**6. The HIV continuum of care**

The HIV continuum of care is a public health model that indicates steps or stages people living with HIV take from diagnosis until they achieve and sustain viral load suppression. The stages include diagnosis of HIV infection, linkage to treatment or ART, management of a patient on ART, retention to care and achievement, and maintenance of viral suppression, as illustrated in **Figure 2** [18].

The HIV care continuum is useful as both an individual and population-level tool or framework to assess care outcomes, and analyzing the proportion of PLWH in a given community, helps policymakers to plan and make a decision about the allocation of resources, and service providers can identify gaps in service delivery and develop interventions to improve the quality of care to PLWH to achieve the treatment goal of viral suppression. Achieving viral suppression has health and prevention benefits. Health benefits to PLWH as the viral load becomes low and can live healthy and longer, increasing life expectancy. The prevention benefit is that PLWH who take treatment as prescribed and have undetectable viral load have no risk of transmitting HIV to their HIV-negative sexual partners. However, these patients need continuous

**Figure 2.** *HIV continuum of care.*

engagement in HIV care with support, and knowing where the problem helps develop targeted intervention to break the cycle of HIV transmission. Therefore, it requires the involvement and collaboration of all stakeholders such as local health departments, community-based organizations, traditional and religious leaders, traditional healers, health care providers, public health officials, and PLWH to develop and implement quality improvement systems to support all PLWH to navigate the continuum and achieve and maintain viral suppression successfully. NIMART nurses play a major role throughout this continuum.

Diagnosed HIV infection can measure the percentage of the total number of PLWH whose infection has been diagnosed and measures prevalence, and NIMART nurses achieve this by conducting provider-initiated counseling and testing (PICT) to all patients coming to their care and confirming those without documented HIV status. This ensures that no one is left behind. Linkage of people who tested HIV positive to quality care is one of the crucial roles of NIMART nurses as clinicians and continues to ensure that PLWH receives effective and efficient care through follow-up, management of OIs, complications and provide adherence counseling messages, thereby keeping PLWH in care until they are viral suppressed, which indicates treatment or failure if the viral load is high while on treatment. It is very easy to lose PLWH if this continuum is not implemented properly. A combination of preventive interventions is also very important in reducing new HIV infections.
