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H H S Department of Health and Human Services
Health Resources and Services Administration
HIV/AIDS Programs

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Continuum of HIV Care: Background

Continuum Engagement in CareThe continuum of engagement in HIV care is an important framework for understanding the status of HIV care and treatment in the United States (Cheever 2007).  An individual person living with HIV (PLWH) may go through several stages and may also return to earlier stages of the continuum throughout his/her life (Cheever 2007).  In order to understand how HIV care delivery fits into the continuum of care, Mugavero and colleagues created a framework through which care services can be better understood, with the ultimate goal of viral load suppression (Mugavero 2011).  Viral load suppression not only improves individual health, but it also reduces HIV transmission on a population level (Das 2010, Montaner 2010).  As there is mounting evidence that treatment of HIV with combination antiretroviral therapy (ART) reduces HIV transmission and HIV incidence (CDC 1994, Cohen 2011, Jia 2012), there has been more of a public health focus on treatment for everyone, and the DHHS guidelines also recently supported this (DHHS 2013).  The continuum focuses on several steps of HIV service delivery, including diagnosis, linkage to care, retention in care, ART, and viral load suppression. 

The Ryan White Comprehensive AIDS Resources Emergency Act of 1990 created a federal program for care services for PLWH who had no other source of health care financing, and there have been revisions in 1996, 2000, 2006, and 2009 (Title XXVI of the Public Health Service (PHS) Act, as amended by the Ryan White HIV/AIDS Treatment Extension Act of 2009 (P. L. 111-87)).  The law created the Ryan White HIV/AIDS Program (RWHAP), which is administered by the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB).  Grantees of this program include individual clinics, community health centers, networks of outpatient clinics, hospital-based clinics, university health systems, AIDS service organizations, cities, states, and territories of the United States.  Here we report the number of Ryan White HIV/AIDS Program clients at each stage of the continuum of HIV care for the first time.

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