HIV Treatment Cascade and Continuum of Care

The HIV treatment cascade models the sequential stages through which individuals living with HIV progress, from initial diagnosis to viral suppression. It serves as a diagnostic tool to identify attrition at each step—testing, linkage to care, retention, adherence to antiretroviral therapy and virological control—thereby guiding targeted interventions and health policy. Integral to global efforts are the UNAIDS 90-90-90 and subsequent 95-95-95 targets, which set ambitious benchmarks for diagnosis, treatment coverage and suppression rates. Despite advances in diagnostics and potent combination therapies, substantial gaps persist: many people remain unaware of their status, others face delays in entering care, and a significant proportion disengage before achieving durable suppression. These gaps are driven by structural, social and individual factors, including stigma, socioeconomic barriers and service fragmentation. The framework has evolved to incorporate longitudinal monitoring, emphasising dynamic entry and exit, reintegration after loss to follow-up and the impact of comorbidities. By harmonising data sources and standard definitions, programmes can assess performance, allocate resources efficiently and adjust strategies to reach marginalised populations. Ultimately, optimising each link in the cascade is essential for improving individual health outcomes, reducing transmission and moving closer to epidemic control.

Research from Nature Portfolio

No recent Nature Portfolio content available.

HIV Treatment Cascade and Continuum of Care publication trend

The graph below shows the total number of articles in hiv treatment cascade and continuum of care across all publications each year (not limited to Nature Index journals).

Technical terms

HIV treatment cascade: A model outlining sequential stages from diagnosis to viral suppression to identify gaps in care.

Continuum of care: The comprehensive pathway encompassing prevention, diagnosis, treatment, retention and ongoing support for people living with HIV.

Antiretroviral therapy (ART): Combination drug regimens that suppress HIV replication and restore immune function.

Viral suppression: Reduction of HIV RNA to undetectable levels in the blood, preventing disease progression and onward transmission.

Linkage to care: The process by which an individual with a positive HIV diagnosis is connected to clinical services.

Retention in care: Continued engagement with HIV clinical services to ensure regular monitoring and treatment adherence.

90-90-90 targets: UNAIDS benchmarks aiming for 90% diagnosed, 90% of those treated and 90% of those virally suppressed by a given deadline.

References

1. Structural violence and the uncertainty of viral undetectability for African, Caribbean and Black people living with HIV in Canada: an institutional ethnography. International Journal for Equity in Health (2023).
2. Status and methodology of publicly available national HIV care continua and 90-90-90 targets: A systematic review. PLOS Medicine (2017).
3. A continuum of HIV care describing mortality and loss to follow-up: a longitudinal cohort study. The Lancet HIV (2018).