We reviewed recent literature on the cascade of HIV care from HIV testing to suppression of viral load, which has emerged as a critical focus as HIV treatment programs have scaled up.
In low- and middle-income countries, HIV testing and diagnosis of people living with HIV (PLHIV), although rapidly expanding, are generally relatively low. Linkage and retention in care are global challenges, with substantial attrition between diagnosis, laboratory or clinical staging, and antiretroviral therapy (ART) initiation, and additional substantial attrition on ART due to loss to follow-up and death. ART coverage is rapidly expanding but is still relatively low, especially when considered as a percentage of all PLHIV. Adherence is also suboptimal and virological suppression is incomplete.
Taken together, the attrition at each step of the cascade of care results in overall low levels of viral load suppression in the total population of PLHIV. More robust monitoring from the facility to global levels and implementation of established and emerging interventions are needed at each step of the cascade to enhance HIV diagnosis, linkage to and retention in care, ART use, and adherence, and ultimately reduce viral load, improve clinical outcomes, and reduce HIV transmission.
aU.S. Centers for Disease Control and Prevention (CDC), Zimbabwe
bDivision of Global AIDS, CDC, Atlanta, USA
cNational OI/ART Programme, AIDS and TB Department, Zimbabwe Ministry of Health and Child Welfare, Harare, Zimbabwe
Correspondence to Peter H. Kilmarx, MD, 2180 Harare Pl, Dulles, VA 20189, USA. Tel: +1 263 772 470 053; fax: +1 263 4 796 032; e-mail: email@example.com