Veteran's Health Administration HIV Care Continuum: 2019 vs 2022

The diagnosis-based Human Immunodeficiency Virus (HIV) Care Continuum offers a well-established framework for measuring HIV care quality. It is used by the government agencies, community organizations, and health care institutions to "guide the nation's response to HIV" and assesses HIV care from the time of HIV diagnosis through viral suppression. Our objective is to present the Veteran Health Administration's (VHA) HIV Care Continuum, assess postpandemic versus prepandemic performance, and compare VHA performance to Centers for Disease Control and Prevention-published data.

We conducted a nationwide retrospective cohort analysis examining the care continuum for people with HIV (PWH) in VHA care in 2019 versus 2022. Measurements included linkage to care, receipt of care, retention in care, and viral suppression. We used multivariable logistic regression of virological suppression to identify factors associated with viral suppression.

In VHA in 2019, 83% of individuals newly diagnosed with HIV were linked to care, 84% of PWH received care, 76% were retained in care, and viral suppression was 76% among those with HIV and 93% of those with viral load (VL) results. In 2022, 74% were linked to care, 79% received care, 67% were retained in care, and viral suppression was 70% among those with HIV and 94% of those with a VL result.

VHA has achieved >90% viral suppression among those with a VL result. Among all PWH, viral suppression decreased an absolute 5.2% between 2019 and 2022. VHA's performance on the HIV Care Continuum exceeds the national HIV Care Continuum reported by the Centers for Disease Control and Prevention.