BACKGROUND: The HIV Continuum of Care is a framework for examining progress on the National HIV/AIDS Strategy and measuring health outcomes for persons living with HIV (PLWH). Data for the continuum has traditionally come from HIV Surveillance systems which rely on reporting of laboratory results to measure retention in HIV care and viral suppression and contain inaccurate and outdated information on PLWH. Improvements in measuring the number of PLWH in a jurisdiction, as well as in measuring care received by PLWH, will increase progress towards the National goals of 90% of PLWH being virally suppressed.
METHODS: The Virginia Department of Health undertook a number of initiatives to more accurately measure PLWH in the state and to increase the availability of care marker data. These included the development of the care marker database, which matched together a number of data systems that contained information on care received by PLWH, including Ryan White care, the AIDS Drug Assistance Program, Medicaid, HIV Surveillance data, and the Medical Monitoring Project. To increase the accuracy of the number of PLWH residing in Virginia, matches were done with people search software, as well as surveillance data in surrounding jurisdictions to determine the current residence of PLWH. Vital status information for PLWH was also updated through a number of processes.
RESULTS: As a result of matches across jurisdictions, Virginia reduced the denonimator of PLWH in 2015 by 760 persons. The addition of care markers, including CD4 counts, viral loads, antiretroviral prescriptions and HIV medical visits, increased retention rates by 8% and viral suppression rates by 9% in 2015.
CONCLUSIONS: Improvements to the HIV Care Continuum must include innovations to data systems that allow for the utilization of multiple data sources and timely use of data for public health action. Surveillance systems that were designed to produce static reports must be updated to utilize new technologies and to meet the needs of current public health issues.