The revolving door of HIV care: Revising the service delivery cascade to achieve the UNAIDS 95-95-95 goals

By Ehrenkranz P,  Professor Sydney Rosen  Boulle A, Eaton JW, Ford N  Dr. Matthew Fox  ,et al.  |  | 

Antiretroviral therapy (ART) for human immunodeficiency virus (HIV) prevents illness and death from HIV disease and transmission of HIV infection. To encourage
global scale-up of ART, the Joint UN Program on HIV/AIDS (UNAIDS) issued the
“95-95-95” targets for the HIV “cascade of care.” These targets state that by 2030, 95%
of individuals living with HIV will know their HIV status, 95% of people with diagnosed HIV infection will receive ART, and 95% of those taking ART will have achieved
suppression of the virus.
• While tremendous progress has been made toward achieving these targets, substantial
gaps remain. The challenge of closing the final gaps requires reconsideration of the
cascade itself.
• The 95-95-95 HIV care cascade depicts a linear and unidirectional continuum of care
with one starting point (HIV diagnosis) and one ending point (treatment discontination or death). This simplification of the cascade oversimplifies the complex cycle of
engagement, disengagement, temporary disuptions, reengagement, and transitions in
care experienced by many people living with HIV (PLHIV).
• As the proportion of PLHIV who reinitiate ART after previously starting and stopping
increases, we propose to update the HIV cascade of care to better reflect actua

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