title: Addressing the Achilles' heel in the HIV care continuum for the success of a test-and-treat strategy to achieve an AIDS-free generation.
abstract: Mathematical models and recent data from ecological, observational, and experimental studies show that antiretroviral therapy (ART) is effective for both treatment and prevention of HIV, validating the treatment as prevention (TasP) approach. Data from a variety of settings, including resource-rich and -limited sites, show that patient attrition occurs at each stage of the human immunodeficiency virus (HIV) treatment cascade, starting with the percent unaware of their HIV infection in a population and linkage to care after diagnosis, assessment of ART readiness, receipt of ART, and finally long-term virologic suppression. Therefore, in order to implement TasP, we must first define practical and effective linkage to care, acceptability of treatment, and adherence and retention monitoring strategies, as well as the cost-effectiveness of such strategies. Ending this pandemic will require the combination of political will, resources, and novel effective interventions that are not only feasible and cost effective but also likely to be used in combination across successive steps on the HIV treatment cascade.
authors.affiliation: Department of Epidemiology, Infectious Diseases Epidemiology Research Program, Pittsburgh University Graduate School of Public Health, Pennsylvania Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa.
authors.forename: Jean B
authors.initials: JB
authors.lastname: Nachega
authors.affiliation: Warwick-Centre for Applied Health Research and Delivery, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, United Kingdom Liverpool School of Tropical Medicine, International Health Group, United Kingdom.
authors.forename: Olalekan A
authors.initials: OA
authors.lastname: Uthman
authors.affiliation: Departments of Global Health and Medicine, Emory University, Atlanta, Georgia.
authors.forename: Carlos
authors.initials: C
authors.lastname: del Rio
authors.affiliation: Department of Medicine and Division of Infectious Diseases, University of Alabama at Birmingham, Alabama.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
authors.affiliation: Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Helen
authors.initials: H
authors.lastname: Rees
authors.affiliation: Stanford Prevention Research Center, Department of Medicine, Stanford University School of Humanities and Sciences, California Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mills
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D003266:Continuity of Patient Care; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control*; D006801:Humans
chemical_list: D019380:Anti-HIV Agents
keywords: ART; HIV; test-and-treat; treatment as prevention; treatment cascade