Transcript Elements of the Care Continuum - International AIDS Society-USA

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
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National HIV/AIDS Strategy: 2020 Goals
Increase HIV serostatus
awareness to at least 90%
Increase linkage to care w/in
1 month of Dx to at least 85%
Ulett et al. AIDS Pt Care STDs 2009;23:41-49, Mugavero et al. Clin Infect Dis 2011;52(S2).
Increase
retention among
persons diagnosed
to at least 90%
Increase proportion of persons
diagnosed with viral suppression
to at least 80%
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~90% of HIV
Transmissions in
2009 in the US
Skarbinski et al. JAMA Intern Med 2015;175
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Measure
Missed visit
data?
Ease of calculating
Follow-up
time
Missed visit
Yes
Easy
~1 day
Appointment
adherence
Yes
Moderate
~1 yr
No-show rate
Yes
Moderate
~1 yr
Constancy:
Visit per 3, 4 or 6 mo
intervals
No
Moderate
~1 yr
Gaps
No
Easy
~1 yr
HRSA/HAB
No
Moderate-to-difficult
1 yr
DHHS
No
Moderate-to-difficult
2 yrs
Adapted from: Giordano TP (2012) Measuring retention in HIV care. www.medscape.com.
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Guidelines: Monitoring ART Adherence
Recommendation
Self-reported adherence
Strength/Quality
IIA
Pharmacy refill data (MPR)
IIB
NOT drug concentrations
IIIC
NOT pill counts
IIIC
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
• 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
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