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Linkage to and Retention in HIV Medical Care

Improving the health of persons with HIV and reducing the number of new HIV infections in the United States will depend on increasing access to HIV medical care and eliminating disparities in the quality of care received. To advance these goals, clinicians and community-based HIV prevention providers can support persons diagnosed with HIV infection to fully engage in HIV medical care (Figure 1).

Figure 1. The continuum of engagement in HIV medical care

This is a text description of Figure 1, titled Continuum of engagement in HIV medical care.  This diagram consists of a shaded blue arrow that extends from a box on the left and points toward a box on the right. The box on the left is labeled Unaware of HIV status; not tested; or never received results.  The box on the right is labeled In long-term, continuous HIV medical care.  The body of the arrow has three labels that describe major steps that can take place once a person is aware that he or she is HIV infected: from left to right it reads linkage to care, retention in care, and re-engagement in care.  Labels above the arrow describe activities related to each step, while labels below the arrow describe the HIV care status of the person at each step.  Together, the arrow and labels graphically describe the continuum of engagement in HIV medical care from the point when an HIV-infected person is unaware of their HIV infection, is tested and notified of his or her infection, initiates HIV medical care, remains in care, has lapses in care, and re-engages in care.
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Source: Adapted from Health Resources and Services Administration, HIV/AIDS Bureau. Continuum of engagement in HIV care. Cheever LW. Engaging HIV-infected patients in care: their lives depend on it. Clin Infect Dis 2007;44(11):1500-02.

Currently, about 60% of persons with HIV have been tested and have had at least one HIV care visit. However, only about 50% of persons diagnosed with HIV receive regular HIV care. Of those retained in care, 89% are prescribed antiretroviral therapy and 77% achieve viral suppression (Figure 2).

Figure 2. Number and Percentage of HIV-infected Persons Engaged in Selected Stages of the Continuum of HIV care—United States

bar chart with data from above and below
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Thus, only about 28% of all persons with HIV in the United States have suppressed viral loads. Without a substantial increase in the proportion of persons with HIV who have suppressed viral load, about 1.2 million new HIV infections can be expected to occur in the United States over the next 20 years.15

The forthcoming recommendations will address many strategies that clinicians, community-based prevention providers, and health departments can use to support linkage to and retention in HIV medical care. Most forthcoming recommendations are consistent with recommendations from existing federal government guidance for these types of providers:

Linkage Clinicians and non-clinical HIV prevention providers who offer HIV testing, care, or prevention services

  • Educate persons at the time of their HIV diagnosis about the benefits of HIV medical care for improving personal health and preventing HIV transmission.16-22
  • Establish the infrastructure and services to assist persons with HIV to
    • start HIV medical care shortly after a positive HIV test result,
    • support long-term retention in HIV medical care, and
    • re-engage into HIV medical care persons if they have dropped out of care.2-8
  • Offer services that promote linkage to and retention in care through collaborations among HIV testing providers, community-based HIV prevention providers, HIV care providers, case managers, and health departments.16-19,22,23

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