The HIV Care Cascade: Facing the Challenges of Scaling Up
The HIV treatment cascade, first brought to international attention in an article by Dr. Edward Gardner and colleagues, has become the primary organizing principle around which to frame discussions about the HIV epidemic across the world. With the recognition that early treatment offers important benefits to improve not only the health of patients but also the community burden of HIV and thereby prevent transmission, the cascade offers a yardstick by which to identify how national programs and local communities are faring along the continuum of diagnosing and treating individuals with HIV in the ongoing quest to stop further transmission of HIV.
The rapidity with which this cascade has caught on and been adopted by HIV providers, policy-makers, and patients is a testament to its simplicity. It offers a visual picture of the information that can be latched onto, while also offering a common vocabulary with which to discuss large-scale efforts to achieve the universal goals that it conveys.
Even more impressive is the ease with which this tool translates epidemiologic surveillance data into user-friendly concepts and dismantles the traditional barriers between epidemiology and clinical care. The benefits of the cascade, however, do not erase the challenges of moving from the larger facts that underpin it to an understanding of what they actually mean, and what happens between the various steps in the framework that can truly change its results.
Introduction
The HIV treatment cascade, first brought to international attention in an article by Dr. Edward Gardner and colleagues, has become the primary organizing principle around which to frame discussions about the HIV epidemic across the world. With the recognition that early treatment offers important benefits to improve not only the health of patients but also the community burden of HIV and thereby prevent transmission, the cascade offers a yardstick by which to identify how national programs and local communities are faring along the continuum of diagnosing and treating individuals with HIV in the ongoing quest to stop further transmission of HIV.
The rapidity with which this cascade has caught on and been adopted by HIV providers, policy-makers, and patients is a testament to its simplicity. It offers a visual picture of the information that can be latched onto, while also offering a common vocabulary with which to discuss large-scale efforts to achieve the universal goals that it conveys.
Even more impressive is the ease with which this tool translates epidemiologic surveillance data into user-friendly concepts and dismantles the traditional barriers between epidemiology and clinical care. The benefits of the cascade, however, do not erase the challenges of moving from the larger facts that underpin it to an understanding of what they actually mean, and what happens between the various steps in the framework that can truly change its results.
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