Step 5: Viral Suppression

The primary goal of HIV treatment and public health interventions is viral suppression through ART. PLWH are considered to be virally suppressed if their most recent viral load, measured within the past year, is <200 copies/milliliter (c/mL).9 An estimated 70% of US PLWH are not virally suppressed.9 But for PLWH who are diagnosed, retained in care, and adherent with ART—ie, those who have completed each step of the HIV care continuum—90% have achieved viral suppression in the US.15 To achieve the NHAS goal of increasing the total number of PWLH with viral suppression to 80% by 2020, providers must work to link and retain PLWH in care.4

Healthcare Policy and Access Across the Continuum

The ACA expanded eligibility for health insurance to all populations, including PLWH. However, the Health Resources and Services Administration’s Ryan White HIV/AIDS Program (RWHAP) will remain a “valuable payer of last resort” for PLWH with low income.4 This program currently services over half a million PLWH who are either uninsured or underinsured, providing supportive and direct medical services to patients with HIV, including access to ART via the AIDS Drug Assistance Program.16,17 A quarter of PLWH in the US still lack health insurance, which underscores the need for continued funding of this program. Current literature urges HIV providers to advocate for this current funding, which has not been reauthorized since 2013 and relies on yearly appropriations from Congress.19-22 Moreover, changes proposed by President-elect Donald Trump may put the ACA in jeopardy.23 AIDS United, a major HIV/AIDs policy/advocacy and research organization, noted that Mr. Trump has not made specific statements regarding HIV.24 It remains to be seen what impact the new administration will have on HIV treatment.

Conclusion

The HIV treatment cascade is “a straightforward, helpful guide for healthcare providers working with PLWH.”4 The authors recommend “concerted collaboration” between policymakers, HIV providers, and other key stakeholders in improving outcomes at each step of the continuum, at a population level. 

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References

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This article originally appeared on MPR