US Centers for Disease Control and Prevention, Zimbabwe.
Curr Opin HIV AIDS. 2013 Jan;8(1):59-64. doi: 10.1097/COH.0b013e32835b806e.
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.
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.
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.
我们回顾了 HIV 治疗项目扩大后，HIV 护理级联（从 HIV 检测到病毒载量抑制）方面的最新文献。
在中低收入国家，HIV 检测和 HIV 感染者（PLHIV）的诊断虽然在迅速扩大，但通常相对较低。连接和维持护理是全球性的挑战，在诊断、实验室或临床分期以及开始抗逆转录病毒治疗（ART）之间存在大量的损耗，并且由于失访和死亡，在 ART 上还存在额外的大量损耗。ART 的覆盖率正在迅速扩大，但仍然相对较低，特别是考虑到所有 PLHIV 的百分比时。依从性也不理想，病毒学抑制不完全。
护理级联的每个步骤中的损耗导致 PLHIV 总人口中病毒载量抑制的总体水平较低。需要在级联的每个步骤中从设施到全球层面进行更有力的监测，并实施既定和新兴的干预措施，以加强 HIV 诊断、连接和维持护理、ART 的使用和依从性，最终降低病毒载量、改善临床结局并减少 HIV 传播。
