The HIV treatment cascade and care continuum: updates, goals, and recommendations for the future

Abstract

The HIV care continuum is a framework that models the dynamic stages of HIV care. The continuum consists of five main steps, which, at the population level, are depicted cross-sectionally as the HIV treatment cascade. These steps include diagnosis, linkage to care (LTC), retention in care (RiC), adherence to antiretroviral therapy (ART), and viral suppression. Although the HIV treatment cascade is represented as a linear, unidirectional framework, persons living with HIV (PLWH) often experience the care continuum in a less streamlined fashion, skip steps altogether, or even exit the continuum for a period of time and regress to an earlier stage. The proportion of PLWH decreases at each successive step of the cascade, beginning with an estimated 86% who are diagnosed and dropping dramatically to approximately 30% of PLWH who are virally suppressed in the United States (US). In this current issues review, we describe each step in the cascade, discuss targeted interventions that address weak points in the continuum, review domestic and international policies that help shape and direct HIV care strategies, and conclude with recommendations and future directions for HIV providers and policymakers. While we primarily examine issues related to domestic HIV care in the US, we also discuss international applications of the continuum in order to provide broader context.

Barriers and Facilitators to the Implementation of a National HIV Linkage, Re-Engagement, and Retention in Care Program

“…It has been estimated that only about 45% of those diagnosed with HIV are retained in continuous care (Hall et al, 2012). Following diagnosis, PLWH can progress forward along the continuum as they link to and stay in care or backward as they fall in and out of treatment (Kay, Batey, & Mugavero, 2016). Suboptimal retention has been associated with use of more costly emergency and hospital resources (Knowlton et al, 2001), avoidable disease progression and ongoing HIV transmission (Skarbinski et al, 2015; U.S.…”

‘Hep C’s like the common cold’: understanding barriers along the HCV care continuum among young people who inject drugs

“…Treatment as prevention is a major component of strategies to combat HIV (identification, linkage, and treatment), but has yet to be widely implemented or evaluated for HCV (Kay et al, 2016). Increasing HCV treatment among young PWID can decrease virus circulation in the community, translating to a decreased infection rate (Cousien et al, 2016).…”

Evaluation of the Isoniazid Preventive Therapy Care Cascade Among HIV-Positive Female Sex Workers in Mombasa, Kenya

“…9,10 Despite WHO recommendations, 7 there has been limited global uptake of this intervention. 2 Similar to the HIV care continuum, 11 successful IPT implementation requires completion of several steps. 12 The optimal approach for IPT delivery is unknown, and few published reports examine this cascade of care in high TB/HIV burden settings, 13,14 or within key populations including FSWs.…”