The Facility-Level HIV Treatment Cascade: Using a Population Health Tool in Health Care Facilities to End the Epidemic in New York State

Abstract

BackgroundThe HIV treatment cascade is a tool for characterizing population-level gaps in HIV care, yet most adaptations of the cascade rely on surveillance data that are ill-suited to drive quality improvement (QI) activities at the facility level. We describe the adaptation of the cascade in health care organizations and report its use by HIV medical providers in New York State (NYS).MethodsAs part of data submissions to the NYS Department of Health, sites that provide HIV medical care in NYS developed cascades using facility-generated data. Required elements included data addressing identification of people living with HIV (PLWH) receiving any service at the facility, linkage to HIV medical care, prescription of antiretroviral therapy (ART), and viral suppression (VS). Sites also submitted a methodology report summarizing how cascade data were collected and an improvement plan identifying care gaps.ResultsTwo hundred twenty-two sites submitted cascades documenting the quality of care delivered to HIV patients presenting for HIV- or non-HIV-related services during 2016. Of 101 341 PLWH presenting for any medical care, 75 106 were reported as active in HIV programs, whereas 21 509 had no known care status. Sites reported mean ART prescription and VS rates of 94% and 80%, respectively, and 60 distinct QI interventions.ConclusionsSubmission of facility-level cascades provides data on care utilization among PLWH that cannot be assessed through traditional HIV surveillance efforts. Moreover, the facility-level cascade represents an effective tool for identifying care gaps, focusing data-driven improvement efforts, and engaging frontline health care providers to achieve epidemic control.

Integrating hypertension and HIV care in Namibia: A quality improvement collaborative approach

“…Selected changes from each region were then presented to the large group, and a final list of changes was determined by group discussion and majority vote. Changes were subsequently collated according to domains of the Chronic Care Model—a heuristic for organizing changes that improve care for chronic conditions [ 38 ], including HIV [ 39 ].…”

“…Changes were subsequently collated according to domains of the Chronic Care Model-a heuristic for organizing changes that improve care for chronic conditions [38], including HIV [39].…”

Ending the HIV Epidemic: New York’s Quest to Become the First State to Reduce HIV Prevalence

“…For example, New York State uses facility-produced treatment cascades to assess care use at the provider level, facilitating locally targeted programming. 37 Political support is also necessary to implement a successful ETE initiative. Political commitment realized at the highest level in New York State's ETE initiative produced dedicated funding, leveraged buy-in, fostered partnerships, and helped to secure several policy and legal changes important to ETE.…”