Since 2004, teams of providers from the City AIDS Center, district polyclinics, TB facilities, and PLWH organizations in St. Petersburg, Russia, have worked together to analyze and improve the HIV/AIDS care system. Using an improvement collaborative process, key changes were introduced initially in a pilot district, and in 2008 began to be scaled up in all 18 districts of the city, including creation of a common database on HIV patients accessed by the AIDS Center and polyclinics, establishment of streamlined patient referral mechanisms between polyclinics, the City AIDS Center, and TB dispensaries; and operationalizing an algorithm for enrolling HIV patients in medical follow-up at the polyclinic level. This short report describes one product of this effort, the “Framework for Engagement into HIV Care”. This tool addresses enrollment and retention in the HIV/AIDS care system by defining a continuum of engagement of HIV-infected people into the system. By tracking target populations along this continuum to quantify gaps in service uptake and patient retention, the interventions needed to close these gaps become clear. The framework is the basis on which many improvement interventions were designed and implemented. Examples include: improved accessibility to substance abuse treatment for intravenous drug users, development of a state social service system for HIV patients, algorithms for polyclinic follow-up of HIV patients, and institutionalized training of providers on HIV counseling and testing. Enrollment and retention of HIV patients at polyclinics have greatly increased as a result of these interventions.