The management of human immunodeficiency virus (HIV) infection has evolved substantially since the advent of the HIV/acquired immune deficiency syndrome (HIV/AIDS) epidemic in the 1980s. The discovery of effective antiretroviral therapy (ART) transformed the lives of persons living with HIV (Deeks, Lewin, and Havlir 2013) by achieving a substantial drop in morbidity and mortality (Danel and others 2015; START Study Group 2015). Additionally, evidence supports the efficacy of ART in preventing the transmission of HIV infection (Cohen and others 2011).
Progress in controlling the HIV epidemic, however, requires the achievement of virologic suppression among all HIV-infected individuals, which, in turn, requires the identification of such individuals and their retention across the care continuum—from conducting HIV testing, linking HIV-positive individuals to care, retaining them in care, and achieving viral suppression (figure 4.1) (Gardner and others 2011). For each step of the continuum, this chapter discusses the rationale, relevant guidelines, measurements of each parameter, barriers to achieving successful outcomes, interventions demonstrated to be effective, and available data on the costs and cost-effectiveness of interventions.
The chapter includes information from peer-reviewed manuscripts identified through a targeted literature review focused on publications pertinent to low- and middle-income countries (LMICs), with a focus on Sub-Saharan Africa. Studies conducted in other LMIC regions and high-income countries are referenced when they address a key relevant issue. A table summarizing approaches to improving HIV testing, linkage to and engagement with HIV care, retention in HIV care, and adherence to HIV treatment is included in annex 4A.
© 2017 International Bank for Reconstruction and Development / The World Bank.