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Member Research & Reports

Member Research & Reports

UNC Study Calls for Improvements to HIV Care ‘Cascade’ Measurements

The HIV care cascade is a commonly used framework that estimates the number of HIV-infected individuals in a geographic area, according to their HIV diagnosis, care and treatment status.


[Photo: Drs. Catherine Lesko (left) and Kimberly Powers]

The cascade, also called a continuum, is used with surveillance data collected by state and city health departments in the United States to estimate the proportion of HIV-infected persons who have been diagnosed, have ever sought HIV care, are currently in care and/or are virally suppressed.

Dr. Kimberly Powers, assistant professor of epidemiology at the University of North Carolina Gillings School of Global Public Health, is senior author of a newly published study that reviews challenges and biases that may limit the accuracy and usefulness of the HIV care cascade as it is currently implemented. Dr. Catherine Lesko, recent epidemiology UNC alumna, is first author of the paper.

Dr. Lesko and co-authors interviewed public health practitioners and epidemiologists responsible for HIV surveillance at the North Carolina Division of Public Health to gain a better understanding of local continuum estimation practices. The research team also reviewed programmatic guidance and HIV estimates from other jurisdictions in order to gain use comparisons. Finally, they analyzed surveillance data from the N.C. Division of Public Health to illustrate the existence and magnitude of potential biases.

The full article, titled “Measuring the HIV Care Continuum Using Public Health Surveillance Data in the United States,” was published online Aug. 6 by the Journal of Acquired Immune Deficiency Syndromes.

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