CFAR/APC Working Group on the HIV Continuum of Care
The CFAR/APC HIV Continuum of Care Working Group, formerly known as the CFAR ECHPP Working Group, was founded in 2011 to promote and conduct HIV implementation science research by academic investigators in collaboration with their local departments of health (DOHs). An initial round of funding (ECHPP-1) was awarded in September 2011 to support CFAR investigators in the 9 highest AIDS prevalence cities in the United States (Atlanta, Chicago, Houston, Los Angeles, Miami, New York City, Philadelphia, San Francisco, and Washington, DC) to conduct research on HIV prevention and care interventions in support of the CDC ECHPP initiative. In a previous supplemental issue of JAIDS published in November 2013, results from these studies were presented on HIV testing, linkage to care, retention and reengagement in care, maximizing viral suppression, HIV health service provision, and nonoccupational postexposure prophylaxis.
In August 2012, a second round of funding (ECHPP-2) was awarded to investigators at these 9 CFARs and to investigators at 3 colocated National Institute of Mental Health (NIMH)-supported APCs in New York, San Francisco, and Los Angeles. This funding was to support implementation science focused on the HIV care continuum—specifically on HIV testing, linkage to care, retention and reengagement in care, and adherence to ARVs. A third round of funding (ECHPP-3) was awarded in summer 2013 to investigators at 10 CFARs (including 6 that were new to this initiative) to develop pilot interventions with their local DOHs to address the HIV continuum of care.
In addition, the NIMH Division of AIDS Research (DAR) and the National Institute of Allergy and Infectious Diseases (NIAID) Division of AIDS (DAIDS) recently issued a Program Announcement intended to address limitations in current understanding of the HIV care continuum [PA-14-132: Accelerating Improvements in the HIV Care Continuum (R01), http://grants.nih.gov/grants/guide/pa-files/PA-14-132.html]. Although this subset of priorities is not meant to be exhaustive, noteworthy among imperative research directions are (1) better understanding of engagement in care in a nonlinear manner, as patients reengage in HIV care in a range of pathways, (2) better understanding and intervention development for subpopulations within the care continuum whose outcomes are particularly poor (eg, young men who have sex with men of color), (3) addressing the relative dearth of intervention development and testing for linkage to care (compared with advancements in treatment adherence), (4) studies of multilevel factors (eg, including systemic and structural barriers and facilitators) that affect HIV testing, linkage, and retention in care, and (5) measurement and methodological progress to help advance accurate assessment of care continuum monitoring (eg, especially with innovative uses of available surveillance data). The articles in this present supplement also target these areas and may contribute to public health department approaches to enhance patient progress through the care continuum to viral load suppression.