Research on the continuum of HIV care must be improved and benchmarked against an integrated, comprehensive framework in order to make strides against the HIV epidemic, according to researchers at the Rollins School of Public Health, Johns Hopkins University, and the Centers for Disease Control and Prevention.
The team performed a systematic search for interventions designed to improve the HIV care continuum – the comprehensive navigation of services that guide individuals from HIV diagnosis to linkage to care, retention in care, and reengagement and adherence to antiretroviral therapy. Interventions published from 2007-2015 were searched and assessed.
Of the 152 studies identified, researchers found that the majority of studies addressed adherence (77 percent), while many fewer addressed linkage (5 percent), retention (22 percent), or reengagement (3 percent). Researchers also noted that there was little uniformity on outcome definitions, with linkage studies utilizing 11 different outcome measures and retention studies utilizing 39 different measures.
According to Carlos del Rio, MD, Hubert Professor and chair of the Department of Global Health at the Rollins School of Public Health and clinical advisor to the Emory team of researchers,it has become clear that the biggest gap in the HIV care continuum is the retention and reengagement of persons living with HIV into effective HIV care. "This study shows precisely the point in care for which we have the fewest interventions in our toolkit. We need evidence-based interventions to help close this gap," he explains.
"Our review highlights the tremendous degree of variability across existing studies evaluating interventions to improve the HIV care continuum", explains Maunank Shah, MD, PhD, associate professor of medicine at The Johns Hopkins University School of Medicine. "We believe, as pointed out in our study, that there must be increased attention aimed at improving HIV care retention, and that researchers must report outcomes in a standardized fashion. A more comprehensive method for evaluating the HIV care continuum is needed in order to address the HIV epidemic in the United States."
The complete study is available in the January online edition of AIDS and Behavior.
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Kathryn A. Risher et al. Challenges in the Evaluation of Interventions to Improve Engagement Along the HIV Care Continuum in the United States: A Systematic Review, AIDS and Behavior (2017). DOI: 10.1007/s10461-017-1687-8