WHAT IS THE HIV CARE CONTINUUM?
Antiretroviral therapy (ART; see Fact Sheet 403) can reduce the risk of serious illness, death or transmission of HIV. ART is now recommended for all people living with HIV (PLHIV) in a strategy called “treatment as prevention” (TasP).
Yet, only half of people living with HIV (PLHIV) around the world are aware of their status. Among those who know their HIV status, many do not receive ART in a timely manner, fail to stay engaged in care, or do not achieve sustained viral suppression.
The HIV care continuum is a way of describing the steps in the care and treatment of PLHIV and include:
• Diagnosis (HIV testing; fact sheet 102)
• Getting into medical care
• Staying in medical care
• Prescription of ART
• Achieving viral suppression (undetectable viral load; see Fact Sheet 125)
The care continuum can help communities and health programs understand how well PLHIV receive care and treatment, improve health and prevent new infections.
WHAT ARE THE IAPAC GUIDELINES?
The International Association of Providers of AIDS Care (IAPAC), through a multidisciplinary panel of international advisors, developed the first comprehensive, evidence-based guidelines for optimizing the HIV care continuum, with an aim to increase HIV testing coverage, linkage to care, treatment coverage, engagement and retention in care, and viral suppression for adults and adolescents (see Fact Sheet 110).
The panel reviewed the scientific literature on the HIV care continuum and made recommendations for interventions on:
• Optimizing the HIV care environment (Fact Sheet 111)
• Increasing HIV testing coverage and linkage to care (Fact Sheet 112)
• Increasing HIV treatment coverage (Fact Sheet 113)
• Increasing retention in care, ART adherence, and viral suppression (Fact Sheet 114)
• Adolescents (Fact Sheet 115)
• Metrics for and monitoring of the HIV care continuum (Fact Sheet 116)
The recommendations are graded by strength and quality of the body of evidence as follows: Strong (A); Moderate (B); Optional (C); Excellent (I); High (II); Medium (III); Low (IV).
RECOMMENDATIONS FOR INCREASING HIV TESTING COVERAGE AND LINKAGE TO CARE:
1. Routinely offering opt-out HIV testing to all individuals who present at health facilities is recommended. (A I)
2. Community-based HIV testing is recommended to reach those who are less likely to attend facility-based HIV testing. (A I)
3. Confidential, voluntary HIV testing in large workplace and institutional settings (military, police, mining/trucking companies, and educational venues) should be considered. (B III)
4. HIV self-testing is recommended with the provision of guidance about the proper method for administering the test and direction on what to do once the results have been obtained. (B II)
5. Use of epidemiological data and network analyses to identify individuals at risk of HIV infection for HIV testing is recommended. (B II)
6. The offer of HIV testing to partners of newly diagnosed individuals is recommended. (A I)
7. Immediate referral to HIV care is recommended following an HIV-positive diagnosis to improve linkage to ART. (A I)
8. For high-risk individuals who test HIV negative, offering PrEP (Fact Sheet 160) is recommended in addition to the provision of free condoms, education about risk reduction strategies, PEP (Fact Sheet 156), and voluntary medical male circumcision. (A I)
9. Use of case managers and patient navigators to increase linkage to care is recommended. (B II)
WHAT’S THE BOTTOM LINE?
The HIV care continuum describes how many people living with HIV know their status, engage in medical care, receive ART and achieve undetectable HIV viral loads.
The IAPAC guidelines are evidence-based recommendations to improve the care environment for PLHIV. The guidelines recommend routine opt-out HIV testing at health care facilities, the guidelines also recommend PrEP and PEP as part of comprehensive HIV prevention for those who test HIV-negative.
FOR MORE INFORMATION:
Full text of the IAPAC guidelines is available at http://www.iapac.org/uploads/JIAPAC-IAPAC-Guidelines-for-Optimizing-the-HIV-Care-Continuum-Supplement-Nov-Dec-2015.pdf
Revised January 2, 2016