The continuum of care (CoC) model has been used to describe the main pillars of HIV care. This study aims to systematically review methods and elucidate gaps in the CoC analyses, especially in terms of the timing of the progression through steps, recognized nowadays as a critical parameter for an effective response to the epidemic. A PubMed and EMBASE databases search up to December 2019 resulted in 1918 articles, of which 209 were included in this review; 84 studies presented in major HIV conferences were also included. Studies that did not provide explicit definitions, modelling studies and those reporting only on metrics for subpopulations or factors affecting a CoC stage were excluded. Included articles reported results on 1 to 6 CoC stages. Percentage treated and virally suppressed was reported in 78%, percentage diagnosed and retained in care in 58%, percentage linked to care in 54% and PLHIV in 36% of the articles. Information for all stages was provided in 23 studies. Only 6 articles use novel CoC estimates: One presents a dynamic CoC based on multistate analysis techniques, two base their time-to-next-stage estimates on a risk estimation method based on the cumulative incidence function, weighted for confounding and censoring and three studies estimated the HIV infection time based on mathematical modelling. A limited number of studies provide elaborated time analyses of the CoC. Although time analyses lack the straightforward interpretation of the cross-sectional CoC, they provide valuable insights for the timely response to the HIV epidemic. A future goal would be to develop a model that retains the simplicity of the cross-sectional CoC but also incorporates timing between stages.

中文翻译：

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HIV 连续护理：将范围从横截面视图扩展到包括时间分析：系统评价

连续护理 (CoC) 模型已被用于描述 HIV 护理的主要支柱。本研究旨在系统地审查方法并阐明 CoC 分析中的差距，特别是在逐步进展的时间方面，如今被认为是有效应对流行病的关键参数。截至 2019 年 12 月的 PubMed 和 EMBASE 数据库搜索结果为 1918 篇文章，其中 209 篇被纳入本综述；还包括了在主要 HIV 会议上发表的 84 项研究。不提供明确定义的研究、建模研究和仅报告亚群指标或影响 CoC 阶段的因素的研究被排除在外。包括的文章报告了 1 到 6 个 CoC 阶段的结果。据报道，治疗和病毒抑制的百分比为 78%，58% 的文章中诊断和保留在护理中的百分比，54% 中与护理相关的百分比，36% 的文章中与 PLHIV 相关。23 项研究提供了所有阶段的信息。只有 6 篇文章使用了新颖的 CoC 估计：一篇提出了基于多态分析技术的动态 CoC，两篇基于累积关联函数的风险估计方法对下一阶段的时间进行了估计，对混杂和审查进行了加权和三项研究基于数学模型估计 HIV 感染时间。有限数量的研究提供了对 CoC 的详细时间分析。虽然时间分析缺乏对横截面 CoC 的直接解释，但它们为及时应对 HIV 流行提供了宝贵的见解。