Antiretroviral Therapy Linkage and Retention in HIV Care

Effective control of the HIV epidemic hinges on both rapid linkage of newly diagnosed individuals into antiretroviral therapy (ART) services and sustained retention in care thereafter. Linkage encompasses the interval between diagnosis and first engagement with HIV treatment services, while retention denotes the continuous attendance and adherence to prescribed regimens over time. Together these steps form critical junctures in the HIV care cascade, determining individual clinical outcomes and the potential to achieve viral suppression at population level. Despite universal treatment guidelines and simplified regimens, attrition persists at multiple stages: from initial post-test referrals and CD4 or viral load assessments, through ART initiation, to long-term follow-up. Barriers span individual factors—such as perceived health, stigma and socioeconomic constraints—to health-system challenges including staffing shortages, clinic operating inefficiencies and inadequate patient support mechanisms. Global strategies such as the ‘treat-all’ policy and differentiated service delivery models aim to streamline pathways, reduce delays and tailor support to diverse populations. Attaining high rates of timely ART uptake and durable retention remains a cornerstone of efforts to end AIDS as a public health threat.

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Antiretroviral Therapy Linkage and Retention in HIV Care publication trend

The graph below shows the total number of articles in antiretroviral therapy linkage and retention in hiv care across all publications each year (not limited to Nature Index journals).

Technical terms

Linkage to care: The process and interval between HIV diagnosis and first attendance at an ART clinic.

Retention in care: Continued patient engagement with HIV services, including clinic visits and adherence to ART, over time.

Universal Test and Treat (treat-all): A policy recommending ART initiation for all individuals diagnosed with HIV, regardless of CD4 count or clinical stage.

Viral suppression: Reduction of HIV RNA in blood to levels undetectable by standard assays, indicating effective ART.

Loss to follow-up: Failure of a patient to attend scheduled clinic visits or maintain contact with care services for a defined period.

References

1. Long-term HIV care outcomes under universal HIV treatment guidelines: A retrospective cohort study in 25 countries. PLOS Medicine (2024).
2. Immediate and long-term outcomes after treat-all among people living with HIV in China: an interrupted time series analysis. Infectious Diseases of Poverty (2023).
3. Enhancing linkage to HIV care in the “Universal Test and Treat” era: Barriers and enablers to HIV care among adults in a high HIV burdened district in KwaZulu-Natal, South Africa. BMC Public Health (2023).