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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, 2012-2014
(click image to enlarge)

Source: Bureau of Epidemiology and Bureau of HIV/STD and Viral Hepatitis Prevention, Houston Health Department, 2016

From 2012-2014, 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.

  • There was a 10% increase in the percentage of persons retained in care over the course of three years, with the greatest increase from 2012-2013.

  • There was a 9% increase in the percentage of those virally suppressed from 2012 to 2014.

  • The percentage of those with met need and those linked within 3 months was relatively stable, with a change of 2% or less between each year.

Click here for the methodology used to develop the Houston EMA HIV Care Continuum.

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, 2014
(click image to enlarge)

Source: Bureau of Epidemiology and Bureau of HIV/STD and Viral Hepatitis Prevention, Houston Health Department, 2016

  • Younger adults had lower percentages of retention and viral suppression compared to the older adult age groups.

  • Youth and young adults (13-24 years old) also had the lowest proportion of newly diagnosed PLWH who were linked within three months of diagnosis when compared to the older adult age groups.

Click here for the methodology used to develop the Houston EMA HIV Care Continuum.

The Houston EMA Care Continuum, by Sex at Birth

Figure 3: Houston EMA HIV Care Continuum by Sex at Birth, 2014
(click image to enlarge)

Source: Bureau of Epidemiology and Bureau of HIV/STD and Viral Hepatitis Prevention, Houston Health Department, 2016

  • Females living with HIV in the Houston EMA in 2014 had a higher proportion of individuals with met need and retention in care than males living with HIV, although females had a smaller proportion of viral suppression.

  • The proportion of newly diagnosed female PLWH linked to care within the first three months after diagnosis was almost 10% higher among females than males.

Click here for the methodology used to develop the Houston EMA HIV Care Continuum.

 

The Houston EMA Care Continuum, by Sex at Birth and Race/Ethnicity in 2014

Figure 4: Houston EMA HIV Care Continuum by Sex at Birth and Race/Ethnicity, 2014
(click image to enlarge)

Source: Bureau of Epidemiology and Bureau of HIV/STD and Viral Hepatitis Prevention, Houston Health Department, 2016

  • Hispanic and Black (non-Hispanic) PLWH had the lowest proportion of individuals with evidence of met need, retention in care, and viral suppression among males in 2014.

  • Among females, White (non-Hispanic) and Black (non-Hispanic) PLWH had the lowest proportion of individuals with evidence of retention in care and viral suppression in 2014.

  • 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.

Click here for the methodology used to develop the Houston EMA HIV Care Continuum.

The Houston EMA Care Continuum, by Transmission Risk Factor in 2014

Figure 5: Houston EMA HIV Care Continuum by Transmission Risk Factor, 2014
(click image to enlarge)

Source: Bureau of Epidemiology and Bureau of HIV/STD and Viral Hepatitis Prevention, Houston Health Department, 2016

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 show evidence of met need and retention in care similar to those observed for other risk groups.

  • MSM also has 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 three months of initial diagnosis.

  • Those with IDU as a primary transmission risk factor exhibited the lowest proportions of both met need and viral suppression.

Click here for the methodology used to develop the Houston EMA HIV Care Continuum.

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