Elements of the Care Continuum

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GUIDELINES FOR IMPROVING ENTRY INTO AND RETENTION IN CARE AND ANTIRETROVIRAL ADHERENCE FOR PERSONS WITH HIV Developed by a Panel Convened by the International.

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Presentation transcript:

Elements of the Care Continuum Michael J. Mugavero, MD, MHSc Associate Professor of Medicine University of Alabama at Birmingham Birmingham, Alabama FORMATTED: 12/09/15 New Orleans, Louisiana: December 15-17, 2015

National HIV/AIDS Strategy: 2020 Goals Slide 10 of 38 Increase retention among persons diagnosed to at least 90% Increase HIV serostatus awareness to at least 90% Increase linkage to care w/in 1 month of Dx to at least 85% Increase proportion of persons diagnosed with viral suppression to at least 80% Ulett et al. AIDS Pt Care STDs 2009;23:41-49, Mugavero et al. Clin Infect Dis 2011;52(S2).

~90% of HIV Transmissions in 2009 in the US Slide 13 of 38 ~90% of HIV Transmissions in 2009 in the US Skarbinski et al. JAMA Intern Med 2015;175

Appointment adherence Moderate ~1 yr Slide 21 of 38 Measure Missed visit data? Ease of calculating Follow-up time Missed visit Yes Easy ~1 day Appointment adherence Moderate ~1 yr No-show rate Constancy: Visit per 3, 4 or 6 mo intervals No Gaps HRSA/HAB Moderate-to-difficult 1 yr DHHS 2 yrs Broadly speaking, retention measures can be classified as those including missed visits <advance for animation>, and those based solely upon arrived visits <advance for animation>, with noted variability in the ease of calculation and requisite follow-up time for capture of each measure. Adapted from: Giordano TP (2012) Measuring retention in HIV care. www.medscape.com. 4

Guidelines: Monitoring ART Adherence Slide 30 of 38 Guidelines: Monitoring ART Adherence Recommendation Strength/Quality Self-reported adherence IIA Pharmacy refill data (MPR) IIB NOT drug concentrations IIIC NOT pill counts NOT electronic devices (MEMS) IC Plasma HIV RNA (viral load) is the biological correlate of the adherence behavior, NOT a screening tool for adherence! Thompson MA et al. Ann Intern Med 2012;156

Take Home Points Slide 38 of 38 Engagement across the continuum of HIV care is dynamic and impacts individual & population health Systematic monitoring of engagement in care and ART adherence is foundational Prognostic value of missed visits Predictive value of self-reported NON-adherence Evidence-based interventions for engagement in care and ART adherence amenable to clinical settings Partnerships with public health and community agencies essential to improve continuum outcomes