A Flow-Based Model of the HIV Care Continuum in the United States

Gregg S. Gonsalves, A. David Paltiel, Paul D. Cleary, Michael J. Gill, Mari M. Kitahata, Peter F. Rebeiro, Michael J. Silverberg, Michael Horberg, Alison G. Abraham, Keri N. Althoff, Richard Moore, Ronald J. Bosch, Tian Tang, H. Irene Hall, Edward H. Kaplan

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background: Understanding the flow of patients through the continuum of HIV care is critical to determine how best to intervene so that the proportion of HIV-infected persons who are on antiretroviral treatment and virally suppressed is as large as possible. Methods: Using immunological and virological data from the Centers for Disease Control and Prevention and the North American AIDS Cohort Collaboration on Research and Design from 2009 to 2012, we estimated the distribution of time spent in and dropout probability from each stage in the continuum of HIV care. We used these estimates to develop a queueing model for the expected number of patients found in each stage of the cascade. Results: HIV-infected individuals spend an average of about 3.1 months after HIV diagnosis before being linked to care, or dropping out of that stage of the continuum with a probability of 8%. Those who link to care wait an additional 3.7 months on average before getting their second set of laboratory results (indicating engagement in care) or dropping out of care with probability of almost 6%. Those engaged in care spent an average of almost 1 year before achieving viral suppression on antiretroviral therapy or dropping out with average probability 13%. For patients who achieved viral suppression, the average time suppressed on antiretroviral therapy was an average of 4.5 years. Conclusions: Interventions should be targeted to more rapidly identifying newly infected individuals, and increasing the fraction of those engaged in care that achieves viral suppression.

Original languageEnglish (US)
Pages (from-to)548-553
Number of pages6
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number5
StatePublished - Aug 15 2017


  • HIV continuum of care
  • antiretroviral therapy
  • operations research
  • queueing model
  • viral suppression

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)


Dive into the research topics of 'A Flow-Based Model of the HIV Care Continuum in the United States'. Together they form a unique fingerprint.

Cite this