The HIV care cascade: models, measures and moving forward.

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Health Services Research

Background:

• The HIV care cascade is a critical framework for monitoring patient progress.
• Understanding and measuring delays at each stage is essential for effective HIV service delivery.
• Current metrics for cascade delays require refinement and standardization.

Purpose of the Study:

• To identify specific points of delay within the adult HIV care cascade.
• To define and measure
• delay
• at each stage of the cascade across diverse settings.
• To inform service delivery improvements for better HIV patient management.

Main Methods:

• Review of current metrics used to assess the HIV care cascade.
• Suggestion of new measures informed by global health guidelines.
• Identification of areas needing further clarification for consistent measurement.

Main Results:

• Delays can occur at HIV testing, linkage to care, treatment initiation, and viral suppression stages.
• Standardized measurement of delayed HIV testing may improve with rapid CD4 testing integration.
• Global guidelines (WHO, UNAIDS) offer thresholds for defining late treatment initiation and viral suppression.

Conclusions:

• No single model fits all settings; service delivery varies.
• Global guideline-informed measures are necessary for consistent evaluation of cascade delays.
• Standardized measures will enhance service delivery and patient engagement in HIV care.