1. Continuum of HIV Care, Treatment, and Prevention
THE CONTINUUM OF CARE
MODULE 5
Continuum of HIV Care, Treatment, and Prevention

2. What is the Continuum of Care? (1)
The Continuum of Care (CoC) is:
A network that links, coordinates, and consolidates prevention, care, treatment, and support services for HIV-positive people.
These services are provided in their homes, communities, and at health facilities.
They are usually supported by a local coordinating body/committee that is responsible for facilitating referral linkages and planning.
Facilitator Notes: People living with HIV and their families have emotional, social, physical, and spiritual needs that change over time. They often must cope with the effects of stigma and discrimination, poverty, loss, neglect, and abandonment. The purpose of the continuum of care (CoC) is to address HIV as a chronic disease and develop systems that provide humane, effective, high-quality, comprehensive, and continuous care to HIV-positive people and their families.

3. What is Continuum of Care? (2)
The CoC is also:
The mutually reinforcing group of services that, together, provide comprehensive support to HIV-positive people and their families with the ultimate goals of:
Increased survival (decreased morbidity and mortality).
Epidemic control (community viral load suppression).

4. THE CONTINUUM OF CARE graphic

5. Continuum of Care Service Spots
Facilitator Notes: The circles represent the different services, clustered by location of delivery, that are included in many continuums of care. The arrows represent the referral network that links the services.
Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization (WHO) Key Elements in HIV/AIDS Care and Support. Geneva: UNAIDS and WHO.

6. Core Services of the CoC: Overall (1)
Are locally defined.
Include range of services related to:
Early HIV testing services.
Prompt linkage to care.
Immediate treatment initiation.
Customised support.
Ongoing combination prevention.

7. Core Services of the CoC: Overall (2)
Include community and clinic-based services networked across the continua of:
Holistic health and well-being
Mental, physical, spiritual, and social
HIV Treatment
ART ongoing clinical monitoring
End-of-life care
Multi-disciplinary care, bereavement support
Different level of service
Community, parish, specialised referral sites

8. Why Establish a CoC? Many reasons, including:
Enhancing the health and well-being of people living with HIV.
To support increased self management of HIV.
Better adherence to antiretroviral therapy (ART).
Reducing stigma and discrimination towards people living with HIV.
Reduced costs of service delivery coupled with improved outcomes.

9. Guiding Principles of a CoC
Needs-based and client-focused.
Rights-based orientation.
Meaningful involvement of people living with HIV.
Links a diverse set of services across different service delivery sites/providers.
Locally-defined design strategy.

10. How is a CoC Created? CoC planners build and sustain a CoC by:
Working with people living with HIV to design individualised CoC.
Linking people living with HIV to existing services.
Building on those services to create enhanced care that is centrally available.
Advocating for and creating other needed services that are not available or accessible to people living with HIV.

11. Putting a CoC in Place
Step-by-step guides exist for how to establish a CoC with key building blocks.
Involving people living with HIV includes:
Working with them to design a CoC.
Promoting them as leaders in managing CoC.
Building their capacity to provide services.
Empowering people living with HIV groups to influence, secure funds, and implement programmes.
Including them in CoC monitoring activities.
For further details, see “Building Block 4,” pages of Family Health International (FHI) Scaling Up the Continuum of Care for People Living with HIV in Asia and the Pacific: A Toolkit for Implementers. Bangkok: FHI.

12. Operational Tools to Build a CoC
Directory of services
Care plan matrix
Networking
Referral system

13. Core Services of the CoC (1)
Most CoCs include the following services:
Early HIV counselling and testing
ART and adherence counselling support
Routine clinical monitoring
Viral load, CD4, clinical exam
Opportunistic infection prevention and management
Tuberculosis detection, prevention, and treatment
Screening for sexually transmitted infections
Cervical cancer screening
Pregnancy testing

14. Core Services of the CoC (2)
CoC networks include most/all of the following services:
Nutritional and daily living screening and support
Psychosocial support:
Peer navigators/educators
Peer support groups
Family planning and reproductive health
Care, support, and protection for orphans and vulnerable children

15. Core Services of the CoC (3)
CoC networks include most/all of the following palliative care services:
Treatment of pain and other symptoms
Psychosocial and spiritual support
End-of-life care
Bereavement support

16. Core Services of the CoC (4)
CoC networks include most/all of the following preventive services:
HIV prevention health services for people living with HIV and discordant couples
Prevention-of-mother-to-child-transmission
Health and support services for HIV- positive mothers and infants
Post-exposure prophylaxis

17. Core Services of the CoC (5)
CoC networks include prevention services for those most at risk including:
Sex workers
Men having sex with men
Prisoners
Migrants
Adolescents and young adults
People who inject drugs

18. Resources
Family Health International Scaling up the Continuum of Care for People Living with HIV in Asia and the Pacific: A Toolkit for Implementers. Available at:
Fujita, M., K. Poudel, N.D. Thi, D.B. Duc, K. Nguyen, et. al “A new analytic framework of ‘continuum of prevention and care’ to maximize HIV case detection and retention in care in Vietnam.” BMC Health Services Research, 12:483. Available at: pdf.
Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization (WHO) Key Elements in HIV/AIDS Care and Support. Geneva: UNAIDS and WHO.