Document Detail

Patching a leaky pipe: the cascade of HIV care.
MedLine Citation:
PMID:  23211779     Owner:  NLM     Status:  In-Data-Review    
PURPOSE OF REVIEW: 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.
RECENT FINDINGS: 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.
SUMMARY: 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.
Peter H Kilmarx; Tsitsi Mutasa-Apollo
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Current opinion in HIV and AIDS     Volume:  8     ISSN:  1746-6318     ISO Abbreviation:  Curr Opin HIV AIDS     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-05     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101264945     Medline TA:  Curr Opin HIV AIDS     Country:  United States    
Other Details:
Languages:  eng     Pagination:  59-64     Citation Subset:  IM; X    
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.
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