Patching a leaky pipe: the cascade of HIV care

Area of Science:

• Public Health
• Infectious Diseases
• Global Health

Background:

• The cascade of HIV care, from testing to viral load suppression, is a critical focus for HIV treatment programs.
• Scaling up HIV treatment programs highlights the importance of optimizing each step of the care continuum.

Purpose of the Study:

• To review recent literature on the cascade of HIV care.
• To identify challenges and opportunities in achieving viral load suppression.

Main Methods:

• Literature review of recent studies.
• Analysis of data on HIV testing, diagnosis, linkage, retention, ART initiation, adherence, and viral load suppression.

Main Results:

• HIV testing and diagnosis rates remain relatively low in low- and middle-income countries.
• Significant attrition occurs at each stage of the cascade, including linkage, retention on ART, and adherence.
• ART coverage is expanding but still insufficient, with suboptimal adherence and incomplete viral suppression.

Conclusions:

• Attrition across the HIV care cascade leads to low overall viral load suppression.
• Enhanced monitoring and targeted interventions are necessary at all stages of care.
• Improving diagnosis, linkage, retention, ART use, and adherence is essential to reduce viral load, improve outcomes, and decrease HIV transmission.