Linkage to Care

There are five steps to the HIV Care Continuum:

1. Diagnosis of HIV Infection
   HIV screening is the first step in CDC’s status-neutral approach to prevention and care. The HIV Care Continuum begins with a positive HIV screening. Patients who have a preliminary positive HIV result should receive a confirmatory HIV test, HIV viral load, and CD4 count lab testing, followed by creation of a treatment plan and linkage to case management services. However, if patients test result are negative patient should be offered prevention options such as PrEP.¹

2. Linkage to HIV Medical Care
   Linking your patients appropriately to prevention and care services is essential to progress through the care continuum. Clinicians and supporting staff may need to address barriers to care including, but excluded to, lack of transportation, lack of medical insurance coverage, medical mistrust/previously stigmatizing experiences, low health literacy, etc. CDC’s status-neutral approach to HIV prevention and care ensures that all patients can benefit from quality HIV prevention and care, regardless of their HIV status.¹

3. Receipt of HIV Medical Care
   Immediate antiretroviral therapy (iART) refers to starting HIV treatment as soon as possible when an individual is diagnosed with HIV, if the patient is prepared for daily medication adherence. Studies and expert opinion suggest that prompt initiation of ART lessens the time from diagnosis to viral suppression and limits the transmission of HIV to others. Ideally, iART should be done on the same day of HIV diagnosis or at the first medical visit. iART is beneficial for all people who are diagnosed with HIV, regardless of how long they have been living with HIV or how healthy they seem. Barriers to engaging patients into medical care may include lack of patient readiness, lack of structure to dispense iART, lack of prescription coverage for medications, etc.²

4. Retention in Medical Care
   Retention in HIV care refers to the ability of individuals living with HIV to consistently engage in and adhere to medical care, including regular appointment attendance with healthcare providers, timely initiation and maintenance of ART, and ongoing monitoring of their disease progression. Retention is crucial in managing HIV as a chronic condition. Barriers to retention in HIV care may involve changes in insurance coverage, lack of reliable communication between facility and patient, lack of understanding that medical care is ongoing and not always acute.¹

5. Achievement and Maintenance of Viral Suppression
   Maintaining viral suppression can help preserve the patient’s immune system, preventing the progression of HIV to AIDS, reduce the risk of developing HIV-related complications, and improves overall health and well-being. Additionally, viral suppression significantly reduces the risk of transmitting HIV to others, contributing to the prevention of new infections. Barriers to viral suppression may include medication side effects, drug-drug interactions, internalized stigma interfering with medication adherence, lack of private space to take medications, etc.¹