Treatment Cascade

Links to Other Initiatives and Plans

Houston Area Comprehensive
HIV Prevention and Care Services Plan
for 2012 through 2014

Capturing the community’s vision for an ideal system of HIV prevention and care for the Houston Area

TREATMENT CASCADE

What is the Treatment Cascade?

In July 2012, the Centers for Disease Control and Prevention (CDC) released an analysis of the number and percentage of people in the United States at each stage of the HIV care continuum. The continuum represents the sequential stages of HIV care, from being diagnosed with HIV to suppressing the HIV virus through treatment. Viral suppression, the last stage of the continuum, keeps HIV at a level that helps individuals stay healthy and reduces the risk of transmitting the virus to others.

Today, this analysis is commonly referred to as the HIV Treatment Cascade or the HIV Care Continuum, and it is used to measure the extent to which communities are achieving national goals related to HIV awareness, linkage to medical care, and viral load suppression.

The most current national Treatment Cascade was released in July 2013 as part of a new White House initiative.

The Houston EMA Treatment Cascade

Applying the Treatment Cascade model to the Houston EMA, areas of success and continued challenge become clear.

Currently, 82% of HIV-infected people in the Houston EMA are aware of their infection, and, of those aware, 73% were in HIV medical care in the past year, and 51% were retained in HIV care within that year. In addition, 46% status aware PLWHA in the EMA have a suppressed viral load.
Compared to the national cascade, the proportion of persons aware of their infection in the Houston EMA is the same as nationwide, but all other stages of the cascade are higher in the Houston EMA than for the nation as a whole.

OVERALL EMA: Number and Percentage of People with HIV in Selected Stages
of the Continuum of HIV Care, 2012
(Version 2, as of 12-17-13)

Click here for the methodology used to develop the Houston EMA Treatment Cascade.

The Houston EMA Treatment Cascade, by Race/Ethnicity

When Treatment Cascades are created for each major racial/ethnic group in the Houston EMA, differences can be observed. For example:

Whites have higher levels of engagement in every stage of the cascade than the EMA as a whole. They also have higher percentages of those in HIV care in the past year and those with viral load suppression than other racial/ethnic groups.
African Americans have lower percentages of people in HIV care, retained in HIV care, and with viral load suppression than the EMA as a whole. When compared to other racial/ethnic groups in the EMA, they also have the lowest proportions of retention in HIV care and viral load suppression (in fact, the lowest of all racial/ethnic, age, or risk groups).
Hispanics have the lowest percentage of those in HIV care in the past year in the EMA (in fact, the lowest of all racial/ethnic, age, or risk groups). However, they have the highest proportion of those retained in HIV care, and their viral load suppression is higher than the EMA as a whole.

National Treatment Cascades by race/ethnicity are also available. Click here.

By Race/Ethnicity: Percent of People with HIV in Selected Stages
of the Continuum of HIV Care, 2012
(Version 2, as of 12-17-13)

Click here for the methodology used to develop the Houston EMA Treatment Cascade.

The Houston EMA Treatment Cascade, by Age

When Treatment Cascades are created by age in the Houston EMA, additional differences can be observed. For example:

The percentage of those in HIV care in the past year is the highest for middle age adults (35 to 49). However, retention in HIV care and viral load suppression are highest among the slightly older age group (age 50 to 64).
Being in HIV care in the past year and being retained in HIV care are both lowest among seniors (age 65+), while having a suppressed viral load is lowest among youth (age 13 to 24). Only African Americans have a lower proportion of viral suppression in the EMA.
In general, engagement in the care continuum in the EMA starts low among youth, peaks among middle age adults, and falls again among those who are 65+.

National Treatment Cascades by age are also available. Click here.

BY AGE: Percent of People with HIV in Selected Stages
of the Continuum of HIV Care, 2012
(Version 1, as of 12-17-13)

Click here for the methodology used to develop the Houston EMA Treatment Cascade.

The Houston EMA Treatment Cascade, by Risk Group

When Treatment Cascades are created by risk group in the Houston EMA, additional differences can be observed. For example:

In general, being in HIV medical care in the past year is comparable across the three major risk groups.
Of the three groups, MSM have the lowest percentage of those retained in HIV care within the year. Only African Americans have a lower proportion of retention in HIV care in the EMA.
Of the three groups, IDU have the lowest percentage of those with viral load suppression, which is comparable to youth PLWHA (age 13 to 24). Only African Americans have a lower proportion of viral suppression in the EMA

National Treatment Cascades by risk group are also available. Click here.

BY RISK GROUP: Percent of People with HIV in Selected Stages
of the Continuum of HIV Care, 2012

(Version 1, as of 12-17-13)

Click here for the methodology used to develop the Houston EMA Treatment Cascade.

Please visit this page again for additional analyses.

Questions about the Houston EMA Treatment Cascade can be directed to: Jen Hadayia, Health Planner in the Office of Support.