within one month. This is measured by documented CD4 or viral load tests within 30 days of diagnosis. Rapid linkage is crucial for reducing time to viral suppression, benefiting individual health and preventing transmission.
Diagnosis-Based Perspective: The care continuum tool can also be analyzed from a diagnosis-based perspective. For instance, CDC data from 2020 focusing on individuals with diagnosed HIV showed that 74% received medical care, 51% were retained in care, and 65% achieved viral suppression. Among new diagnoses in 2020, 82% were linked to care within a month. (It’s important to note that 2020 data may be affected by COVID-19 disruptions.) (Further details on the diagnosis-based approach are available from the CDC.)
Utilizing the Care Continuum Tool for Progress
Health departments at federal, state, and local levels, alongside community organizations, healthcare providers, and individuals living with HIV, actively utilize the care continuum tool. It serves as a metric to gauge progress towards HIV-related goals and to pinpoint service gaps hindering individuals from accessing sustained, high-quality care and treatment. By identifying critical drop-off points and affected populations, policymakers, public health officials, and healthcare providers can strategically implement system-level improvements. These enhancements aim to support all individuals with HIV in successfully navigating the continuum, achieving, and maintaining viral suppression, ultimately leading to improved health outcomes and reduced transmission rates.
Explore Further
To gain a deeper understanding of the care continuum tool in the U.S., including definitions and measurement methodologies, refer to the resources provided by the CDC and other public health organizations.
