With guest co-blogger Nikhil Prachand, Director of HIV/STI Surveillance at Chicago Department of Public Health
The HIV epidemic in our nation is rapidly becoming concentrated among poor, young black and Hispanic men who have sex with men. In Chicago, there are over 25,000 people living with HIV. Approximately 1,000 people are newly diagnosed every year. There are over 50 neighborhoods in which more than 2% of the population is living with the disease.
We are, however, at an opportune time in the course of the epidemic. New one pill-once a day regimens are safer and more effective than ever. Pre-exposure prophylaxis holds great promise. And results from recent randomized controlled trials have shown that sustained viral suppression is not only beneficial for the individual in care but can virtually eliminate new transmission in the community.
The successes of biomedical interventions, however, depend on the successes of some old-fashioned tenets of public health. Efforts to improve screening rates, access to quality care and adherence to medication require a roadmap built on strong partnerships. In Chicago, this effort is led by the Chicago Department of Public Health (CDPH) and its roadmap, the HIV care continuum —sometimes referred to as the HIV treatment cascade. The continuum is a new visual tool that is being developed and utilized by many Federal, State and Local agencies to identify issues and opportunities related to improving the delivery of services to people living with HIV across the entire continuum of care. There are four main stages of engagement:
- Getting linked to care—Once a person knows they are infected with the HIV virus, it is important to be promptly connected to an HIV healthcare provider.
- Staying in care—Because there is no cure for HIV at this time, treatment is a lifelong process.
- Getting antiretroviral therapy— Antiretroviral therapy (ART) is the recommended treatment for HIV infection. It involves uses using a combination of three or more antiretroviral drugs from at least two different HIV drug classes every day to control the virus.
- Achieving a low amount of HIV virus in your body—By taking ART regularly, a person can achieve viral suppression, meaning a very low level of HIV in your blood.
By monitoring the continuum, CDPH and its partners are proactively able to identify gaps at each stage of engagement and support the development of innovative programs and interventions to address these gaps. CDPH is developing the use of predictive analytics to pinpoint individuals likely to need linkage to care support, a mobile data collection platform for partner investigations and mobile health technology to promote adherence to appointments and medications.
Expanding access to new and existing data and continuing innovations in its use have made much of these recent successes possible. Major changes to disease reporting regulations were required to ensure community medical providers and testing laboratories were providing sufficient and accurate data to track progress along the continuum . The local HIV planning body, known as the Chicago Area HIV Integrated Services Council (CAHISC) is informing priority setting and resource allocation for care. This body was recently reorganized into three steering committees whose objectives aligned with the four stages of the continuum.
Other examples include the use of standard laboratory reports received by the health department’s HIV surveillance program as markers of HIV care and analyzing them to identify individuals who either never linked to care after diagnosis or who fell out of HIV medical care and need to be re-engaged. The CDPH ‘Bridgeworker’ program utilizes these lists of individuals to visit them at their home and assist them with getting into HIV care. The program is ongoing at CDPH HIV primary care clinics and will soon be available to community HIV care providers citywide.
If we are ever going to witness a truly AIDS-free generation, it will be requisite that the tools and resources available to local and state health departments continue to be integrated with the expertise of the existing HIV prevention community and the innovative use of data and other emerging technologies as they become available.
Jay Bhatt is is part of the GovLoop Featured Blogger program, where we feature blog posts by government voices from all across the country (and world!). To see more Featured Blogger posts, click here.