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Care Cascade for Smart People

This presentation was developed by the Office of HIV Planning, Philadelphia for use by the Philadelphia EMA Ryan White Part A Planning Council and the Philadelphia HIV Prevention Group.

Nicole Johns

on 9 June 2015

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Transcript of Care Cascade for Smart People

HIV Care Continuum from Testing to Undetectable
Care Cascade for Smart People
Viral Suppression
Help may come from her testing counselor, doctor, an Early Intervention Specialist or a Peer Navigator.
Linkage to HIV Care
Linkage to HIV Care
Whitney continues to meet with her HIV doctor every few months or as needed to maintain her health.
Retention in HIV Care
Whitney takes her medication according to her treatment regimen, as prescribed by her doctor.

After several months her viral load is
What the heck is it?
You might have seen a graph like this recently. It's often called the "Gardner Cascade".
Each bar represents a different step along the care continuum
Where a person is on the "continuum" refers to how they are engaged in HIV care and adherent to HIV treatment. Different people are at different places along the path.
Care Continuum
HIV Care Continuum
HIV Diagnosis
Whitney tests positive for HIV.
So does that help?
Probably not that much.
Let's start at the beginning and walk our way through.
Whitney will need help to take the next step of making that first HIV care appointment
If no one helps Whitney make that first appointment, she might not go to the Dr at all. She may have barriers that prevent her from making it there.
HIV Status
Lack of knowledge
Substance use
Competing Needs
What we see
What we can't see
The factors below the surface have a real impact on Whitney's decisions and actions
Barriers may feel like a brick wall
She doesn't know what to do.
Where does she go for help?
Let's take a minute to think about what's happening in Whitney's head.
lack of transportation
work responsibilities
child care responsibilities
confidentiality concerns
Whitney makes that first appointment.

This is called Linkage to Care
Whitney's testing counselor contacts a case manager at another organization to meet with Whitney the next day.

Her counselor also contacts a local HIV medical provider and arranges an appointment for later that week.
If Whitney makes at least 1 doctor visit in a year she is considered "maintained" or "retained" in care.
Adherence to ART
Whitney's doctor and case manager will work with her to make sure she is able to take her HIV medicines at the prescribed times.
Taking medications on time and regularly is called ADHERENCE.
Adherence is really important to reduce viral load in HIV+ people
People with viral loads so low we can't count them are said to have UNDETECTABLE viral loads.
Now Whitney has reached
Like this awesome lady!
People with suppressed viral loads are less likely to transmit HIV to a partner
So what's so important about viral load suppression?
So what about that "Gardner Cascade"?
How does that fit in to all this?
A goal of the National HIV Strategy is to reduce transmission of HIV.

If we have more people in care and with a reduced viral load, we will have less HIV transmissions.
Right now we aren't doing great at helping people stay in care and adhere to their medications.
The effort to diagnose HIV+ people, help them maintain HIV care and reach viral load suppression is called the
But we are working
on it.

Test and Treat is just one of our tools.
Remember those barriers?

They can prevent Whitney from taking her medication too.
For more information about the
Gardner Cascade and how Philadelphia stacks up check out:
If you live in the Philadelphia area and would like more information about HIV testing or HIV care services call:
This presentation was developed by
Full transcript