HOUSTON EMA HIV CARE CONTINUUM


What is the Care Continuum?

The HIV Care Continuum, previously known as a Treatment Cascade, was first released in 2012 by the Centers for Disease Control and Prevention (CDC). It represents the sequential stages of HIV care, from being diagnosed with HIV to suppressing the HIV virus through treatment. Ideally, the Care Continuum describes a seamless system of HIV prevention and care services, in which people living with HIV (PLWH) receive the full benefit of HIV treatment by being diagnosed, linked to care, retained in care, and taking HIV medications as prescribed to achieve viral suppression.

The Houston EMA Care Continuum (HCC)

The HCC is a diagnosis-based continuum. The HCC reflects the number of PLWH who have been diagnosed ("HIV diagnosed"); and among the diagnosed, the numbers and proportions of PLWH with records of engagement in HIV care ("Met need"), retention in care ("Retained in care"), and viral suppression ("Virally suppressed") within a calendar year. Although retention in care is a significant factor for PLWH to achieve viral suppression, ‘Virally suppressed’ also includes those PLWH in the Houston EMA whose most recent viral load test of the calendar year was <200 copies/mL but who did not have evidence of retention in care.

Linking newly diagnosed individuals into HIV medical care as quickly as possible following initial diagnosis is an essential step to improved health outcomes. In the HCC, initial linkage to HIV medical care ("Linkage to care") is presented separately as the proportion of newly diagnosed PLWH in the Houston EMA who were successfully linked to medical care within three months or within one year after diagnosis

 

 

 

Figure 1: Houston EMA HIV Care Continuum, 2014-2016

Source: Bureau of Epidemiology and Bureau of HIV/STD and Viral Hepatitis Prevention, Houston Health Department, 2017

 

From 2014-2016, the total number of HIV diagnosed increased each year, but the percentage of those with met need, retained in care, and virally suppressed also increased.  The percentage of those retained in care remained constant

·       There was a 3% increase in the percentage of those virally suppressed from 2014 to 2016.

·       The percentage of newly diagnosed PLWH linked to care within one month of diagnosis increased by 3%, while the percentage of newly diagnosed PLWH not linked to care decreased by 3% from 2014 to 2016.

 

 

 

 

Disparities in Engagement among Key Populations

Multiple versions of the HCC have been created to illustrate engagement disparities and service gaps that key populations encounter in the Houston EMA.

It is important to note that available data used to construct each version of the Houston EMA HCC do not portray the need for activities to increase testing, linkage, retention, ART access, and viral suppression among many other at-risk key populations, such as those who are transgender or gender non-conforming, intersex, experiencing homelessness, or those recently released from incarceration

 

The Houston EMA Care Continuum, by Age

 

Figure 2: Houston EMA HIV Care Continuum by Age Groups, 2016

Source: Bureau of Epidemiology and Bureau of HIV/STD and Viral Hepatitis Prevention, Houston Health Department, 2017

 

·       Younger adults had lower percentages of retention and viral suppression compared to older adults.

·       Youth and young adults (13-24 years old) had the highest percentage of met need.

·       Youth to middle age adults (13-44 years old) had the lowest proportion of newly diagnosed PLWH who were linked within three months of diagnosis when compared to the older adult age groups.

 

The Houston EMA Care Continuum, by Sex at Birth

 

Figure 3: Houston EMA HIV Care Continuum by Sex at Birth, 2016

Source: Bureau of Epidemiology and Bureau of HIV/STD and Viral Hepatitis Prevention, Houston Health Department, 2017

·       Females living with HIV in the Houston EMA in 2016 had a higher proportion of individuals with met need and retention in care than males living with HIV, although females had a slightly smaller proportion of viral suppression.

·       The proportion of newly diagnosed female PLWH linked to care within the first month after diagnosis was 3% higher than males.

 

The Houston EMA Care Continuum, by Sex at Birth and Race/Ethnicity

Figure 4: Houston EMA HIV Care Continuum by Sex at Birth and Race/Ethnicity, 2016

Source: Bureau of Epidemiology and Bureau of HIV/STD and Viral Hepatitis Prevention, Houston Health Department, 2017

 

·       Hispanic and Black (non-Hispanic) males living with HIV had lower proportions of met need, retention in care, and viral suppression compared to White males in 2016.

·       Among females, White (non-Hispanic) PLWH had the lowest proportion of individuals with evidence of met need and retention in care while Black (non-Hispanic) PLWH had the lowest proportion of individuals with evidence of viral suppression in 2016.

·       Among those newly diagnosed with HIV,  White (non-Hispanic) males and females had the highest proportion linked to care within 1 month of diagnosis

·       Overall, Black (non-Hispanic) males living with HIV had the lowest proportion of individuals in each care continuum stage across all birth sex and race/ethnicity groups.

 

The Houston EMA Care Continuum, by Transmission Risk Factor*

Figure 5: Houston EMA HIV Care Continuum by Transmission Risk Factor, 2016

Source: Bureau of Epidemiology and Bureau of HIV/STD and Viral Hepatitis Prevention, Houston Health Department, 2017

*Transmission risk factors that are associated with increased risk of HIV exposure and transmission include men who have sex with men (MSM), injection drug use (IDU), MSM who also practice IDU (MSM/IDU), and heterosexual exposure.

·       Although MSM have higher numbers of PLWH than the other risk groups, the proportion of diagnosed MSM living with HIV with evidence of met need and retention in care is similar to those observed for other risk groups.

·       MSM also have a higher proportion of diagnosed PLWH who are virally suppressed but a lower proportion of newly diagnosed PLWH who were successfully linked to care within one month of initial diagnosis.

·       Those with IDU as a primary transmission risk factor exhibited the lowest proportions of individuals in each care continuum stage.

 

Questions about the Houston EMA HIV Care Continuum can be directed to: Amber Harbolt, Health Planner in the Office of Support.