Now that we know where our data comes from, and some of the ways we can use it, let’s take a look at one of the most common ways HIV data gets visualized – The HIV Treatment Cascade some of the ways we can use it, let’s take a look at one of the most common ways HIV data gets visualized – The HIV Treatment Cascade The main goal of HIV treatment is to achieve viral suppression, which means the amount of HIV in the body is very low or “undetectable”. This is important for people living with HIV to stay healthy, have improved quality of life, and live longer. In addition, people who maintain viral suppression for at least six months do not transmit HIV sexually, as long as they maintain an “undetectable” status. You may hear people referring to this as “Undetectable equals Untransmittable” The HIV Treatment Cascade is a way to visualize the steps a person has to take starting with diagnosis, in order to achieve viral suppression. HIV Treatment Cascades can help us understand what parts of our system of care are creating challenges for our communities and need improvement, and what parts of our system are creating the opportunities communities need to achieve their health and wellness goals. Let’s take a look at each bar of the treatment cascade so we can understand how our data is used to visualize the HIV care continuum in Texas. The Texas HIV Treatment Cascade, and most HIV treatment cascades, begins with the number of people living with HIV who have received a diagnosis. This is called a diagnosis based treatment cascade. However, it’s important to note there is a bar before this that looks at HIV prevalence – or all people living with HIV, including those who have not received a diagnosis and don’t know they have HIV. It’s estimated in Texas that 1 out of every 5 people living with HIV hasn’t received a diagnosis and isn’t aware of their status. For this overview, we’re going to be focusing on those who are aware of their status and the steps they take to achieve viral suppression. As mentioned in earlier presentations, anyone who receives an HIV diagnosis has that test result reported to the Texas Department of State Health Services. Everyone who has received an HIV diagnosis and is living in Texas, is represented in this bar. Next in our pathway towards viral suppression is “evidence of care”. This means that a person living with HIV had at least 1 contact with the HIV care system during the year. This can be either a visit with a medical provider about their HIV, evidence of an ART prescription being filled, or HIV lab work. Next in our pathway towards viral suppression is “retained in care”. This means that a person living with HIV was regularly engaged in HIV care. We define this as having evidence of care at least twice during the year or at least 2 contacts with the HIV care system and that those contacts were at least 3 months apart). Additionally, because Texas’ strongest data set is our required viral load reporting, anybody whose last viral load of the year shows viral suppression is also included in this measure. This is based on the assumption that if somebody achieved viral suppression they were most likely retained in care – we just don’t have evidence of it. Some HIV treatment cascades will have an additional “bar” or measure here that shows how many people received an ART prescription. When Texas has reliable data available about who has received an ART prescription, there will also be an “On ART” bar or measure in our treatment cascade. Finally we have Viral Suppression. Anyone whose last lab work of the year shows a viral load under 200 copies/ml is considered as having achieved viral suppression. The main goal of HIV treatment is to achieve viral suppression, which means the amount of HIV in the body is very low or “undetectable”. This is important for people living with HIV to stay healthy, have improved quality of life, and live longer. In addition, people who maintain viral suppression for at least six months do not transmit HIV sexually, as long as they continue to maintain an “undetectable” status. There are two different ways for us to look at viral suppression – diagnosis based viral suppression and in-care viral suppression. Diagnosis-based viral suppression starts with everyone who has received an HIV diagnosis and looks to see how many of those folks have been able to achieve viral suppression. This lets us know what HIV looks like in an overall community and what proportion of folks in a community potentially have higher viral loads. We also want to monitor in-care viral suppression – instead of looking at everyone with a diagnosis, we’re only going to look at people who are retained in care. We’ll start with all those folks who have been regularly engaged with the HIV care system and will look to see how many of them have been able to achieve viral suppression. This lets us look more closely at our systems of care to see how effective they are in creating the opportunities people need to achieve viral suppression. The HIV treatment cascade, including both ways to monitor viral suppression, can be used to look at the HIV care continuum in a variety of ways, and to compare HIV outcomes across groups to better understand where disparities in care potentially exist. We can look and compare HIV treatment cascades across geographic regions We can compare treatment cascades across our Priority Populations We can even compare treatment cascades across age groups The HIV Treatment Cascade is a great foundation for us to start with to better understand what HIV looks like across the state and across populations so we know what communities we need to focus on and understand in order to provide better support so everyone in Texas can easily access high quality care and treatment.