Michael J. Mugavero, MD, MHScAssociate Professor of Medicine

University of Alabama at BirminghamBirmingham, Alabama

Elements of the Care Continuum

FORMATTED: 12/09/15

New Orleans, Louisiana: December 15-17, 2015

National HIV/AIDS Strategy: 2020 Goals

Increase linkage to care w/in 1 month of Dx to at least 85%

Increase HIV serostatus awareness to at least 90%

Increase retention among

persons diagnosed to at least 90%

Increase proportion of persons diagnosed with viral suppression

to at least 80%Ulett et al. AIDS Pt Care STDs 2009;23:41-49, Mugavero et al. Clin Infect Dis 2011;52(S2).

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Skarbinski et al. JAMA Intern Med 2015;175

~90% of HIV Transmissions in

2009 in the US

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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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Thompson MA et al. Ann Intern Med 2012;156

Guidelines: Monitoring ART AdherenceGuidelines: Monitoring ART Adherence

Recommendation Strength/Quality

Self-reported adherence 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!

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• 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

Take Home PointsTake Home PointsSlide 38 of 38