HRSA’s HIV Care Continuum Efforts Bring Country One Step Closer to Achieving an AIDS-free Generation

The continuum of engagement in care (later changed to the HIV Care Continuum) was a phrase used by Dr. Laura Cheever, HRSA’s Associate Administrator for the HIV/AIDS Bureau, in her seminal 2007 editorial to describe the fluid nature of HIV health care delivery and patient experience.1 Today, that concept of engaging patients and moving them along the HIV Care Continuum to achieve and sustain viral load suppression has received unprecedented attention and led to a federal HIV Care Continuum Initiative,2 in which the Ryan White HIV/AIDS Program plays a critical role.

The HIV Care Continuum has given the country metrics through which to understand HIV care and treatment in the United States. Moreover, it has facilitated targeted interventions to populations in need and identified critical points where people living with HIV (PLWH) are most likely to fall out of care.

The Ryan White HIV/AIDS Program 2012 Services Report (RSR) client-level data (released in 2014) revealed that PLWH who receive care in HAB-funded clinics are better engaged, retained, and virally suppressed than national HIV Care Continuum estimates for the general population.3 For example, in 2012 approximately 75% of Ryan White HIV/AIDS Program clients were virally suppressed and 82% were retained in care. Retention in care was defined as having at least one outpatient/ambulatory medical care visit before September 1, 2012, and at least two visits within 90 or more days apart, and viral suppression was defined as having at least one outpatient/ambulatory medical care visit, and at least one viral load count, and a last viral load test of <200. Together, with advancements in treatment efficacy and prevention knowledge, the future of HIV and of the Ryan White HIV/AIDS Program have never been more promising.

With 60% of estimated people diagnosed with HIV in the country receiving at least one Ryan White HIV/AIDS Program service, HRSA’s HIV/AIDS Bureau has a critical role to play in advancing the HIV Care Continuum and working towards an AIDS-free generation. The tools with which to get there are in place and the Ryan White HIV/AIDS Program’s “Zero New Infections Framework,” provides the roadmap with which to do so.