Improving Retention in HIV Care: Which Interventions Work?

Michael J. Mugavero, MD, MHSc

Disclosures

September 13, 2012

Introduction

Mounting enthusiasm for HIV "treatment as prevention" approaches has brought increased focus to current gaps across a continuum of care that spans HIV acquisition to plasma viral suppression.[1,2] In contrast to extensive literature describing scientifically rigorous studies comparing the efficacy of antiretroviral therapy (ART) regimens and interventions to promote ART adherence, a relative paucity of evidence-based interventions have been evaluated for the earlier steps on the care continuum: testing, linkage, and retention in care.

Deficiencies in these initial steps pose some of the greatest challenges to achieving the individual and public health benefits afforded by sustained viral suppression at an individual and community level. Among the 1.1 million persons living with HIV infection in the United States, only 79% are aware of their serostatus; among those with known HIV infection, 69% are linked to care in a timely fashion, and only 59% are retained in medical care over time.[3,4] Yet, the US National HIV/AIDS Strategy has set goals of 90% serostatus awareness, 85% linkage to care within 3 months of diagnosis, and 80% retention in continuous care among Ryan White CARE Act clients by 2015.[5]

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