# The HIV Care Continuum and Health Policy: Changes through Context and Geography

> **NIH NIH K01** · VANDERBILT UNIVERSITY MEDICAL CENTER · 2021 · $124,717

## Abstract

PROJECT SUMMARY (ABSTRACT).
 The HIV Care Continuum is a compelling epidemiologic framework describing the
movement of people living with HIV/AIDS through care, including diagnosis, linkage and
retention in care, use of antiretroviral therapy (ART), and ultimately, viral suppression. Health
policies may profoundly influence outcomes along the Care Continuum, and these effects may
be modified across regions and through individual contexts.
 In observational cohorts, retention in clinical care, ART use, and viral suppression
proportions have varied depending on available data and the population under study. The US
National HIV/AIDS Strategy (updated to 2020) and the revised 2013 World Health Organization
ART guidelines also reference milestones in the Care Continuum. Because the Patient
Protection and Affordable Care Act (ACA) and other national health policies in North and Latin
American countries aim to improve healthcare access and reduce health disparities, describing
the effect of policy and contextual factors on Care Continuum outcomes in these settings is of
great interest to epidemiologists, clinicians, and policy makers.
 This research seeks to quantify health policy, sociodemographic, contextual, and
geographic patterns and correlates of HIV Care Continuum outcomes among HIV-infected
persons in the United States (US), Canada, and Mexico. Contextual factors include psychiatric
illness, regional poverty, residential urbanicity, and other individual and environmental
characteristics. The North American AIDS Cohort Collaboration on Research and Design (NA-
ACCORD) and Caribbean, Central and South America network for HIV epidemiology
(CCASAnet) provide rich data sources in which to conduct this work.
 Aim 1 will quantify disparities in Care Continuum outcomes in North and Latin America,
assessing health system, demographic, risk, contextual, and geographic differences. Because
research into the influence of contextual factors and health system characteristics on Care
Continuum outcomes in longitudinal cohorts with clinical care data have been sparse or
geographically limited, this analysis will be novel and of significant importance.
 Aims 2 and 3 will provide inferences about the ACA's effects on improving healthcare
among HIV-infected individuals in care in the US. The state-led expansion of Medicaid coverage
under the ACA will be used as a quasi-experiment to assess effects on Care Continuum and
other HIV disease outcomes, comparing pre-ACA (pre-2014) to ACA implementation periods.

## Key facts

- **NIH application ID:** 10172831
- **Project number:** 5K01AI131895-05
- **Recipient organization:** VANDERBILT UNIVERSITY MEDICAL CENTER
- **Principal Investigator:** Peter F Rebeiro
- **Activity code:** K01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $124,717
- **Award type:** 5
- **Project period:** 2017-07-05 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10172831

## Citation

> US National Institutes of Health, RePORTER application 10172831, The HIV Care Continuum and Health Policy: Changes through Context and Geography (5K01AI131895-05). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10172831. Licensed CC0.

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