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Focusing the National HIV/AIDS Strategy: The HIV Care Continuum Initiative


Dr. Grant Colfax

As we celebrate the third anniversary of the National HIV/AIDS Strategy, our nation’s first comprehensive plan to address the domestic epidemic, President Barack Obama has reaffirmed the Administration’s commitment to the Strategy’s vision and goals, and directed federal departments to prioritize addressing the HIV continuum of care as they continue to implement the Strategy.

While we have made tremendous strides as a result of the smarter and more coordinated investments in evidence-based practices to address the epidemic, continued work is needed to achieve the Strategy’s goals. Data from the CDC tell us that along the HIV care continuum, there is significant fall-off (often referred to as the HIV “treatment cascade,” or “care cascade”). Nearly one-fifth of the 1.1 million people living with HIV in the U.S. are undiagnosed; one-third of people diagnosed with HIV are not linked to medical care; nearly two-thirds are not engaged in ongoing care; and only one-quarter – one in four – have the virus effectively controlled, which is necessary to maintain long-term health and reduces transmission to others. This must change.

Today, the President issued an Executive Order establishing the HIV Care Continuum Initiative as the next step in the Strategy’s implementation. This new Initiative will focus our continued implementation of the Strategy on activities that will better address the drop-offs along the continuum of care and increase the proportion of individuals who have the virus effectively controlled. The ultimate goal is to go from one in four to four in four.

The Initiative will mobilize federal efforts by supporting the further integration of HIV prevention and care efforts, promoting the expansion of successful HIV testing and service delivery models, encouraging new approaches to addressing barriers to HIV testing and treatment, and ensuring that federal resources are appropriately focused on evidence-based interventions along the HIV care continuum in relation to other efforts to combat HIV

Learn more about the White House’s HIV Care Continuum Initiative:

Fortunately, since the Strategy was launched, there have also been many new scientific and policy developments that are helping us to move forward. These include a deeper understanding about how people living with HIV in the U.S. are accessing care and how that care affects their long-term health. Among those advances are scientific studies demonstrating that antiretroviral treatment (ART) reduces the risk of HIV transmission, as well as recommendations by expert panels that clinicians test all persons 15-65 for HIV and offer ART for all adults and adolescents living with HIV whether or not the immune system shows clear evidence of decline. In addition, implementation of the Affordable Care Act is supporting considerable strides in expanding access to HIV testing and high-quality care for people living with HIV. All of these important developments will provide additional clarity and focus for our national efforts to increase HIV testing, linkage to care, and treatment along the continuum.

The President’s Executive Order responds to these developments by establishing the HIV Care Continuum Initiative, to be overseen by the Director of the Office of National AIDS Policy. The Executive Order directs key federal Departments to align and coordinate their efforts to maximize outcomes along the HIV care continuum and to report back on their progress to the President.

As the President observed in releasing the Strategy, “the federal government can’t do this alone, nor should it.” This remains true today as we sharpen our focus on actions to achieve better outcomes for people living with and at risk for HIV in the United States. There are important roles for individuals and organizations from every state and across all sectors of society, including businesses, faith communities, philanthropic organizations, the scientific and medical communities, educational institutions, the media, people living with HIV, and others. Won’t you join us in thinking critically and creatively about what you and your organization can do? Working together, we can improve outcomes for Americans living with HIV along care continuum and achieve the goals of the National HIV/AIDS Strategy.

To learn more, read the White House’s HIV Care Continuum Initiative fact sheet, view the blog post by HHS Secretary Kathleen Sebelius and Senior Advisor to the President Valerie Jarrett, and visit the new page on the HIV care continuum.