Tipping the balance towards long-term retention in the HIV care cascade: A mixed methods study in southern Mozambique

Fuente-Soro, Laura; Iniesta, Carlos; López-Varela, Elisa; Cuna, Mauro; Guilaze, Rui; Maixenchs, María; Bernardo, Edson; Augusto, Orvalho; González, Raquel; Couto, Aleny; Munguambe, Khátia; Naniche, Denise

doi:10.1371/journal.pone.0222028

Cited by 17 publications

(22 citation statements)

References 52 publications

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“…Many PLHIV start and stop ART multiple times over the course of their lives, creating what has been termed a “side door” into the cascade through which individuals who have left the system reenter it [ 18 ]. Some people report fear of being treated poorly if they return to care after an absence [ 19 ] and may perceive it as more acceptable to retest and restart ART at a new facility as a “new” patient rather than facing censure from healthcare staff [ 20 , 21 ]. Routinely collected medical records in most settings do not adequately document this phenomenon.…”

Section: Introductionmentioning

confidence: 99%

The revolving door of HIV care: Revising the service delivery cascade to achieve the UNAIDS 95-95-95 goals

et al. 2021

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Antiretroviral therapy (AAU : PleasenotethatforARTðabbreviationÞ; bothantiretroviraltreatmentan RT) for human immunodeficiency virus (HIV) prevents illness and death from HIV disease and transmission of HIV infection. To encourage global scale-up of ART, the Joint UN Program on HIV/AIDS (UNAIDS) issued the "95-95-95" targets for the HIV "cascade of care." These targets state that by 2030, 95% of individuals living with HIV will know their HIV status, 95% of people with diagnosed HIV infection will receive ART, and 95% of those taking ART will have achieved suppression of the virus.

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Section: Introductionmentioning

confidence: 99%

The revolving door of HIV care: Revising the service delivery cascade to achieve the UNAIDS 95-95-95 goals

et al. 2021

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“… 23 , 24 Barriers to linkage to care include the fear of dissemination of one’s HIV status, feeling subjectively healthy, migration, health system issues and fears of discrimination. 23 , 24 , 26 …”

Section: Challenges For Achieving 95-95-95 In Esamentioning

confidence: 99%

HIV infection in Eastern and Southern Africa: Highest burden, largest challenges, greatest potential

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et al. 2021

Southern African Journal of HIV Medicine

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Background: The burden of HIV is especially concerning for Eastern and Southern Africa (ESA), as despite expansion of test-and-treat programmes, this region continues to experience significant challenges resulting from high rates of morbidity, mortality and new infections. Hard-won lessons from programmes on the ground in ESA should be shared.Objectives: This report summarises relevant evidence and regional experts’ recommendations regarding challenges specific to ESA.Method: This commentary includes an in-depth review of relevant literature, progress against global goals and consensus opinion from experts.Results: Recommendations include priorities for essential research (surveillance data collection, key and vulnerable population education and testing, in-country testing trials and evidence-based support services to improve retention in care) as well as research that can accelerate progress towards the prevention of new infections and achieving ambitious global goals in ESA.Conclusion: The elimination of HIV in ESA will require continued investment, commitment to evidence-based programmes and persistence. Local research is critical to ensuring that responses in ESA are targeted, efficient and evaluated.

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“…Twenty-eight studies reported on this step [20,23,24,[26][27][28]31,[33][34][35][37][38][39]41,44,45,[47][48][49][50][51][52][53][54][55][56][57][58]: 15 cohort studies, 10 crosssectional and three of mixed design. Twenty-four studies (86%) provided a clear definition of the step (Table 2).…”

Section: Linkage To Pre-art Carementioning

confidence: 99%

The HIV care cascade in sub‐Saharan Africa: systematic review of published criteria and definitions

et al. 2021

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Introduction:The HIV care cascade examines the attrition of people living with HIV from diagnosis to the use of antiretroviral therapy (ART) and suppression of viral replication. We reviewed the literature from sub-Saharan Africa to assess the definitions used for the different steps in the HIV care cascade. Methods: We searched PubMed, Embase and CINAHL for articles published from January 2004 to December 2020. Longitudinal and cross-sectional studies were included if they reported on at least one step of the UNAIDS 90-90-90 cascade or two steps of an extended 7-step cascade. A step was clearly defined if authors reported definitions for numerator and denominator, including the description of the eligible population and methods of assessment or measurement. The review protocol has been published and registered in Prospero. Results and discussion: Overall, 3364 articles were screened, and 82 studies from 19 countries met the inclusion criteria. Most studies were from Southern (38 studies, 34 from South Africa) and East Africa (29 studies). Fifty-eight studies (71.6%) were longitudinal, with a median follow-up of three years. The medium number of steps covered out of 7 steps was 3 (interquartile range [IQR] 2 to 4); the median year of publication was 2015 (IQR 2013(IQR to 2019. The number of different definitions for the numerators ranged from four definitions (for step "People living with HIV") to 21 (step "Viral suppression"). For the denominators, it ranged from three definitions ("Diagnosed and aware of HIV status") to 14 ("Viral suppression"). Only 12 studies assessed all three of the 90-90-90 steps. Most studies used longitudinal data, but denominator-denominator or denominator-numerator linkages over several steps were rare. Also, cascade data are lacking for many countries. Our review covers the academic literature but did not consider other data, such as government reports on the HIV care cascade. Also, it did not examine disengagement and reengagement in care. Conclusions: The proportions of patients retained at each step of the HIV care cascade cannot be compared between studies, countries and time periods, nor meta-analysed, due to the many different definitions used for numerators and denominators. There is a need for standardization of methods and definitions.

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Tipping the balance towards long-term retention in the HIV care cascade: A mixed methods study in southern Mozambique

Cited by 17 publications

References 52 publications

The revolving door of HIV care: Revising the service delivery cascade to achieve the UNAIDS 95-95-95 goals

The revolving door of HIV care: Revising the service delivery cascade to achieve the UNAIDS 95-95-95 goals

HIV infection in Eastern and Southern Africa: Highest burden, largest challenges, greatest potential

The HIV care cascade in sub‐Saharan Africa: systematic review of published criteria and definitions

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