A recent publication1 led by TAG, the Treatment Action Group, and amfAR, the Foundation for AIDS Research, proposes a conceptual framework for an integrated primary and secondary HIV prevention continuum for the United States. The model builds upon the widely used HIV care continuum, which tracks the percentage of the population living with HIV who are diagnosed, treated, and ultimately virally suppressed, to additionally focus on the reduction of HIV acquisition through linkage and engagement in personalized HIV prevention services (Figure 1).
With the advent of the new highly effective prevention tool PrEP (pre-exposure prophylaxis), in addition to other established methods of HIV prevention and treatment, the United States has the capacity to prevent every new HIV infection and avoid every HIV-related death. However, serious gaps remain in the full implementation of both HIV treatment and prevention services, with striking racial and geographic disparities in new infections.
The proposed model conceptualizes the interplay between HIV treatment and prevention by using HIV testing/retesting as the central metric to quantify successful HIV prevention. Potential data sources and methods to build local and national continuums are discussed. The creation of such continuums have the potential to inform HIV prevention service coverage, identify gaps, and facilitate advocacy to reach national goals to reduce HIV incidence.
1 Horn, Tim, Jennifer Sherwood, Robert H. Remien, Denis Nash, and Judith D. Auerbach. "Towards an integrated primary and secondary HIV prevention continuum for the United States: a cyclical process model." Journal of the International AIDS Society 19, no. 1 (2016).