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Member Research & Reports

Member Research & Reports

CUNY: Analytic Review of the Literature to Understand Continuum Models

Dr. Denis Nash, a Professor at the CUNY Graduate School of Public Health and Health Policy. One co-author is his doctoral student and the other a colleague. The team studied lessons from HIV, hepatitis C virus, tuberculosis and implications for the development of improved care and prevention continua. The findings were published in the Journal Frontiers in Public Health.


[Photo: Dr. Dennis Nash (left) and Ms. Ashly E. Jordan]

This study provides an analytic review of the literature to examine the application of continuum models to tuberculosis, HIV, and other conditions as well as to theorize the concept of continua; and to learn lessons that could inform the development of improved care and prevention continua as public health metrics.

The continuum construct is now part of public health evaluation systems for HIV, and is increasingly used in public health and the medical literature. There have been issues raised with the comparability and optimal design of care continuum models, with the sense that there needs to be more concentration on the methodologic and theoretic underpinnings and scope of focus.

Review of relevant publications suggests that a key limitation of current models is their lack of measures reflecting incidence and mortality. There are issues relating to continua data being longitudinal or cross-sectional, the definition of numerators and denominators for each step, data sources, and measures of timeliness of step completion. Other issues include theoretic models to facilitate inferences of causes of care continuum gaps, how measures of prevention efforts, reinfection/relapses, and interactions of continua for co-occurring comorbidities should be reflected. How analyses of differences in retention over time, across geographic regions, and in response to interventions should be conducted are also issues. All of these matters are critical to the development of sound care and prevention continuum models.

Lessons learned from the application of continuum models to HIV and other conditions suggest that the application of well-formulated constructs of care and prevention continua, that depict, in well defined, standardized steps, incidence and mortality, along with degrees of and time to screening, engagement in care and prevention, treatment and treatment outcomes, including relapse or reinfection, may be vital tools in evaluating intervention and program outcomes, and in improving population health and population health metrics for a wide range conditions.